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Yıldız Miniksar D, Kılıç B, Kılıç M, Miniksar ÖH, Topçu Y, Aydın K. Evaluation of suicide probability in children and adolescents with epilepsy. Pediatr Int 2022; 64:e15130. [PMID: 35510727 DOI: 10.1111/ped.15130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 12/13/2021] [Accepted: 01/11/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND We aimed to examine suicide probability, factors affecting suicide, and personality traits of children and adolescents diagnosed with epilepsy, and to compare their results with those of children without epilepsy. METHODS Fifty-six children diagnosed with epilepsy and 56 control children, aged 11-16 years, were evaluated by using the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria, the Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version, the Child Depression Inventory, the Suicide Probability Scale (SPS), and the Personality Inventory for DSM-5 - Brief Form - Children (PID-5-BF) scales. Factors predicting suicide risk in children with epilepsy were analyzed. RESULTS The mean age, SPS total score, and hopelessness subscale score, PID-5-BF total score as well as disinhibition and psychoticism subscale scores of the epilepsy group were significantly higher than those of the control group (P < 0.05). There was no significant difference between the groups in terms of the Child Depression Inventory, and other subscales of the Suicide Probability Scales and PID-5-BF scales. The SPS total score was higher in patients with comorbid psychiatric diseases, those using psychiatric drugs, and girls (P < 0.05). An ANCOVA analysis indicated that the most important factor that predicted the probability of suicide and its subscale scores was the level of depression, and the presence of epilepsy was not predictive. CONCLUSIONS We found a high probability of suicide and personality pathology in children with epilepsy but the main predictor of suicide probability was the level of depression, not the presence of epilepsy.
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Affiliation(s)
| | - Betül Kılıç
- Pediatric Neurology, Medipol University Hospital, Istanbul, Turkey
| | - Mahmut Kılıç
- Department of Public Health, Bozok University, Yozgat, Turkey
| | | | - Yasemin Topçu
- Pediatric Neurology, Medipol University Hospital, Istanbul, Turkey
| | - Kürşad Aydın
- Pediatric Neurology, Medipol University Hospital, Istanbul, Turkey
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2
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Fahed M, Ramanathan S. Psychoses of Epilepsy in Pregnancy: A Case Report. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2021; 19:388-390. [PMID: 33888667 PMCID: PMC8077056 DOI: 10.9758/cpn.2021.19.2.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 03/30/2020] [Indexed: 11/25/2022]
Abstract
To discuss the unique relationship between psychosis and seizures in a young individual, who is also pregnant. Psychosis of epilepsy can present in multitude of ways, including pre-ictal, ictal, post-ictal, chronic interictal, and forced normalization psychosis.
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Affiliation(s)
- Mario Fahed
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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3
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Anzellotti F, Dono F, Evangelista G, Di Pietro M, Carrarini C, Russo M, Ferrante C, Sensi SL, Onofrj M. Psychogenic Non-epileptic Seizures and Pseudo-Refractory Epilepsy, a Management Challenge. Front Neurol 2020; 11:461. [PMID: 32582005 PMCID: PMC7280483 DOI: 10.3389/fneur.2020.00461] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/29/2020] [Indexed: 12/11/2022] Open
Abstract
Psychogenic nonepileptic seizures (PNES) are neurobehavioral conditions positioned in a gray zone, not infrequently a no-man land, that lies in the intersection between Neurology and Psychiatry. According to the DSM 5, PNES are a subgroup of conversion disorders (CD), while the ICD 10 classifies PNES as dissociative disorders. The incidence of PNES is estimated to be in the range of 1.4-4.9/100,000/year, and the prevalence range is between 2 and 33 per 100,000. The International League Against Epilepsy (ILAE) has identified PNES as one of the 10 most critical neuropsychiatric conditions associated with epilepsy. Comorbidity between epilepsy and PNES, a condition leading to "dual diagnosis," is a serious diagnostic and therapeutic challenge for clinicians. The lack of prompt identification of PNES in epileptic patients can lead to potentially harmful increases in the dosage of anti-seizure drugs (ASD) as well as erroneous diagnoses of refractory epilepsy. Hence, pseudo-refractory epilepsy is the other critical side of the PNES coin as one out of four to five patients admitted to video-EEG monitoring units with a diagnosis of pharmaco-resistant epilepsy is later found to suffer from non-epileptic events. The majority of these events are of psychogenic origin. Thus, the diagnostic differentiation between pseudo and true refractory epilepsy is essential to prevent actions that lead to unnecessary treatments and ASD-related side effects as well as produce a negative impact on the patient's quality of life. In this article, we review and discuss recent evidence related to the neurobiology of PNES. We also provide an overview of the classifications and diagnostic steps that are employed in PNES management and dwell on the concept of pseudo-resistant epilepsy.
