Interictal Anxiety Disorders

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As stated above, anxiety disorders are a common co-morbidity in PWE. Panic disorder (PD) and generalized anxiety disorder (GAD) are the most frequent types of anxiety disorders identified in PWE [1]. The DSM-IV classification of anxiety disorders lists six other types: agoraphobia without panic disorder, obsessive compulsive disorder (OCD), social phobia, specific phobia, post-traumatic stress disorder and acute stress disorder. These may also be identified in PWE, but with a much lower frequency. In addition, PWE may often exhibit symptoms of anxiety that fail to meet any DSM-IV diagnostic criteria for a categorical anxiety disorder.

As stated above, PD and GAD are commonly associated with depressive disorders and their presence conveys an increased suicidal risk. Thus, when the primary complaint is that of an anxiety disorder, clinicians must carefully investigate the presence of depressive symptoms or episodes. GAD consists of constant uncontrollable worry on a daily basis of at least 6 months' duration that is associated with at least three of the following six symptoms: restlessness, easy fatiguability, decreased concentration, irritability, muscle tension and sleep disturbances. Given the frequent confusion between ictal and interictal panic, the differences between the two will be discussed in greater detail in the next section.

To date, there are no screening instruments specifically developed to identify anxiety disorders in PWE. The available screening instruments developed for patients with primary anxiety disorders must be used with caution as they have several items of vegetative symptoms that can easily yield false positive findings and which in reality may be the expression of the seizure disorder or toxicity of the AED.

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