Postictal Psychosis: A Comparison with Acute Interictal and Chronic Psychoses

Kanemoto, Kousuke; Kawasaki, Jun; Kawai, Itsuo

doi:10.1111/j.1528-1157.1996.tb00608.x

Cited by 223 publications

(145 citation statements)

References 13 publications

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“…Its presentation is typically pleomorphic, with delusions and hallucinations, loose associations, mannerisms and mood swings 1,2 . Prevalence is of 4% in cases of apparently non-refractory epilepsy 3 and of 7-18% in cases of refractory epilepsy 2,4,5 . Interictal psychoses are chronic and/or recurrent, with delusions, hallucinations, thought disorders, disorganized behavior, relative absence of catatonic symptoms, mood swings, apragmatism and emotional blunting (less intense than that observed in classic schizophrenia), may progress with persistence of psychotic symptoms, psycho-organic sequelae, suicide attempts, multiple hospitalizations and functional descent 6,7 .…”

mentioning

confidence: 99%

Complete remission of epileptic psychosis after temporal lobectomy: case report

Marchetti

Tavares

Gronich

et al. 2001

Arq. Neuro-Psiquiatr.

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-We report a case of a female patient with refractory complex partial seizures since 15 years of age, recurrent postictal psychotic episodes since 35 which evolved to a chronic refractory interictal psychosis and MRI with right mesial temporal sclerosis (MTS). After a comprehensive investigation (video-EEG intensive monitoring, interictal and ictal SPECT, and a neuropsychological evaluation including WADA test) she was submitted to a right temporal lobectomy. Since then, she has been seizure-free with remission of psychosis, although with some persistence of personality traits (hiperreligiosity, viscosity) which had been present before surgery. This case supports the idea that temporal lobectomy can be a safe and effective therapeutic measure for patients with MTS, refractory epilepsy and recurrent postictal epileptic psychosis or interictal epileptic psychosis with postictal exacerbation.KEY WORDS: epilepsy, mental disorders, psychosis, temporal lobe.Remissão completa de psicose epiléptica de paciente submetida a lobectomia temporal: relato de caso RESUMO -Relatamos o caso de uma paciente que apresentava crises parciais complexas desde a idade de 15 anos, episódios psicóticos recorrentes desde os 35, evoluindo para psicose crônica interictal refratária, em quem investigação pela ressonância magnética (RM) revelou a presença de esclerose temporal mesial (ETM) direita. Após investigação abrangente (monitorização intensiva pelo vídeo-EEG, SPECT interictal e ictal e avaliação neuropsicológica incluindo teste de WADA), a paciente foi submetida a lobectomia temporal direita. Desde então, ela está sem crises e a sua psicose remitiu, persistindo apenas alguns traços de personalidade (religiosidade, viscosidade) que ela já apresentava anteriormente. Este caso dá suporte à idéia de que a lobectomia temporal pode ser uma medida terapêutica segura e eficaz para pacientes com ETM, epilepsia refratária e psicose epiléptica pós-ictal recorrente ou psicose epiléptica interictal com agravamento pós-ictal. PALAVRAS-CHAVE: epilepsia, transtornos mentais, psicose, lobo temporal. Several mental disorders may occur in patients with epilepsy. Psychoses associated with epilepsy are among those of major concern to neurologists and psychiatrists. These psychoses are classified into periictal (of which most significant are the postictal psychoses) and interictal. Postictal psychoses have onset in the late postictal period (hours or days after) of an isolated seizure or of a cluster of complex partial seizures (CPS) with or without secondary generalization. Its presentation is typically pleomorphic, with delusions and hallucinations, loose associations, mannerisms and mood swings 1,2 . Prevalence is of 4% in cases of apparently non-refractory epilepsy 3 and of 7-18% in cases of refractory epilepsy 2,4,5 . Interictal psychoses are chronic and/or recurrent, with delusions, hallucinations, thought disorders, disorganized behavior, relative absence of catatonic symptoms, mood swings, apragmatism and emotional blunting (less intense t...

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mentioning

confidence: 99%

Complete remission of epileptic psychosis after temporal lobectomy: case report

Marchetti

Tavares

Gronich

et al. 2001

Arq. Neuro-Psiquiatr.