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Affiliation(s)
| | - Fedele Dono
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Giacomo Evangelista
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Martina Di Pietro
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Claudia Carrarini
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Mirella Russo
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Camilla Ferrante
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Stefano L Sensi
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy.,Institute for Mind Impairments and Neurological Disorders, University of California, Irvine, Irvine, CA, United States
| | - Marco Onofrj
- Department of Neuroscience, Imaging and Clinical Science, "G. D'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Behavioral Neurology and Molecular Neurology Units, Center for Advanced Studies and Technology (CAST), University G. d'Annunzio of Chieti-Pescara, Chieti, Italy
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4
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Fontanella CA, Warner LA, Steelesmith D, Bridge JA, Sweeney HA, Campo JV. Clinical Profiles and Health Services Patterns of Medicaid-Enrolled Youths Who Died by Suicide. JAMA Pediatr 2020; 174:470-477. [PMID: 32202589 PMCID: PMC7091475 DOI: 10.1001/jamapediatrics.2020.0002] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/23/2019] [Indexed: 12/18/2022]
Abstract
Importance Youth suicide is a major public health problem, and health care settings play a critical role in suicide prevention efforts, but limited data are available to date on health and mental health service use patterns before suicide. Objective To compare the clinical profiles and patterns of use of health and mental health care services among children and adolescents who died by suicide and a matched living control group. Design, Setting, and Participants This population-based case-control study used Medicaid data from 16 states merged with mortality data. Suicide cases (n = 910) included all youths aged 10 to 18 years who died by suicide from January 1, 2009, to December 31, 2013. Controls (n = 6346) were matched to suicide cases on sex, race, ethnicity, Medicaid eligibility category, state, and age. Data were analyzed from July 18 to November 19, 2019. Exposures Use of health and mental health care services. Main Outcomes and Measures Health and behavioral health care visits in the 6-month period before the index date (date of suicide). Associations among visits, clinical characteristics, and suicide were examined using logistic regression. Results The study population of 7256 Medicaid-enrolled youths included 5292 males (72.9%) with a mean (SD) age of 15.7 (2.0) years at the index date; 3619 (49.9%) were non-Hispanic white. Three hundred seventy-six suicide decedents (41.3%) had a mental health diagnosis in the 6 months before death compared with 1111 controls (17.5%; P < .001). A greater proportion of suicide decedents than controls used services before the index date (in 6 months, 687 suicide decedents [75.5%] vs 3669 controls [57.8%]; odds ratio [OR], 2.39 [95% CI, 2.02-2.82]). Suicide risk was highest among youths with epilepsy (OR, 4.89; 95% CI, 2.81-8.48; P < .001), depression (OR, 3.19; 95% CI, 2.49-4.09; P < .001), schizophrenia (OR, 3.18; 95% CI, 2.00-5.06; P < .001), substance use disorder (OR, 2.65; 95% CI, 1.67-4.20; P < .001), and bipolar disorder (OR, 2.09; 95% CI, 1.58-2.76; P < .001). More mental health visits within the 30 days before the index date were associated with decreased odds of suicide (OR, 0.78; 95% CI, 0.65-0.92; P = .005). Conclusions and Relevance This study found that among youths aged 10 to 18 years who were enrolled in Medicaid, clinical characteristics and patterns of use of health care services among suicide decedents were distinct from those of nonsuicide controls. Implementation of suicide screening protocols for youths enrolled in Medicaid, targeted based on the frequency of visits, psychiatric diagnoses, and epilepsy, may have the potential to decrease suicide rates.
