Criterion Value of Atypical Drug Responses in the Diagnosis of Atypical Psychiatric Disorders

Psychosis commonly occurs as a direct result of complex partial seizure disorder (CPSD). This organic mental disorder is indeed "complex" and is easily and frequently misdiagnosed as a variety of functional disorders, including schizophrenia, schizoaffective disorder, bipolar illness, psychotic depression, and, at best, "atypical psychosis." However, this important clinical syndrome has several clinical features that suggest its presence and which often permit it to be distinguished from other forms of psychosis. Furthermore, this disorder can be successfully treated with limbic anticonvulsants, with or without neuroleptics and/or lithium, but it is generally refractory to neuroleptic medications alone. In this paper, the author reviews the available literature relevant to the clinical phenomenology and treatment of this topic and illustrates the clinical profiles of 10 treatment-refractory patients admitted to a state hospital with previously undiagnosed psychoses secondary to CPSD. This illness needs to be seriously considered in the differential diagnosis of severely ill patients with atypical psychoses refractory to traditional treatments.

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Barbiturate Anticonvulsants in Refractory Affective Disorders

Hayes

1993

Ann. of Clinical Psychiatry

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Despite an increasing literature demonstrating both acute and long-term positive psychopharmacological effects of both valproate and carbamazepine, phenytoin has remained a controversial intervention, and barbiturate anticonvulsants have generally received poor press with regard to psychotropic effects. In the present investigation, 27 seizure-free, affectively ill patients who received therapeutic trials of primidone and/or mephobarbital after failing on antidepressants, lithium, carbamazepine, valproate, and phenytoin were analyzed with regard to effects on illness severity and affective cycle rate over a period of as long as four years. Nine (33%) of the patients had a sustained positive therapeutic effect on affective state and/or psychotic symptoms to primidone and three (11%) had positive effects on mephobarbital after primidone failure. Four (15%) had brief positive effects that were not sustained, and the remaining 11 (41%) had no effects or negative effects to these agents. The theoretical and practical implications of this new and unexpected finding are discussed.

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Criterion Value of Atypical Drug Responses in the Diagnosis of Atypical Psychiatric Disorders

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Epidemiological and clinical research as a guide in the search for risk factors and biological markers

Epidemiological and clinical research as a guide in the search for risk factors and biological markers

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Barbiturate Anticonvulsants in Refractory Affective Disorders

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