Psychotic illness in patients with epilepsy

Abstract

Apart from the rather rare ictal psychotic events, such as non-convulsive status epilepticus, modern epileptic psychoses have been categorized into three main types; chronic and acute interictal psychoses (IIPs) and postictal psychosis (PIP). Together, they comprise 95% of psychoses in patients with epilepsy (PWE). Four major questions, that is, "Is psychosis in PWE a direct consequence of epilepsy or schizophrenia induced by epilepsy?", "Is psychosis in PWE homogeneous or heterogeneous?", "Does psychosis in PWE have symptomatological differences from schizophrenia and related disorders?", "Is psychosis in PWE uniquely associated with temporal lobe epilepsy (TLE)?" are tried to be answered in this review with relevant case presentations. In the final section, we propose a tentative classification of psychotic illness in PWE, with special attention to those who have undergone epilepsy surgery. Psychotic disorders in PWE are often overlooked, mistreated, and consequently lingering on needlessly. While early diagnosis is unanimously supported as a first step to avoid this delay, necessity of switching from antiepileptic drugs with supposedly adverse psychotopic effects. to others is more controversial. To elucidate the riddle of alternative psychosis, we need badly further reliable data.

Psychoses in epilepsy: A comparison of postictal and interictal psychoses

“…Furthermore, patients with IP were found to be younger at occurrence of first psychosis and to have a shorter interval between the onset of epilepsy and psychosis than those with PP, which confirms previous findings [17,18]. Together with studies that compared ages at psychosis onset between schizophrenia, IP, and PP (indicating the youngest age to be for onset of schizophrenia and the oldest for that of PP [15,19]), this supports the assumption that epileptic and genetic determinants may have differential impacts among distinct subtypes of epilepsy-related psychoses [14]. Mean ages for psychosis onset in our patients were 33.9 years (PP) and 29.0 years (IP).…”

“…The association between TLE and PP may be even more pronounced. In accordance with our finding of PP being the predominant type of psychosis in TLE, the average ratio of TLE associated with PP has been estimated to be as high as 81% [14].…”

“…This corresponds to previous reports indicating that PP may be characterized by a relative prominence of affect-laden paranoid/referential delusions and hallucinations [3,20,21] (with violent or suicidal behavior presumably being a specific hallmark of PP [11,22]), while phenomenology of IP mayin contrast be closer to nonepileptic psychoses (therefore also termed "schizophrenia-like psychosis") [4,17,23]. Negative symptoms, however, were exceedingly rare in our group with IP, which is inconsistent with what is expected in IP at the very least [14,19,24].…”

“…These findings support the commonly held views of both a preponderance of LRE in patients with epilepsy and psychosis and a specific association between psychosis and TLE. Although some researchers argue against the assumption that the risk of psychosis differs by type of epilepsy [12,13], numerous studies found patients with LRE to be more susceptible to both IP and PP compared with patients with GE [4,7,14]. Several reports indicate a close relationship between TLE and IP [4,7,15], while only one study failed to demonstrate an increased susceptibility to IP in TLE [16].…”

Co-Morbidity in Patients with Violence Episodes an Effort to Correlate Its Association and Prevention

“…In 1953, Landolt stressed the seesaw relationship between epileptic discharges on EEG and psychosis, and proposed the concept of forced normalization, which led to the concept of alternative psychosis proposed by Tellenbach [11] .…”