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“…3 Religious delusions are also commonly observed in the psychoses of epilepsy, occurring both between and immediately following a bout of seizures. 4 In this study, we aimed to investigate the cerebral basis of hypergraphia, hyposexuality and hyper-religiosity components of the Geschwind system in patients with refractory epilepsy, specifically addressing the hypothesis that pathology in the amygdala and/or hippocampus is associated with the occurrence of these phenomena. 5 Accordingly, we assessed inter-ictal behaviour in a series of patients with refractory epilepsy and correlated these findings with volumetric measurements of the amygdala and hippocampus obtained through magnetic resonance imaging (MRI).…”

mentioning

confidence: 99%

Religiosity is associated with hippocampal but not amygdala volumes in patients with refractory epilepsy

Wuerfel

Krishnamoorthy²,

Brown³

et al. 2004

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: To assess the relationship between the behavioural triad of hyper-religiosity, hypergraphia and hyposexuality in epilepsy, and volumes of the mesial temporal structures. Method: Magnetic resonance images were obtained from 33 patients with refractory epilepsy and mesial temporal structure volumes assessed. Amygdala and hippocampal volumes were then compared in high and low scorers on the religiosity, writing, and sexuality sub-scales of the Neurobehavioural Inventory. Results: Patients with high ratings on the religiosity scale had significantly smaller right hippocampi. Religiosity scores rated by both patient and carer showed a significant negative correlation with right hippocampal volumes in this group. There were no other differences in amygdala or hippocampal volumes between these groups, or between high and low scorers on the writing and sexuality sub-scales. Conclusions: These findings suggest that right hippocampal volumes are negatively correlated with religiosity in patients with refractory epilepsy.

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“…También se han descrito episodios de estupor aquinético, miedo, síndrome de Capgras, o la sensación de que alguien se encuentra próximo a uno mismo todo el tiempo (19).…”

Section: Notas Clínicasunclassified

Las psicosis de la epilepsia: presentación de un caso clínico y revisión de la literatura

Perlado

Rivas

Olea

et al. 2013

Rev. Asoc. Esp. Neuropsiq.

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Recibido: 13/08/2012; aceptado con modificaciones: 17/12/2012 RESUMEN: Presentamos el caso de un varón de 72 años con un diagnóstico previo de epilepsia del lóbu-lo temporal y esquizofrenia paranoide, que mostraba episodios de psicosis con sintomatología pleomórfica y atípica que no respondía bien al tratamiento antipsicótico. El paciente no presentaba un deterioro en su personalidad y había demostrado un buen ajuste y funcionamiento social. Tras revisar el caso se llega a cuestionar el diagnóstico previo de esquizofrenia paranoide proponiendo el diagnóstico alternativo de epilepsia del lóbulo temporal: crisis comiciales con sintomatología psicótica. Se instaura el tratamiento adecuado con éxito lo que permite el alta del paciente a su domicilio. Revisamos la literatura en la materia, concluyendo que las psicosis de la epilepsia han de tenerse en cuenta en casos de psicosis atípicas, resistentes a tratamiento en personas con buen funcionamiento psico-social sin deterioro en su personalidad. PALABRAS CLAVE: epilepsia del lóbulo temporal; psicosis comiciales; psicosis de la epilepsia; psicosis de la epilepsia tipo esquizofrenia. CONFLICTO DE INTERESES: Ninguno.ABSTRACT: We describe the case of a 72 year old man with a diagnosis of temporal lobe epilepsy and paranoid schizophrenia, who presented atypical psychotic episodes which did not respond to anti-psychotic medication. His personality had not deteriorated and he showed good social adjustment and functioning. After reviewing the case, we challenged the diagnosis of paranoid schizophrenia, proposing an alternative diagnosis of temporal lobe epilepsy with ictal psychosis. He was successfully treated and discharged home. We review the literature on the subject. The psychosis of epilepsy are a diagnostic option which must be seriously considered in cases of treatment resistant atypical psychosis in subjects with good pre-morbid functioning and social adjustment free from personality decline. KEY WORDS: temporal lobe epilepsy; ictal psychosis; psychosis of epilepsy; schizophrenia like psychosis of epilepsy. DECLARATION OF INTEREST: None.

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Postictal Psychosis: A Comparison with Acute Interictal and Chronic Psychoses

Cited by 223 publications

References 13 publications

Complete remission of epileptic psychosis after temporal lobectomy: case report

Complete remission of epileptic psychosis after temporal lobectomy: case report

Religiosity is associated with hippocampal but not amygdala volumes in patients with refractory epilepsy

Las psicosis de la epilepsia: presentación de un caso clínico y revisión de la literatura

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