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Affiliation(s)
- Cynthia A. Fontanella
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus
| | - Lynn A. Warner
- Department of Psychiatry, The Ohio State University College of Medicine, Columbus
| | - Danielle Steelesmith
- Department of Psychiatry and Behavioral Health, Wexner Medical Center, The Ohio State University, Columbus
| | - Jeffrey A. Bridge
- Abigail Wexner Research Institute, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - John V. Campo
- Rockefeller Neuroscience Institute, Behavioral Medicine and Psychiatry, West Virginia University, Morgantown
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Fröscher W, Faust V, Steinert T. Clinical characteristics of forced normalization and alternative psychosis with special consideration of the new anticonvulsants. JOURNAL OF EPILEPTOLOGY 2020. [DOI: 10.21307/jepil-2020-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Fasano RE, Kanner AM. Psychiatric complications after epilepsy surgery… but where are the psychiatrists? Epilepsy Behav 2019; 98:318-321. [PMID: 30658895 DOI: 10.1016/j.yebeh.2018.12.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 12/09/2018] [Indexed: 11/26/2022]
Abstract
In patients with refractory epilepsy, there is a significant risk of postoperative psychiatric complications after epilepsy surgery. The main risk factors for this phenomenon include a lifetime or family history of psychiatric illness; these risk factors can be easily identified through a preoperative evaluation performed by a psychiatrist. Despite this, very few comprehensive epilepsy centers include a psychiatrist on the treatment team. Preoperative evaluations often fail to identify patients at risk of postoperative psychiatric complications, thus missing the opportunity to counsel and prophylactically treat patients at risk. In this article, we review the risk factors for the development of postoperative psychiatric complications and discuss the reasons why epilepsy centers continue to perform presurgical evaluations without psychiatrists. Additionally, we provide practical solutions for neurologists in the identification and management of postoperative psychiatric disorders. This article is part of the Special Issue "Obstacles of Treatment of Psychiatric Comorbidities in Epilepsy".
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Affiliation(s)
- Rebecca Ellen Fasano
- Emory University School of Medicine, Department of Neurology, 12 Executive Park Dr. NE, Atlanta, GA 30329, United States of America.
| | - Andres M Kanner
- University of Miami Miller School of Medicine, Department of Neurology, 1150 NW 14th St, Miami, FL 33136, United States of America
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de Toffol B, Trimble M, Hesdorffer DC, Taylor L, Sachdev P, Clancy M, Adachi N, Bragatti JA, Mula M, Kanemoto K. Pharmacotherapy in patients with epilepsy and psychosis. Epilepsy Behav 2018; 88:54-60. [PMID: 30241054 DOI: 10.1016/j.yebeh.2018.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 08/28/2018] [Accepted: 09/01/2018] [Indexed: 11/28/2022]
Abstract
The recognition and treatment of psychosis in persons with epilepsy (PWE) is recommended with the apparent dilemma between treating psychosis and opening the possibility of exacerbating seizures. The pooled prevalence estimate of psychosis in PWE is 5.6%. It has been proposed that a 'two hit' model, requiring both aberrant limbic activity and impaired frontal control, may account for the wide range of clinical phenotypes. The role of antiepileptic drugs in psychosis in PWE remains unclear. Alternating psychosis, the clinical phenomenon of a reciprocal relationship between psychosis and seizures, is unlikely to be an exclusively antiepileptic drug-specific phenomenon but rather, linked to the neurobiological mechanisms underlying seizure control. Reevaluation of antiepileptic treatment, including the agent/s being used and degree of epileptic seizure control is recommended. The authors found very few controlled studies to inform evidence-based treatment of psychosis in PWE. However, antipsychotics and benzodiazepines are recommended as the symptomatic clinical treatments of choice for postictal and brief interictal psychoses. The general principle of early symptomatic treatment of psychotic symptoms applies in epilepsy-related psychoses, as for primary psychotic disorders. In the authors' experience, low doses of antipsychotic medications do not significantly increase clinical risk of seizures in PWE being concurrently treated with an efficacious antiepileptic regimen.
