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Epilepsy is defined as the occurrence of one seizure with high probability of recurrence as newly defined by the International League Against Epilepsy. Psychosis is a psychiatric illness characterized by the presence of delusions, hallucinations and thought disorder with loss of perception of reality. Epidemiological studies suggest that epilepsy i...
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... antipsychotics (often referred to as atypical) act on a range of receptors and have more distinct clinical profiles compared with first-generation drugs, particularly with regard to side effects. Examples include olanzapine, risperidone, quetiapine, amisulpride, lurasidone, aripiprazole and clozapine (table 3). 28 Early use of psychotropic medication, particu- larly in agitated and aggressive patients, may reduce the duration of a psychotic episode. ...
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Citations
... In any case, many studies have found and agreed on the existence of a lucid interval and proposed that psychotic symptoms of PIP would appear within a few hours to a few days after the seizure, generally no more than 1 week. Reports suggest that PIP may be characterized by relatively prominent emotionally charged delusions and hallucinations [28,30]. Violent or suicidal behavior may be a specific marker of PIP [17,31,32]. ...
Epilepsy is a prevalent chronic neurological disorder that can significantly impact patients’ lives. The incidence and risk of psychosis in individuals with epilepsy are notably higher than in the general population, adversely affecting both the management and rehabilitation of epilepsy and further diminishing patients’ quality of life. This review provides an overview of the classification and clinical features of psychosis of epilepsy, with the aim of offering insights and references for the clinical diagnosis and treatment of various types of psychosis of epilepsy. Additionally, we examine the potential pathophysiological mechanisms underlying the psychosis of epilepsy from three perspectives: neuroimaging, neurobiology, and genetics. The alterations in brain structure and function, neurotransmitters, neuroinflammatory mediators, and genetic factors discussed in this review may offer insights into the onset and progression of psychotic symptoms in epilepsy patients and are anticipated to inform the identification of novel therapeutic targets in the future.
... Recent research has shown that 50.49% of epilepsy patients experience psychiatric morbidity (6). Research indicates that individuals (2 to 7 percent) with epilepsy are more likely to exhibit psychiatric symptoms than the general population (3 percent) (7). The various phases of psychiatric disturbances and epilepsy can be easily distinguished by using EEG techniques (different waves and frequencies). ...
Background: Numerous studies have revealed that psychological disorders often accompany epilepsy seizures, with recent research showing that 50.49% of epilepsy patients experience depression, anxiety, and cognitive abnormalities. Identifying whether all types of epilepsy patients possess unique or various mental health issues and determining their severity in different situations and variables is critical. Still, this information is scarce in Odisha, so the study aims to assess the incidence of psychiatric disorders in patients with focal and generalized epilepsy across different stages of the disease and analyze the association of psychiatric disorders with various variables. Method: This ethically approved cross-sectional study, conducted at a tertiary care hospital between 2022 and 2023, involved 154 epilepsy patients over 18. Psychiatric data were collected using HAM-D, HAM-A, MOCA scales, and EEG assessments. Chi-square statistical analysis with IBM SPSS was used to correlate between clinical variables and psychiatric levels. Result: Aura symptoms in focal epilepsy patients cause fear but this fear does not correlate with psychiatric manifestations. At the first visit, patients with focal epilepsy (p=.040) were associated with depression due to their seizure frequency while those with generalized epilepsy patients (p=.033) correlated with cognition. The seizure frequency in focal epilepsy patients does not cause anxiousness in them but we got this anxiety symptom in generalized epilepsy after 6 months(p=.041) EEG was found correlated with cognitive impairment in both focal and generalized epilepsy patients after 6 months. Conclusion: Psychiatric manifestations are often seen in both focal epilepsy and generalized epilepsy patients but generalized epilepsy patients are more likely to exhibit clinical features (heredity, presence of more post-ictal symptoms) than focal epilepsy patients. Future studies should focus on the bidirectional relationship between epilepsy and psychiatric disorders at various points in the progression of the disease.
... Epilepsy patients who associated with psychosis are categorized as ictal, postictal, and interictal psychosis. Ictal is the rarest condition which appears during prolonged nonconvulsive seizure with sudden onset and is resolved with end of the seizure, while interictal usually appears 10-15 years after the onset of epilepsy for months to years, which is often correlated to delusions, and visual or auditory hallucinations (Maguire et al., 2018). In meta-analysis, interictal psychosis was the most common form of epilepsy-associated psychosis, with a prevalence of 5% (Clancy et al., 2014). ...
... Epilepsy patients who associated with psychosis are categorized as ictal, postictal, and interictal psychosis. Ictal is the rarest condition which appears during prolonged nonconvulsive seizure with sudden onset and is resolved with end of the seizure, while interictal usually appears 10-15 years after the onset of epilepsy for months to years, which is often correlated to delusions, and visual or auditory hallucinations (Maguire et al., 2018). In meta-analysis, interictal psychosis was the most common form of epilepsy-associated psychosis, with a prevalence of 5% (Clancy et al., 2014). ...
