TY - JOUR
AU - R. Ishii
A1 - 
AB - Psychiatric comorbidities in epilepsy are prevalent, disabling, and persistently undertreated due to conceptual and operational fragmentation between neurology and psychiatry. This paper proposes Network-Pluralistic Psychiatry in Epilepsy (NPPE), a hypothesis-generating, disease-contextualized framework that integrates four mechanistic layers: (1) shared genetic vulnerability, (2) epileptogenic network dysfunction as a neuropsychiatric substrate, (3) a bidirectional psychosocial stress loop, and (4) societal and institutional amplifiers. NPPE moves beyond high-level biopsychosocial heuristics by positing testable causal pathways linking genetic liability to network instability, symptom expression, and environmental feedback in epilepsy. The manuscript situates NPPE within existing integrated-care paradigms (e.g., collaborative and stepped-care models), proposing NPPE as a mechanistic engine to personalize measurement-based treatment-to-target decisions while explicitly acknowledging feasibility constraints for advanced tools. A tiered assessment concept (Tiers 1-3) and candidate mechanism-informed interventions are outlined as research targets rather than clinical recommendations. The paper delineates a research agenda prioritizing longitudinal, multimodal cohorts; incorporation of network biomarkers in clinical trials; evaluation of integrated-care implementations; and attention to equity and real-world feasibility. NPPE aims to provide a coherent, testable roadmap to transform descriptive comorbidity accounts into mechanism-oriented, personalized neuropsychiatric care in epilepsy, contingent on rigorous validation, refinement, or falsification.
AD - Department of Occupational Therapy Osaka Metropolitan University Graduate School of Rehabilitation Science Habikino Osaka Japan.; Department of Rehabilitation Osaka Kawasaki Rehabilitation University Kaizuka Osaka Japan.; Department of Psychiatry Osaka University Graduate School of Medicine Suita Osaka Japan.
AN - 41209827
BT - PCN Rep
C5 - Healthcare Disparities
CP - 4
DA - Dec
DO - 10.1002/pcn5.70237
DP - NLM
ET - 20251106
IS - 4
JF - PCN Rep
LA - eng
N2 - Psychiatric comorbidities in epilepsy are prevalent, disabling, and persistently undertreated due to conceptual and operational fragmentation between neurology and psychiatry. This paper proposes Network-Pluralistic Psychiatry in Epilepsy (NPPE), a hypothesis-generating, disease-contextualized framework that integrates four mechanistic layers: (1) shared genetic vulnerability, (2) epileptogenic network dysfunction as a neuropsychiatric substrate, (3) a bidirectional psychosocial stress loop, and (4) societal and institutional amplifiers. NPPE moves beyond high-level biopsychosocial heuristics by positing testable causal pathways linking genetic liability to network instability, symptom expression, and environmental feedback in epilepsy. The manuscript situates NPPE within existing integrated-care paradigms (e.g., collaborative and stepped-care models), proposing NPPE as a mechanistic engine to personalize measurement-based treatment-to-target decisions while explicitly acknowledging feasibility constraints for advanced tools. A tiered assessment concept (Tiers 1-3) and candidate mechanism-informed interventions are outlined as research targets rather than clinical recommendations. The paper delineates a research agenda prioritizing longitudinal, multimodal cohorts; incorporation of network biomarkers in clinical trials; evaluation of integrated-care implementations; and attention to equity and real-world feasibility. NPPE aims to provide a coherent, testable roadmap to transform descriptive comorbidity accounts into mechanism-oriented, personalized neuropsychiatric care in epilepsy, contingent on rigorous validation, refinement, or falsification.
PY - 2025
SN - 2769-2558
SP - e70237
ST - Network-Pluralistic Psychiatry in Epilepsy: A theoretical framework and research agenda for personalized, mechanistic, and integrated care
T1 - Network-Pluralistic Psychiatry in Epilepsy: A theoretical framework and research agenda for personalized, mechanistic, and integrated care
T2 - PCN Rep
TI - Network-Pluralistic Psychiatry in Epilepsy: A theoretical framework and research agenda for personalized, mechanistic, and integrated care
U1 - Healthcare Disparities
U3 - 10.1002/pcn5.70237
VL - 4
VO - 2769-2558
Y1 - 2025
ER -