Psychiatric comorbidities and treatment patterns in epilepsy: A retrospective review from a tertiary neuropsychiatric clinic

Background: Psychiatric conditions, including neurodevelopmental disorders are common among people with epilepsy (PwEs). However, data comparing their distribution across different epilepsy types are limited, particularly in Indian context. Aim: To explore and compare the psychiatric comorbidities and treatment adherence among focal and generalized epilepsy (FE/GE). Methods: This retrospective chart review included 2,258 PwEs attending a tertiary neuropsychiatry clinic in India between 2013 and 2023. Their sociodemographic and clinical data were compared between FE and GE groups. Results: Nearly 30% had psychiatric comorbidities, most frequently depression (20.6%). Mood and anxiety disorders were more common in FE, while non-affective psychosis was more common in GE. Neurodevelopmental disorders, particularly intellectual disability (ID), were more prevalent in GE (41.9% vs. 16.3%). Medication compliance was suboptimal (60%) and follow-up rates declined over time, reaching 40% at 1-year. Conclusion: PwEs have a high prevalence of psychiatric comorbidities, with differential occurrences across epilepsy types. Inadequate compliance and follow-up rates remain major challenges.