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Affiliation(s)
- Bertrand de Toffol
- Service de Neurologie & Neurophysiologie Clinique, CHU Bretonneau, Tours, France, Service de Neurologie Hôpital de Cayenne, Guyane France et UMR 1253, iBrain, Université de Tours, Inserm, France.
| | - Michael Trimble
- Institute of Neurology, Queen Square, London WC1N 3BG, United Kingdom
| | - Dale C Hesdorffer
- Gertrude H.K Sergievsky Center and Department of Epidemiology, Columbia University, USA
| | - Lauren Taylor
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Perminder Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia; Neuropsychiatric Institute, Prince of Wales Hospital, Randwick, NSW, Australia
| | - Maurice Clancy
- Department of Liaison Psychiatry, University Hospital Waterford, Ireland
| | | | | | - Marco Mula
- Atkinson Morley Regional Neuroscience Centre, St George's University Hospitals NHS Foundation Trust and Institute of Medical and Biomedical Education, St. George's University of London, United Kingdom
| | - Kousuke Kanemoto
- Aichi Medical University, Neuropsychiatric Department, Nagakute, Japan
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8
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Giannitelli M, Consoli A, Raffin M, Jardri R, Levinson DF, Cohen D, Laurent-Levinson C. An overview of medical risk factors for childhood psychosis: Implications for research and treatment. Schizophr Res 2018; 192:39-49. [PMID: 28526280 DOI: 10.1016/j.schres.2017.05.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Psychotic disorders in childhood and early adolescence often progress to chronic schizophrenia, but in many cases there are diagnosable medical and genetic causes or risk factors. We reviewed our clinical experience and the relevant literature to identify these factors and to define their clinical features, appropriate work-up and treatment. METHOD We reviewed the results of comprehensive medical evaluations of 160 psychotic children and adolescents in our center. We also searched the Medline database (January 1994 to December 2015) with the following keywords and combinations: early onset schizophrenia, childhood onset schizophrenia, early onset psychosis, first episode psychosis, inborn errors of metabolism (IEM), genetic syndrome, copy number variants, autoimmune disorders, endocrine diseases, nutritional deficiencies, central nervous system infections, movement disorders, and epilepsy. RESULTS In our center, 12.5% of cases had medical disorders likely to be contributing to psychosis. Based on 66 relevant papers and our experience, we describe the clinical features of multiple genetic syndromes, IEM, and autoimmune, neurological, endocrinological and nutritional disorders that increase the risk of psychotic disorders in childhood and adolescence. We propose an algorithm for systematic laboratory evaluation, informed by clinical examination, emphasizing common and/or treatable factors. CONCLUSIONS In children and early adolescents with psychotic disorders, systematic medical work-up is warranted to identify medical and genetic factors. Not every rare cause can be worked up, thus careful clinical examinations are required to detect medical, neurological and genetic signs. Comprehensive medical evaluation can detect treatable diseases among cases of early-onset psychosis.
