What Possible Strategies Exist For The Improvement Of Psychiatric Care For Patients With Refractory Epilepsy

At each level of the spectrum of training there are possible improvements that could focus treatment on both abolishing seizures and treating the comorbidities that would facilitate the best overall health. At the resident level, clearly more didactic sessions, interdisciplinary interactions at conferences and in clinics and more exposure to the outpatient management of mood disorders, anxiety, psychosis and ADHD would be helpful in the training of a neurologist. Specifically, more emphasis on the frontal lobe-related and affective portions of the mental status examination would be helpful, and neurobehavioral rounds in an outpatient or inpatient setting can serve to better integrate the disciplines (Matthews et al., 1998) . The current moment seems an excellent time to develop a curriculum for our residents in psychiatry: the residents just starting mandatory rotations and their psychiatry mentors seem ideally positioned to comment on what that experience should entail. What rotations provided the most insight? Would more time with psychiatry be helpful?

Fellowship training in epilepsy would seem the ideal time to incorporate some significant exposure to neuropsychiatric syndromes encountered in patients with seizures. A specific competency could be developed that requires some level of didactic exposure and a measure of sensitivity and diagnostic acumen for psychiatric comorbidities. There could be a clear curriculum about when to refer patients, and how to consider or measure quality of life in decisions about medications and surgical treatment.

After graduation from residency and fellowship training, ongoing updates to provide the best interdisciplinary information to psychiatrists and neurologists could be made available through regular courses at national meetings in the primary discipline or in epilepsy (i.e., at American Neurological Association — ANA, American Epilepsy Society — AES, American Clinical Neurophysiology Society — ACNS and/or American Psychiatry Association — APA). CME courses could be provided by both disciplines online or at these meetings as a way to maintain focused attention on the important role that psychiatric management plays in long-term epilepsy outcomes.

In conclusion, the current level of sophistication in training for psychiatric comorbidities of epilepsy is very limited, and there is an important opportunity to strengthen interdisciplinary education, ultimately aiming to improve the health and satisfaction of patients with epilepsy. Our residency and fellowship programs would benefit from more focused attention on improving access for epilepsy patients to the most complete and integrated interventions that will improve quality of life and outcome.

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