An epileptic seizure is a transient occurrence of symptoms due to abnormal excessive or synchronous neuronal activity. Epilepsy is a disorder of the brain characterized by an enduring predisposition to generate repeated epileptic seizures. The diagnosis of epilepsy includes a differentiation of epilepsy from other conditions, a determination of the type of epileptic seizure and epilepsy syndrome, and an identification of comorbidities. Electroencephalography (EEG) is an essential investigation, because the pathophysiology of epilepsy is an abnormal, excessive or synchronized neuronal electrical activity in the brain. A detailed clinical interview and description of the seizure semiology is important. Video-EEG monitoring is a valuable diagnostic tool that records the EEG findings and clinical seizure manifestation simultaneously. Antiepileptic drug medication is a mainstay of epilepsy treatments. The choice of antiepileptic drugs are made according to seizure type and epilepsy syndrome. Patients with epilepsy often have physical and mental comorbidities, as well as psychosocial issues, which have adverse effects on their daily life and QOL. In epilepsy treatment, comprehensive care by a multidisciplinary team is indispensable.

Among patients with psychiatric illness in general hospital psychiatry, it is very common to develop disturbance of consciousness. In the clinical management of those patients, such as diagnosis or treatment, EEG undoubtedly plays a primary role. However, unfortunately, younger-generation psychiatrists in Japan are not familiar with EEG and do not recognize the importance of EEG. In this short lecture, the authors will briefly present about actual patients who were diagnosed by EEG and treated effectively. The authors would be happy if this lecture helped young psychiatrist in Japan to understand the importance of EEG in clinical settings.

Besides the epileptic seizures themselves, some social disadvantages and adverse impacts caused by them often become pressing issues for people with epilepsy. Therefore, epilepsy specialists should focus on concerns beyond patient's seizures as well. Understanding the idea of "recovery" could be helpful to us to support epileptic patients in being independent and living their lives on their own. We also need to make active efforts in improving the social integration of people with epilepsy, since it is one of the possible factors in reducing the social stigma associated with epilepsy. In addition, this article will review the issue of driving with epilepsy.

With the improvement of survival due to therapeutic advances for various diseases, pediatric patients reaching adulthood, so called carry-over patients, are increasingly seen in various medical disciplines. Epilepsy is one of the diseases in which carry-over care poses certains issues. According to the questionnaire surveys that we conducted among members of the Japanese Society of Child Neurology [childhood neurologists (CN)] and members of the Societas Neurologica Japonica [adult neurologists (AN)], 95 % of CNs who responded had knowledge of the term “carry-over”, which was remarkably higher than 46% of the responding ANs. Approximately 27% of the patients cared for by CNs were adults. Sixty-nine percent of CNs and seventy-eight percent of ANs experienced difficulties with epilepsy care. The reasons for these difficulties, as provided by both CNs and ANs, were “psychiatric and psychological complications” as well as “laws and regulations related to epilepsy”. In addition, CNs provided the reasons of “no adult inpatient facilities” and “medical complications”, while ANs responded “EEG interpretation” and “treatment for epileptic seizures.” The factors impeding transition to adult specialties for CNs were ① no specialists in adult epilepsy in local areas, and ② unwillingness of families and patients to change specialty; the factors for ANs were ① difficulty in achieving a complete picture of the disease course from childhood and ② lack of familiarity with childhood-specific epilepsy syndromes. To overcome the issues of carry-over, several strategies are essential, such as increasing the number of doctors providing care for epilepsy; enhancing interdisciplinary collaborations between pediatric neurology, adult neurology, psychiatry, neurosurgery, and other related disciplines; and education of the public.

Various psychiatric disorders occur in people with epilepsy with high incidence, which not only exert harmful influence on their quality of life, but also pose challenges to epileptologists' practice. It is clinically helpful to classify those psychiatric symptoms with chronological relation to ictal activity and with epilepsy treatment. This review introduces the clinical characteristics and treatment of major psychiatric comorbidities of epilepsy, focusing on mood disorders and psychoses. Psychiatrists in general hospitals, if not treating epilepsy itself, are expected to do active clinical practice on the psychiatric issues of epilepsy in a manner that is, so to say, "psycho-epileptological."

Sleep disorders occur in approximately 20% to 25% of healthy adults, but are 2 to 3 times more common in individuals with epilepsy. In this paper, we review the international classification and diagnosis of sleep disorders, their manifestation in patients with epilepsy, and the methods of diagnosing whether abnormal behaviors during sleep are due to epilepsy or sleep disorders. Compared with healthy individuals, those with epilepsy often suffer from multiple sleep disorders, such as insomnia, excessive daytime sleepiness, sleep-related breathing disorders, parasomnia, and sleep-related movement disorders. Since sleep disorders and epilepsy are thought to be reciprocally related, with each worsening the other, the treatment of sleep disorders diminishes seizure frequency and improves quality of life. When determining whether abnormal behaviors during sleep are due to epilepsy or sleep disorders, cooperation with medical institutions that can perform video-polysomnography is extremely important.

Various risk factors for depression in lung cancer patients have been suggested, but have been examined separately in studies with relatively small sample sizes. The present study examined the bio-psycho-social risk factors of depression in lung cancer patients, focusing on psychological factors in the largest patient sample reported to date. A total of 1334 consecutively recruited lung cancer patients were selected, and data on cancer-related variables, personal characteristics, health behaviors, physical symptoms, and psychological factors were obtained. The participants were divided into groups with or without depression using the Hospital Anxiety and Depression Scale. Among the recruited patients, 165 (12.4%) manifested depression. The results of a binary logistic regression analysis were significant (overall R², 36.5%), and a greater risk for depression was strongly associated with psychological factors, such as personality characteristics (neuroticism) and coping style (low fighting spirit, helplessness/hopelessness, and anxious preoccupation). Although the contributions of cancer-related variables, personal characteristics, health behaviors, and clinical state were relatively low, cancer stage, cancer type, sex, and age correlated significantly with depression. In conclusion, depression was most strongly linked with personality traits and coping style, and using screening instruments to identify these factors may be useful for preventive interventions.

We experienced a case of posterior reversible encephalopathy syndrome (PRES) in a 67-year-old woman during the course of depression. Her symptoms started with disturbance of consciousness and developed to a state of disinhibition with hyperactivity and incoherence of thought. After admission, her emergency physician consulted us about her presenting psychiatric symptoms, and we collaborated with her neurologist for diagnosis and treatment. An accurate diagnosis of PRES was made based on the presence of hyperintense lesions in the white matter of the bilateral occipital lobe on brain magnetic resonance imaging. She was started on Nicardipine Hydrochloride and oral olanzapine and her psychological symptoms remitted 10 days later. Psychiatrists in general hospitals should be aware of distinguishing organic from psychotic disease in patients with psychological symptoms who have hypertension and a psychiatric history.