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Further neuropsychiatric studies of patients with epilepsy who commit suicide need to be made available before one can draw more definite conclusions about all the modes of suicide in epilepsy. The current review allows a number of conclusions, similar to those reached earlier by Diehl (1986), but more specific in nature.

Suicide in epilepsy results from the psychiatric disorder of temporal lobe epilepsy; that is, from a severe dysphoric disorder, from interictal psychosis (associated with preceding and concomitant dysphoric disorder, and at times with command hallucinations), or from a severe postictal depressive state. These psychiatric disorders develop gradually as seizure-suppressing mechanisms become established or, at times, upon acute engagement of the inhibition. Suicide in epilepsy has increased with our improved ability to suppress seizures.

Patients with early onset of temporal lobe epilepsy and prolonged duration of the illness (more than 20 years) are at particular risk of suicide once their seizures are suppressed. Males in the age range of 30-50 are more at risk. Treatment with barbiturates, availability of drugs, loss of loved ones or of jobs, and other difficult psychosocial predicaments are not aetiological factors but may contribute to the suicide risk.

Suicide in epilepsy tends to occur precipitately during a 'fit of melancholy' (as van Gogh described the depressive mood of his dysphoric episodes) and is often not anticipated. However, there are usually warnings that precede a suicide. Upon the occurrence of episodes of suicidal moods, prompt intervention is required with psychotropic medication, chiefly of the antidepressant type, and with careful follow-up that includes adjusting the psychotropic medication as needed.

Although transient suicidal moods among epileptic patients were observed frequently by premodern psychiatrists, completed suicide was not often reported (Delay et al., 1957). Deaths from seizures have been markedly decreased by our progress in seizure control but may be surpassed by now in numbers by deaths from suicide. Our ability to suppress seizures must become paired with our ability to treat the psychiatric consequences of improved seizure control.

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