One of the most vexing issues in a busy emergency department is patients with neurologic psychogenic conversion disorders, also known as functional neurologic symptoms or hysteria. To understand and treat these patients requires patience, understanding, composure, knowledge of neuroanatomy and physiology, and a comprehension of human nature. Long experience evaluating patients with neurologic disorders may be the most important factor, and younger emergency physicians may not have this ability fully developed.

Epilepsy care often intersects with mental health care. The chapter begins with nonepileptic events.This commonly encountered diagnosis is frequently on the differential for people with new onset seizures. Prompt recognition of a nonepileptic diagnosis can lead to early evidence-based treatment with cognitive behavioral therapy. Moreover, a nonepileptic event diagnosis can avoid inappropriate treatments such as antiseizure medicines (ASMs). It is critical to understand a nonepileptic event diagnosis does not mean that the events are not real or the patient is faking. Specific diagnostic clues for nonepileptic events are thoroughly discussed. The other section of the chapter explores the management of comorbid psychiatric diagnoses in patients with epilepsy and nonepileptic events. The use of most psychiatric medications, including stimulants, can be considered without affecting an epilepsy patient’s treatment plan. An understanding of psychiatric medication and ASM interaction can guide drug selection. As psychiatric diagnoses negatively affect epilepsy patients’ quality of life, prompt recognition and compassionate care can improve your patient’s overall health care.