Epileptic Psychosis—Diagnostic Comparison with Process Schizophrenia

Abstract

The mental states of 23 epileptic psychotic patients and 10 patients with process schizophrenia were compared, using the Present State Examination. The epileptics displayed marked heterogeneity of psychiatric diagnoses. Disturbances of affect underlying the psychosis or presenting as manic-depressive psychosis were frequent and independent of the type of epilepsy. Schizophrenic psychosis, classified with psychopathological criteria similar to those used in the non-epileptic schizophrenic group, was significantly associated with temporal lobe epilepsy. Psychoses other than schizophrenia, however, were present in 5 out of 16 patients with temporal lobe epilepsy. These results support a relationship between schizophrenic symptoms and temporal lobe pathology and emphasize the need to use reproducible methods of diagnosis in psychiatric research.

Psychiatric comorbidity in epilepsy

“…Yet, together with several other investigators, they stated that the schizophrenia-like psychosis of epilepsy has some atypical features that are diff erent from what is seen in classic schizophrenia. Notable and frequently mentioned diff erences are the lack of negative symptoms (i.e., preservation of warm affect) and adequate or even well-preserved personalities and interpersonal relations in schizophrenia-like psychoses (88)(89)(90)(91)(92)(93)(94)(95)(96). Slater et al (88) also mentioned a high frequency of delusions and religious, mystical experiences.…”

“…A number of investigators described the symptoms as being largely paranoid-hallucinatory (88-91, 95, 97). Furthermore, the onset of schizophrenia-like psychosis usually occurs after a 10-to 20-year duration of epilepsy, and an association with TLE is repeatedly suggested (88,91,(93)(94)(95).…”

Behavioral, Psychotic, and Anxiety Disorders in Epilepsy: Etiology, Clinical Features, and Therapeutic Implications

“…Nevertheless the interictal psychoses can be differentiated from functional schizophrenia in terms of phenomenology, course, and outcome. They comprise a heterogeneous group of psychoses (45,55,56) that differ clinically from schizophrenia by the preponderance of purely delusional states, preservation of warm affect and personality, and predominance of visual rather than auditory hallucinations. Less common features include formal thought disorders and negative symptoms, a relatively rare familial schizophrenia or schizoid premorbid personality, and a generally more favourable outcome (31,5237).…”

The relationship between schizophrenia and epilepsy: the history and current state of the problem

“…В зависимости от используемых оценочных инстру-ментов распространенность шизофреноподобных психо-зов при сложных парциальных и генерализованных судо-рогах составляет от 0,8 до 70% при применении неструк-турированного клинического интервью [24], 9,25% -в случаях парциальной эпилепсии при применении крите-риев DSM-III [25] и 50% -у пациентов с парциальной и генерализованной эпилепсией при применении критери-ев шкалы Present State Examination [26]. При использова-нии операциональных критериев для психотических рас-стройств (Operational Criteria Checklist for Psychotic Illness) распространенность шизофреноподобных психозов при парциальной и генерализованной эпилепсии составляла от 9 до 52% [27].…”