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Affiliation(s)
- Marianna Giannitelli
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, 1 place Jussieu, 75005 Paris, France
| | - Angèle Consoli
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Marie Raffin
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Renaud Jardri
- University of Lille, SCALab, CNRS UMR-9193 & CHU Lille, CURE platform, Fontan Hospital, Lille, France
| | - Douglas F Levinson
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - David Cohen
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; CNRS UMR 7222, Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, 1 place Jussieu, 75005 Paris, France
| | - Claudine Laurent-Levinson
- Sorbonne Universités, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris, Groupe de Recherche Clinique n°15 (PSYDEV), Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Centre de référence des maladies rares à expression psychiatrique, Department of Child and Adolescent Psychiatry, Hôpital Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.
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Morita S, Taniguchi G, Tamune H, Kumakura Y, Kondo S, Kasai K. A case of interictal dysphoric disorder comorbid with interictal psychosis: Part of the same spectrum or separate entities? EPILEPSY & BEHAVIOR CASE REPORTS 2018; 10:102-105. [PMID: 30191125 PMCID: PMC6125793 DOI: 10.1016/j.ebcr.2018.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/09/2018] [Accepted: 07/10/2018] [Indexed: 11/28/2022]
Abstract
Depressive disorders in epilepsy often present characteristic clinical manifestations atypical in primary, endogenous depression. Here, we report a case of a 64-year-old woman with right mesial temporal lobe epilepsy, who complained of bizarre, antipsychotic-refractory cenesthetic hallucinations in her interictal phase, and was hospitalized after a suicide attempt. Detailed clinical observations revealed mood symptoms, which led to the diagnosis of interictal dysphoric disorder comorbid with interictal psychosis. Sertraline with low-dose aripiprazole markedly alleviated both depressive and psychotic symptoms. This case suggested that the two diagnostic entities may overlap and that depressive symptoms tend to be concurrent when concurring with psychosis, which hampers the appropriate choice of a treatment option. Prominent psychosis overshadowed symptoms of interictal dysphoric disorder (IDD). Interictal psychosis (IIP) may be more severe form of IDD. Self-report inventories may miss IDD with psychotic features. Sertraline with low-dose aripiprazole may be a promising pharmacological treatment in severe IDD.
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Affiliation(s)
- Susumu Morita
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Go Taniguchi
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Corresponding author at: 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Hidetaka Tamune
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Cellular Neurobiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yousuke Kumakura
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinsuke Kondo
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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10
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Abstract
Psychiatric comorbidities, including mood, anxiety, and psychotic disorders, are common in epilepsy, often occurring at rates 2-3-fold or higher than in the general population without epilepsy. This article discusses the epidemiology of psychiatric disorders in epilepsy, hypotheses regarding the pathogenesis of these comorbidities, and treatment implications. More specifically, it addresses: (1) How common are major depressive disorder, anxiety disorders, and psychotic disorders in epilepsy? (2) How does one screen for these psychiatric disorders in persons with epilepsy? (3) Why do psychiatric conditions occur in epilepsy? (4) Is the treatment of psychiatric comorbidity in epilepsy associated with seizures? The important topic of suicide and suicidal ideation in epilepsy, risk factors for their occurrence, and how to screen for these co-existent conditions is also discussed. Finally, gaps in knowledge regarding psychiatric conditions in epilepsy are briefly discussed.
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Affiliation(s)
- Colin B Josephson
- a Department of Clinical Neurosciences , Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary , AB , Canada
| | - Nathalie Jetté
- a Department of Clinical Neurosciences , Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary , Calgary , AB , Canada
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11
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Bob P. Dissociation, Epileptiform Discharges and Chaos in the Brain: Toward a Neuroscientific Theory of Dissociation. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/bf03379587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Dissociated states represent pathological conditions when psychological trauma may emerge in a variety of forms such as psychic dissociative symptoms or, on the contrary, as paroxysms or other somatoform symptoms. There is evidence that epileptic activity plays an important role in the generation of dissociative states and it is able to generate various psychopathological processes as well as a wide spectrum of somatic symptoms or seizures. For the explanation of these connections between dissociative states and epileptic discharges the author proposes a neuroscientific model of dissociation based on the theory of competitive neural assemblies which can lead to chaotic self-organization in brain neural networks. This model is suggested as an integrative view interconnecting the various psychopathological and somatoform manifestations of dissociative states and suggests further possibilities for future research regarding common pathogenic mechanisms among epilepsy and mental disorders.
