Epileptic Psychosis: An Evaluation of PSE Profiles

Abstract

Data are presented on 24 patients with epilepsy and psychosis whose clinical presentation was rated using the Present State Examination (PSE). Seventeen had complex partial seizures and a diagnosis of temporal lobe epilepsy, seven had generalised epilepsy. An association between a CATEGO category of nuclear schizophrenia (NS) and a lesion of the left side was noted. No clear link between depressive symptoms and a right-sided focus was discovered. Affective disorders were noted in both groups of epileptic patients, although paranoid psychoses were commoner in the temporal lobe group. There was also a tendency for the latter to have more delusions of persecution, ideas of reference, and special features of depression. The group rated as NS appear less likely to show evidence of intellectual deterioration than the other psychotic patients; in addition, the interval between the onset of their epilepsy and the onset of their psychosis is shorter. Radiological assessment by CAT reveals few differences between groups, but the psychotic samples do show higher than expected values on a number of variables, in particular the bilateral septum-caudate distance and the size of the third and fourth ventricle.

Complete remission of epileptic psychosis after temporal lobectomy: case report

“…Although there is evidence that pathologic processes situated in the left cerebral hemisphere as shown by left epileptic focus 27,35,36 , left-handedness 23,26 or left MTS 7 are associated with epileptic psychoses, this is not invariably observed. There are reports of postictal psychoses accompanied by elation and hiperreliogisity associated with right hemisphere epileptic focus 37,38 .…”

Psychiatric comorbidity in epilepsy

“…Also, the lack of a (psychiatric) control group and phenomenological descriptions that are based on impression only make these fi ndings not very convincing. Perez and colleagues (98) tried to overcome these weaknesses by comparing 11 patients with epilepsy and psychosis with 9 nonepileptic schizophrenic controls using the Present State Examination (PSE). They concluded that the psychotic episodes in patients with epilepsy are indistinguishable from those of classic schizophrenics.…”

Transtornos mentais associados à epilepsia

“…A associação das psicoses interictais com a ELT é reforçada pela presença de CPC (Marchetti et al, 2003a;Slater et al, 1963;Perez e Trimble, 1980), crises de origem límbica (Hermann et al, 1982;Taylor e Lochery, 1987), comorbidade com mudança de personalidade pela ELT (Gudmundsson, 1966;Slater et al, 1963) e crises freqüentes (Jensen e Larsen, 1979;Mendez et al, 1993), particularmente quando a ELT se deve a lesões de origem embriológica como hamartomas e disgenesias corticais (Taylor, 1975;Roberts et al, 1990) ou esclerose mesial (Marchetti et al, 2003a;Stevens, 1986;Marchetti et al, 2003b), e quando o processo patológico se situa no hemisfério cerebral esquerdo, conforme evidenciado por zona irritativa (EEG interictal) à esquerda (Perez e Trimble, 1980;Flor-Henry, 1969;Perez et al, 1985), canhotismo (Taylor, 1975;Sherwin et al, 1982) ou esclerose mesial à esquerda (Marchetti et al, 2003b). Outros estudos chamam a atenção para a contribuição de outros fatores como a duração da epilepsia entre 10 e 22 anos (Slater et al, 1963;Trimble, 1991), o período em que as crises estão menos freqüentes (Flor-Henry, 1969;Kristensen e Sindrup, 1978) e o papel de drogas específicas, como a vigabatrina e o topiramato (Mula et al, 2003;Sander et al, 1991).…”