Post-traumatic epilepsy (PTE) is a form of acquired epilepsy that arises from traumatic brain injury (TBI). It presents a complex relationship with various neuropsychiatric comorbidities. TBIs alone can lead to brain damage, causing underlying disruptions in normal brain function and affecting cognition, behavior,
and emotional processing. The development of recurrent seizures in PTE can
further exacerbate the neuropsychiatric issues, inducing higher emotional distress,
aggression, anxiety, and depression. PTE patients often require long-term
treatment with antiseizure medications, which may have neuropsychiatric-relatedand cognitive side effects. Moreover, the psychosocial impact of TBIs with PTE,
including changes in work, social life, and relationships, can elevate the risk of
developing neuropsychiatric disorders. The coexistence of PTE with other neurological and psychiatric conditions may further reduce one’s quality of life.
Several research reports have shown the importance of particular shared biomarkers/pathways that contribute to these complications, which may be targeted
for therapeutic interventions. Effective management of PTE and its neuropsychiatric
comorbidities requires a multidisciplinary approach, integrating anticonvulsant
therapy and health support services to improve overall well-being and quality
of life of the affected individuals, as well as prioritizing early interventions and
continuous monitoring to reduce the burden of PTE.
... Psychotic manifestations can be due to underlying psychiatric disorders or a secondary manifestation of neurological disorders, such as epilepsy (7). The plausible link between epilepsy and psychosis has captivated the interest of psychiatrists for nearly a century (8). While previous studies have reported a prevalence rate of about 3% for psychotic disorders in the general population, some reports have suggested that psychosis develops in 7% to 10% of individuals with epilepsy (9). ...
... While previous studies have reported a prevalence rate of about 3% for psychotic disorders in the general population, some reports have suggested that psychosis develops in 7% to 10% of individuals with epilepsy (9). A metaanalysis demonstrated that approximately 6% of patients with epilepsy also experience a form of psychotic illness, suggesting a nearly eight times higher rate of psychosis in patients with epilepsy compared to the general population (8). Notably, another research showed that individuals diagnosed with schizophrenia are also more likely to have epilepsy compared to the general population (10). ...
... Our findings revealed that approximately 10% of the patients with epilepsy experienced epilepsy-related psychosis, which is consistent with previous reports indicating remarkably higher rates of psychosis in individuals with epilepsy (19). A recent meta-analysis suggested that up to 6% of patients with epilepsy can manifest psychosis and have an approximately eight-fold increased risk of developing psychosis compared to the general population (8). Similarly, a three-year longitudinal cohort study conducted in the UK demonstrated a significantly higher incidence rate of psychosis in patients with epilepsy (20). ...
Objective: Psychoses of epilepsy usually have an acute onset, accompanied by brief symptom duration and a risk of recurrence. Managing these conditions can be challenging due to the potential for seizures associated with certain antipsychotic medications, as well as exacerbating psychosis resulting from some antiepileptic medications. Our objective in this study was to assess the occurrence of psychosis among patients with epilepsy, as well as identify the factors linked to the presence and severity of psychosis in this population.
Method : In this study, we included a total of 514 subjects diagnosed with epilepsy referring to our neuropsychiatry clinic affiliated with Tehran University of Medical Sciences from April 2011 to December 2021, among whom 57 patients showed psychotic presentations. We compared baseline and clinical characteristics between patients with psychosis of epilepsy and non-psychosis patients who also had epilepsy.
Results: Marital status was the sole demographic factor that displayed a statistically significant difference between the psychosis and non-psychosis groups (P = 0.019). There was no significant difference observed between the two groups regarding family history of epilepsy and age at the onset of the epilepsy. Patients with psychosis experienced significantly more frequent seizures and generalized type (P < 0.001). Participants were matched for demographics and other clinical factors between the refractory and controlled psychosis groups, except for the psychosis frequency (P = 0.007). The type of epilepsy was significantly associated with psychosis when adjusted for the covariates (P < 0.001).
Conclusion: Patients with psychosis of epilepsy experienced more episodes of epilepsy than non-psychotics. We identified generalized epilepsy as an independent risk factor for the development of psychosis. Additional cohorts are warranted to explore the factors associated with epilepsy-related psychosis across diverse populations.
... 5 Psychosis is a constellation of symptoms ranging from positive symptoms, that is thought disorder, delusions and hallucinations to negative symptoms that is avolition and social withdrawal. 9 There is a paucity of data with regard to rates of health service utilisation in PWE in Africa, but studies in the UK have shown that PWE with psychiatric comorbidity had higher rates of health service utilisation than PWE without psychiatric comorbidity. 10 The World Health Organization (WHO) has acknowledged that epilepsy and psychiatric illness cannot be separated if epilepsy is to be adequately treated across the globe. ...