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12
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Clinique et neurobiologie des psychoses post-ictales. Encephale 2016; 42:443-447. [DOI: 10.1016/j.encep.2015.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/09/2015] [Accepted: 12/14/2015] [Indexed: 11/18/2022]
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13
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Hilger E, Zimprich F, Pataraia E, Aull-Watschinger S, Jung R, Baumgartner C, Bonelli S. Psychoses in epilepsy: A comparison of postictal and interictal psychoses. Epilepsy Behav 2016; 60:58-62. [PMID: 27179193 DOI: 10.1016/j.yebeh.2016.04.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/01/2016] [Accepted: 04/02/2016] [Indexed: 11/30/2022]
Abstract
We retrospectively analyzed data of patients with epilepsy (n=1434) evaluated with prolonged EEG monitoring in order to estimate the prevalence of postictal psychosis (PP) and interictal psychosis (IP), to investigate a potential association of psychosis subtype with epilepsy type, and to assess differences between PP and IP. The overall prevalence of psychosis was 5.9% (N=85); prevalence of PP (N=53) and IP (N=32) was 3.7% and 2.2%, respectively. Of patients with psychosis, 97.6% had localization-related epilepsy (LRE). Prevalence of psychosis was highest (9.3%) in patients with temporal lobe epilepsy (TLE). When comparing PP with IP groups on demographic, clinical, and psychopathological variables, patients with IP were younger at occurrence of first psychosis (P=0.048), had a shorter interval between epilepsy onset and first psychosis (P=0.002), and more frequently exhibited schizophreniform traits (conceptual disorganization: P=0.008; negative symptoms: P=0.017) than those with PP. Postictal psychosis was significantly associated with a temporal seizure onset on ictal EEG (P=0.000) and a higher incidence of violent behavior during psychosis (P=0.047). To conclude, our results support the presumption of a preponderance of LRE in patients with psychosis and that of a specific association of TLE with psychosis, in particular with PP. Given the significant differences between groups, PP and IP may represent distinct clinical entities potentially with a different neurobiological background.
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Affiliation(s)
- Eva Hilger
- Department of Neurology, Medical University of Vienna, Austria.
| | | | | | | | - Rebekka Jung
- Department of Neurology, Medical University of Vienna, Austria
| | - Christoph Baumgartner
- Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhuegel, Vienna, Austria
| | - Silvia Bonelli
- Department of Neurology, Medical University of Vienna, Austria
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14
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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.
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D'Alessio L, Scévola L, Fernandez Lima M, Oddo S, Solís P, Seoane E, Kochen S. Psychiatric outcome of epilepsy surgery in patients with psychosis and temporal lobe drug-resistant epilepsy: a prospective case series. Epilepsy Behav 2014; 37:165-70. [PMID: 25036902 DOI: 10.1016/j.yebeh.2014.06.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/02/2014] [Accepted: 06/04/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Temporal lobe resistant epilepsy has been associated with a high incidence of psychotic disorders; however, there are many controversies; while some patients get better after surgery from their psychiatric condition, others develop psychosis or de novo depression. The aim of this study was to determine the psychiatric and seizure outcome after epilepsy surgery in patients with a previous history of psychoses. METHODS Surgical candidates with temporal lobe drug-resistant epilepsy and a positive history of psychosis diagnosed during the presurgical psychiatric assessment were included. A two-year prospective follow-up was determined after surgery. The DSM-IV Structural Interview, GAF (global assessment of functionality, DSM-IV), Ictal Classification for psychoses, and Engel's classification were used. The Student t test and chi-square-Fisher tests were used. RESULTS During 2000-2010, 89 patients were admitted to the epilepsy surgery program, 14 patients (15.7%) presented psychoses and were included in this series. After surgery, six patients (43%) did not develop any psychiatric complications, three patients (21%) with chronic interictal psychosis continued with no exacerbation, three patients (21%) developed acute and transient psychotic symptoms, and two patients (14%) developed de novo depression. Seizure outcome was Engel class I-II in 10 patients (71%). Total GAF scores were higher after surgery in patients found to be in Engel class I-II (p<0.05). CONCLUSIONS Patients with comorbid psychosis and temporal lobe drug-resistant epilepsy may benefit from epilepsy surgery under close psychiatric supervision.
