Psychosis of epilepsy: a multifaceted neuropsychiatric disorder

Abstract

Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy. The prevalence of POE is more than 7 times higher than the frequency of primary schizophreniform disorders in the general population. While POE has been associated with focal epilepsy of temporal and frontal lobe origin, its etiology and pathophysiology of POE have yet to be established.The treatment of all forms of POE, with the exception of ictal psychotic episodes, requires the use of antipsychotic drugs, preferably the atypical antipsychotic agents with a very low or negligible potential to lower the seizure threshold (eg, risperidone, apiprazole), starting at a low dose with stepwise increments.

Forced normalization: A systematic review

“…The bidirectional association between epilepsy and psychosis has been widely studied during the past century . Much of the evidence in this regard has emerged from experimental studies of kindling and electroconvulsive seizures, as well as the observed therapeutic effect of electroconvulsive therapy in psychotic and depressive disorders in humans …”

“…1 Much of the evidence in this regard has emerged from experimental studies of kindling and electroconvulsive seizures, 2 as well as the observed therapeutic effect of electroconvulsive therapy in psychotic and depressive disorders in humans. 3 The occurrence of psychosis and epilepsy is not coincidental. The annual incidence of schizophreniform psychosis in epilepsy (0.4%) is twice as high as that of schizophrenia in the general population (0.2%).…”

Bilateral anterior capsulotomy enhances medication compliance in patients with epilepsy and psychiatric comorbidities

“…First, these patients typically receive antipsychotic medications to alleviate the comorbid “positive” (eg, delusions, hallucinations) and “negative” (eg, apathy, blunted affect) symptoms of schizophrenia. Antipsychotic medications, however, may not always be effective and may even exacerbate seizure frequency and severity . Second, due to the nature of their psychiatric comorbidities, these patients often fail to comply with prescribed anti‐epileptic medication regimens.…”

“…Antipsychotic medications, however, may not always be effective and may even exacerbate seizure frequency and severity. 10 Second, due to the nature of their psychiatric comorbidities, these patients often fail to comply with prescribed anti-epileptic medication regimens. This lack of compliance also applies to other therapeutic interventions offered, including neurophysiologic (eg, EEG, MEG, MRI) assessments required for seizure monitoring or surgery.…”

Letter to the Editor

“…Diagnostically, there is a possibility that the seizure disorder could be presenting as mental illness such as in the psychoses of epilepsy (Kanner & Rivas-Grajales, 2016). Conversely, seizures could be mistaken as evidence of psychiatric illness (Mirsattari et al 2011).…”