Psychotic illness in patients with epilepsy

Department of Neuropsychiatry, Aichi Medical University, Nagakute, Aichi, Japan.
Therapeutic Advances in Neurological Disorders (Impact Factor: 3.14). 11/2012; 5(6):321-34. DOI: 10.1177/1756285612454180
Source: PubMed

ABSTRACT Apart from the rather rare ictal psychotic events, such as non-convulsive status epilepticus, modern epileptic psychoses have been categorized into three main types; chronic and acute interictal psychoses (IIPs) and postictal psychosis (PIP). Together, they comprise 95% of psychoses in patients with epilepsy (PWE). Four major questions, that is, "Is psychosis in PWE a direct consequence of epilepsy or schizophrenia induced by epilepsy?", "Is psychosis in PWE homogeneous or heterogeneous?", "Does psychosis in PWE have symptomatological differences from schizophrenia and related disorders?", "Is psychosis in PWE uniquely associated with temporal lobe epilepsy (TLE)?" are tried to be answered in this review with relevant case presentations. In the final section, we propose a tentative classification of psychotic illness in PWE, with special attention to those who have undergone epilepsy surgery. Psychotic disorders in PWE are often overlooked, mistreated, and consequently lingering on needlessly. While early diagnosis is unanimously supported as a first step to avoid this delay, necessity of switching from antiepileptic drugs with supposedly adverse psychotopic effects. to others is more controversial. To elucidate the riddle of alternative psychosis, we need badly further reliable data.

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Available from: Kousuke Kanemoto, Aug 10, 2015
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    • "They are specifically separated into chronic psychoses or multiple types of acute episodic psychoses, which are further divided into postictal and interictal psychoses [1]. The prevalence of epileptic psychoses varies among reports; however, some studies have reported similar findings at a frequency of approximately 5% [1] [2] [3]. Symptoms widely vary and may involve not only psychotic symptoms but also anxiety or mood disorders [4]. "
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    ABSTRACT: This is a case report of a 38-year-old woman with temporal lobe epilepsy and epileptic psychoses. The psychoses consisted of three rare symptoms that were “a distortion in the sense of time,” “what should be there disappears,” and “the next scene is supposed to be in a particular way.” There have been few reports that included these symptoms; therefore, we report the course of this patient in detail.
    Epilepsy and Behavior Case Reports 08/2014; 2:133–135. DOI:10.1016/j.ebcr.2014.07.004
  • Harvard Review of Psychiatry 05/2014; 22(3):193-200. DOI:10.1097/HRP.0000000000000033 · 1.73 Impact Factor
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    ABSTRACT: Objectives Temporal lobe resistant epilepsy has been associated with a high incidence of psychotic disorders; however, there are many controversies; while some patients get better after surgery from their psychiatric condition, others develop psychosis or de novo depression. The aim of this study was to determine the psychiatric and seizure outcome after epilepsy surgery in patients with a previous history of psychoses. Methods Surgical candidates with temporal lobe drug-resistant epilepsy and a positive history of psychosis diagnosed during the presurgical psychiatric assessment were included. A two-year prospective follow-up was determined after surgery. The DSM-IV Structural Interview, GAF (global assessment of functionality, DSM-IV), Ictal Classification for psychoses, and Engel's classification were used. The Student t test and chi-square–Fisher tests were used. Results During 2000–2010, 89 patients were admitted to the epilepsy surgery program, 14 patients (15.7%) presented psychoses and were included in this series. After surgery, six patients (43%) did not develop any psychiatric complications, three patients (21%) with chronic interictal psychosis continued with no exacerbation, three patients (21%) developed acute and transient psychotic symptoms, and two patients (14%) developed de novo depression. Seizure outcome was Engel class I-II in 10 patients (71%). Total GAF scores were higher after surgery in patients found to be in Engel class I–II (p < 0.05). Conclusions Patients with comorbid psychosis and temporal lobe drug-resistant epilepsy may benefit from epilepsy surgery under close psychiatric supervision.
    Epilepsy & Behavior 08/2014; 37:165–170. DOI:10.1016/j.yebeh.2014.06.002 · 2.26 Impact Factor