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Affiliation(s)
- Luciana D'Alessio
- Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina.
| | - Laura Scévola
- Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Mónica Fernandez Lima
- Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina
| | - Silvia Oddo
- Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina
| | - Patricia Solís
- Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Eduardo Seoane
- Neurosurgery Center, Ramos Mejía Hospital, Buenos Aires, Argentina
| | - Silvia Kochen
- Epilepsy Center, Ramos Mejía Hospital, Buenos Aires, Argentina; E de Robertis Neuroscience Institute, Epilepsy Research Laboratory, CONICET, Buenos Aires, Argentina
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Anzellotti F, Franciotti R, Zhuzhuni H, D’Amico A, Thomas A, Onofrj M. Nonepileptic seizures under levetiracetam therapy: a case report of forced normalization process. Neuropsychiatr Dis Treat 2014; 10:959-64. [PMID: 24926197 PMCID: PMC4049430 DOI: 10.2147/ndt.s60089] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Nonepileptic seizures (NES) apparently look like epileptic seizures, but are not associated with ictal electrical discharges in the brain. NES constitute one of the most important differential diagnoses of epilepsy. They have been recognized as a distinctive clinical phenomenon for centuries, and video/electroencephalogram monitoring has allowed clinicians to make near-certain diagnoses. NES are supposedly unrelated to organic brain lesions, and despite the preponderance of a psychiatric/psychological context, they may have an iatrogenic origin. We report a patient with NES precipitated by levetiracetam therapy; in this case, NES was observed during the disappearance of epileptiform discharges from the routine video/electroencephalogram. We discuss the possible mechanisms underlying NES with regard to alternative psychoses associated with the phenomenon of the forced normalization process.
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Affiliation(s)
- Francesca Anzellotti
- Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d’Annunzio University Foundation, Gabriele d’Annunzio University, Chieti, Italy
| | - Raffaella Franciotti
- Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d’Annunzio University Foundation, Gabriele d’Annunzio University, Chieti, Italy
| | - Holta Zhuzhuni
- Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d’Annunzio University Foundation, Gabriele d’Annunzio University, Chieti, Italy
| | - Aurelio D’Amico
- Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d’Annunzio University Foundation, Gabriele d’Annunzio University, Chieti, Italy
| | - Astrid Thomas
- Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d’Annunzio University Foundation, Gabriele d’Annunzio University, Chieti, Italy
| | - Marco Onofrj
- Department of Neuroscience and Imaging, Aging Research Centre, Gabriele d’Annunzio University Foundation, Gabriele d’Annunzio University, Chieti, Italy
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De Benedictis L, Dumais A, Nicole L, Grou C, Lesage AD. A patient with medication-resistant epilepsy featuring psychosensorial and psychotic symptoms presenting with significant functional improvement on psychotherapeutic treatment: a case report. J Med Case Rep 2013; 7:259. [PMID: 24215787 PMCID: PMC3834551 DOI: 10.1186/1752-1947-7-259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2013] [Accepted: 09/14/2013] [Indexed: 12/04/2022] Open
Abstract
Background Partial complex epilepsy with psychosensorial and psychotic symptoms remains a relatively rare condition that can sometimes be mistaken for an axis I psychiatric disorder. There is no specific treatment for this particular type of epilepsy, anti-epileptic medication being the cornerstone of therapeutic intervention with the occasional addition of neuroleptics. Lack of response to anti-epileptic agents is often a sign of poor prognosis and requires risky and sometimes invasive interventions with high morbidity for patients. Case presentation We report the case of a 21-year-old right-handed Caucasian man of French-Canadian descent who was living with his mother immediately before being