Abstracts

Rationale: According to a population study, about 30% of patients had psychiatric comorbidities. Sometimes, psychiatric symptoms are closely related to pathological condition of epilepsy. Some patients have both psychogenic non epileptic seizures (PNES) and epileptic seizures. In these cases, knowledge of epileptology and psychiatry is required. In Japan Epilepsy Society (JES), 18.0% of members and 15.4% of board certified epileptologists are psychiatrists. This is the unique circumstances among the world. Our epilepsy center had epilepsy unit in psychiatry department. In this study, we will report a picture of the closed psychiatry ward specialized in epilepsy. Methods: We searched all the patients who had been admitted to the epilepsy ward in psychiatry department of National Center Hospital of Neurology and Psychiatry from January 2015 to December 2015. Clinical information such as diagnosis of epilepsy, diagnosis of psychiatric diseases, purposes of admission, types of admission, age, gender, duration of hospitalization and results of examinations was collected from medical records. This study was approved by the Ethics Committee of National Center Hospital of Neurology and Psychiatry. Results: In our ward, 354 patients were admitted during the year. Among the 354 patients, 229 (65%) had epilepsy or suspicion of epilepsy. Average age of the patients with epilepsy was 39.6 (16-88). 48% of the epilepsy patients were admitted for examinations including long-term video EEG monitoring (VEEG). 72/229 (31%) of the epilepsy patients were admitted due to psychiatric symptoms. About 1/3 of the patients with psychiatric symptoms needed treatment for epileptic seizures. 36% of the patients with epilepsy were admitted involuntary due to mental retardation or severe psychiatric symptoms which prevent them from understanding and agreeing to their hospitalization. The most frequent psychiatric comorbidity was psychosis. Dissociative disorder, depression, anxiety disorder, pervasive development disorder and dementia were also observed. Eight patients had psychiatric symptoms which were strongly related with seizures such as postictal psychosis and epileptic dysphoria. Thirty-five patients were eventually diagnosed as non-epileptic diseases. Fifteen patients had pure PNES and 10 patients had both epilepsy and PNES. Conclusions: Diagnosis of epilepsy using VEEG and treatment of seizures and psychiatric comorbidities were provided in the ward. For more than 20% of the cases which had psychiatric symptoms strongly related with epilepsy or PNES, solid knowledge of both epilepsy and psychiatry were required. Recently, the proportion of psychiatrists has been declining in JES. However, psychiatric comorbidities are not rare among patients with epilepsy and we always need to consider the relationship between psychiatric symptoms and pathophysiology of epilepsy. If we can treat epilepsy in a comprehensive manner instead of being separated into two departments, it must be benefits for patients. We believe that psychiatrists specialized in epilepsy are necessary for providing truly comprehensive care for epilepsy. Funding: There is no funding for this study.