Psychiatric comorbidities go unrecognized in patients with epilepsy: "You see what you know".

Patients with epilepsy (PWE) have a significantly higher prevalence of psychiatric comorbid disorders involving depression, anxiety, psychotic, and attention-deficit disorders compared with the general population or patients with other chronic medical conditions. Currently, there is no systematic approach in the evaluation and management of psychiatric comorbidities in these patients. In addition, neurologists are not trained to recognize these disorders, and consequently, they remain undertreated. Despite the high prevalence of psychiatric comorbidities in patients evaluated for epilepsy surgery, most epilepsy centers in North America do not include a psychiatric evaluation as part of the presurgical work-up. Despite the intimate relationship between psychiatric comorbidities and epilepsy, collaboration between epileptologists and psychiatrists is sparse at best and nonexistent at worse. The purpose of this paper was to highlight and try to understand the causes behind the persistent lack in communication between neurologists and psychiatrists, the gap in the training of neurologists on psychiatric aspects of neurologic disorders and vice versa and to propose new initiatives to fix the problem. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy". • This article analyzes the reasons behind the lack of identification of psychiatric comorbidities by neurologists in patients with epilepsy. • This complex problem includes a lack of communication between neurologists and psychiatrists, the existence of serious gaps in the training of neurologists on psychiatric aspects of neurologic disorders (and vice-versa), and finally, the limited access to mental health services for these patients. • The article proposes strategies that can be implemented to optimize the training of Neurology and Psychiatry residents in these areas. [ABSTRACT FROM AUTHOR]