A study assessed the psychiatric side effects of cenobamate (CNB) in 60 adults with focal-onset drug-resistant epilepsy who received treatment for at least six months. Researchers aimed to understand CNB’s effects on existing psychiatric conditions and identify risk factors for developing new psychiatric symptoms. Findings showed that CNB was effective, with 12% of patients achieving complete seizure freedom and 57% experiencing a significant reduction in seizure frequency. No new psychiatric adverse effects were reported. Among the 22 patients with pre-existing psychiatric or behavioral symptoms at the start of treatment, 68% showed no change, 9% improved, and 23% worsened. Notably, all five patients who experienced worsening symptoms had intellectual disabilities and exhibited irritability or aggression at baseline. In contrast, none of the patients with normal cognitive function and similar symptoms experienced deterioration. The study concluded that while CNB did not induce new psychiatric side effects and was well-tolerated in patients with normal intellectual functioning, it may exacerbate irritability in individuals with intellectual disabilities and pre-existing psychiatric conditions.