... 12 Psychotic disorders in epilepsy are a serious complication affecting prognosis, morbidity and mortality. 9 The lifetime prevalence of psychosis in the United Kingdom (UK) is 3%. 9 The prevalence of psychosis in PWE ranges from 4% to 6% with a prevalence of up to 7% in populations with temporal lobe epilepsy. ...
... 9 The lifetime prevalence of psychosis in the United Kingdom (UK) is 3%. 9 The prevalence of psychosis in PWE ranges from 4% to 6% with a prevalence of up to 7% in populations with temporal lobe epilepsy. 2,4 PWE are estimated to have an 8-fold increase in risk of developing psychosis. ...
Background: The International League against Epilepsy (ILAE) defines epilepsy as a brain disorder characterised by an enduring risk to generate seizures with neurobiological, cognitive, psychological and social consequences. Psychotic disorders in epilepsy are a serious psychiatric complication affecting the prognosis, morbidity and mortality of patients. There is a paucity in literature with regard to the prevalence of psychotic symptoms in epileptic patients in low- to middle-income countries.
Aim: This study aimed to look at the prevalence of psychotic symptoms in epileptic patients at an outpatient clinic using the prodromal questionnaire 16 (PQ-16).
Setting: The study was conducted at the epilepsy clinic at Charlotte Maxeke Academic Hospital (CMJAH), a tertiary hospital located in Johannesburg, South Africa.
Method: The PQ-16 was distributed to patients at the epilepsy clinic at CMJAH.
Results: The study consisted of 121 participants. The prevalence of patients found to be at high risk of psychosis (i.e., PQ-16 score 6) was 61.2% (95% lower confidence interval (LCI): 0.53, upper confidence interval (UCI): 0.70). None of the demographic variables showed significant associations in the percentage of patients found to be at high risk. No association was found between any antiepileptic drug and high risk of psychosis.
Conclusion: The high prevalence of psychotic like experiences found suggests it is imperative to screen for psychotic disorders in epileptic patients and if required to involve neuropsychiatrists in their management.
Contribution: This study highlights the importance of assessing psychotic symptoms in epileptic patients and the importance of a multidisciplinary approach in managing these complex patients.
... Temporal lobe epilepsy (TLE) is a disorder characterized by the presence of spontaneous seizures, or uncontrolled neural activity, involving the temporal lobe, typically the hippocampal formation. Given that seizures are the hallmark feature of TLE, other neuropsychiatric comorbidities, such as psychosis, are often overlooked, despite the wellestablished relationship between TLE and psychotic symptoms [1][2][3][4]. TLE patients are 6-12 times more likely than the general population to suffer from psychosis [5,6]; however, the management of psychosis for patients with TLE is currently inadequate. Both firstand second-generation antipsychotics are associated with an increase in seizure incidence, Int. ...
Although seizures are a hallmark feature of temporal lobe epilepsy (TLE), psychiatric comorbidities, including psychosis, are frequently associated with TLE and contribute to decreased quality of life. Currently, there are no defined therapeutic protocols to manage psychosis in TLE patients, as antipsychotic agents may induce epileptic seizures and are associated with severe side effects and pharmacokinetic and pharmacodynamic interactions with antiepileptic drugs. Thus, novel treatment strategies are necessary. Several lines of evidence suggest that hippocampal hyperactivity is central to the pathology of both TLE and psychosis; therefore, restoring hippocampal activity back to normal levels may be a novel therapeutic approach for treating psychosis in TLE. In rodent models, increased activity in the ventral hippocampus (vHipp) results in aberrant dopamine system function, which is thought to underlie symptoms of psychosis. Indeed, we have previously demonstrated that targeting α5-containing γ-aminobutyric acid receptors (α5GABAARs), an inhibitory receptor abundant in the hippocampus, with positive allosteric modulators (PAMs), can restore dopamine system function in rodent models displaying hippocampal hyperactivity. Thus, we posited that α5-PAMs may be beneficial in a model used to study TLE. Here, we demonstrate that pilocarpine-induced TLE is associated with increased VTA dopamine neuron activity, an effect that was completely reversed by intra-vHipp administration of GL-II-73, a selective α5-PAM. Further, pilocarpine did not alter the hippocampal α5GABAAR expression or synaptic localization that may affect the efficacy of α5-PAMs. Taken together, these results suggest augmenting α5GABAAR function as a novel therapeutic modality for the treatment of psychosis in TLE.
... Certain factors may act like risk factors which may include Family history of psychosis or affective disorder, Early age of onset of epilepsy, Left temporal epileptogenic focus, Hippocampal sclerosis and a history of status epilepticus. 16 Usually, a change of antiepileptic or an early withdrawal of AED, behavioural side effect of certain AED and seizure clusters are the usual precipitator. 17,18,19 out of the seven patients, three had seizure cluster and one had antiepileptic changed because of the desire to conceive. ...
Epileptic psychosis is a cerebral dysfunction that occurs or is further classified in temporal relation to the occurrence of a seizure. These phenomena, also called ‘epileptic mania’, can last for days to months, not only increase the caregiver's burden, but also statistically add to the morbidity and mortality of an epileptic patient. Its symptoms can vary and fluctuate from a mild degree of confusion and delirium to a serious thought and perceptual disorder. The prevalence of psychosis increases drastically in patient with temporal lobe epilepsy or refractory epilepsy. Here we report seven such cases that have endangered human life in the form of self-harm or grievous injury to others.
... Finally, outline the mental disorders above. Eventually, considering how the mental disorders are connected to epilepsy which is involved in schizophrenia (Maguire et al. 2018). ...
... Epilepsy is neurological disorder, not an illness characterized by recurrent epileptic seizures and other different reasons (Maguire et al. 2018). Typically, epileptic seizure is the reason for electrical activity in the brain. ...
... Typically, epileptic seizure is the reason for electrical activity in the brain. Schizophrenia is a risk factor for epilepsy and seizure that include cognitive problem (Hyde and Weinberger 1997;Maguire et al. 2018). Also, the depressive disorder and the anxiety disorder are types of cognitive problems, so that depression in people living with epilepsy is very common and an important issue. ...
Schizophrenia is the seventh largest cause of impairment in people aged from 15 to 44 years around the world. This is the long-term psychological disorder marked by illusions, thinking and attention difficulties, absence of desire along with that the majority will have significant and long-term social impairments. Generally, schizophrenia is associated with positive as well as negative or cognitive symptoms. The conventional antipsychotics are used to treat the positive symptoms but the negative symptoms are rarely treated. There were no effective drugs for the treatment of schizophrenia before the introduction of antidopaminergic psychotropic drugs in the 1950s. Here, we described the key meta-analytic evidence on the efficacy of antipsychotics in the acute treatment of schizophrenia, particularly clozapine in treatment-resistant patients. In this chapter, primarily we have focused on the neuropharmacological treatment options available for schizophrenia and how has the treatment changed over time. An improved understanding of how conventional antipsychotic drugs convey their therapeutic effect during the treatment and what are the cutting-edge alternatives that are available in order to mitigate the drawbacks of traditional neuroleptics.
... Psychoses associated with epilepsy are well-described but incompletely understood phenomena. 1 Low-grade gliomas are a relatively common cause of epilepsy 2,3 but are less frequently associated with psychotic symptoms. [4][5][6][7] One schema for categorizing epilepsy-associated psychoses focuses on the temporal relationship of psychotic symptoms to seizures: ictal psychosis, postictal psychosis, and chronic interictal psychosis. ...
... 9,23 The epilepsy-associated psychosis of the patient in this report may best be described as chronic interictal psychosis. 1,8 The primary treatment of other forms of epilepsy-associated psychoses such as ictal psychosis and postictal psychosis are focused around treating the epilepsy. 8 Treatment of chronic interictal psychosis is generally similar to that of treating psychosis independent of epilepsy. ...
... 8 Treatment of chronic interictal psychosis is generally similar to that of treating psychosis independent of epilepsy. 1,8 The preoperative persistence of the patient's psychotic symptoms despite adequate preoperative control of seizures makes the connection between these phenomena complicated but highlights how interictal psychosis may require antipsychotic treatment independent of AEDs. ...
BACKGROUND Epilepsy-associated psychoses are poorly understood, and management is focused on treating epilepsy. Chronic, interictal psychosis that persists despite seizure control is typically treated with antipsychotics. Whether resection of a mesial temporal lobe lesion may improve interictal psychotic symptoms that persist despite seizure control remains unknown.
OBSERVATIONS In a 52-year-old man with well-controlled epilepsy and persistent comorbid psychosis, brain magnetic resonance imaging (MRI) revealed an infiltrative, intraaxial, T2 fluid-attenuated inversion recovery intense mass of the left amygdala. The patient received an amygdalectomy for oncological diagnosis and surgical treatment of a presumed low-grade glioma. Pathology was ganglioglioma, World Health Organization grade I. Postoperatively, the patient reported immediate resolution of auditory hallucinations. Patient has remained seizure-free on 2 antiepileptic drugs and no antipsychotic pharmacotherapy and reported lasting improvement in his psychotic symptoms.
LESSONS This report discusses improvement of psychosis symptoms after resection of an amygdalar glioma, independent of seizure outcome. This case supports a role of the amygdala in psychopathology and suggests that low-grade gliomas of the limbic system may represent, at minimum, partially reversible etiology of psychotic symptoms.