hospitalized in a psychiatric setting for the first time. He seemed obsessed with developing new concepts to reach a more ‘perfect’ existence. He also claimed feeling odd sensations in his mind and in his body that could be linked to some sort of ‘evolutionary’ process resulting from spiritual uplift. He reported non-specific visual hallucinations and what sounded like auditory hallucinations and telepathic powers. The first diagnosis was a possible schizophreniform disorder and our patient was hospitalized. Shortly afterwards, an electroencephalogram showed an important subcortical epileptic activity, compatible with partial complex epilepsy with psychosensorial and psychotic symptoms. Despite a negative response to medication, symptoms proper to this type of epilepsy were substantially alleviated using a psychotherapeutical treatment intended for patients with psychotic disorders, namely integrated psychological therapy (IPT). Significant functional improvement in our patient has been achieved since then. Conclusions This case report illustrates that despite a negative response to medication, symptoms proper to this type of epilepsy could be substantially alleviated using psychotherapeutical treatment modalities. To the best of our knowledge, this is the first time such a finding has been reported in the scientific literature. This could open the way for new research themes and therapeutic interventions for such patients.
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Affiliation(s)
- Luigi De Benedictis
- Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, 7401, Rue Hochelaga, Montréal, Québec H1N 3M5, Canada.
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19
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Treatments for patients with comorbid epilepsy and depression: a systematic literature review. Epilepsy Behav 2013; 28:36-40. [PMID: 23651914 DOI: 10.1016/j.yebeh.2013.03.029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 11/23/2022]
Abstract
Depression is recognized as a serious comorbidity of epilepsy, but treatment of depression and anxiety in people with epilepsy is challenging. The aim of this article was to review published controlled clinical treatment studies of depression and anxiety in patients with epilepsy. The PubMed, Cochrane and PsycINFO databases were searched for controlled clinical trials, or controlled psychosocial or behavioral trials published in English before June 2012. Search terms were: seizures, epilepsy, depression, psychotherapy, cognitive therapy/treatment, behavioral therapy/treatment and nonpharmacologic therapy/treatment, education and stress management. Seven studies were included in this review. Interventions included antidepressant medications, antiepileptic medications, and cognitive behavioral therapy. Despite the methodological limitations in the studies identified by this review, both medications and psychotherapy improved depression and anxiety in patients with epilepsy. However, further research is needed in the form of randomized controlled clinical trials to establish appropriate pharmacological and psychosocial co-management of depression and epilepsy.
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Abstract
PURPOSE OF REVIEW Epilepsy is a chronic disorder with several associated comorbidities requiring timely recognition and treatment. This article discusses aspects of cognitive impairment; psychiatric disorders including depression, anxiety, and psychosis; and health-related quality-of-life issues pertaining to patients with epilepsy. RECENT FINDINGS Cognitive problems in epilepsy may be present early in the disease course. Advances in imaging techniques are allowing correlation of structure and function as they relate to cognitive impairment in epilepsy. The relationship between epilepsy, depression, and anxiety is increasingly recognized, and these psychiatric comorbidities may affect suicide risk, patient-reported adverse antiepileptic drug effects, and quality of life. Psychiatric disorders are underrecognized and undertreated in patients with epilepsy. SUMMARY Physicians who treat patients with epilepsy should be aware of the major impact that cognitive impairment and psychiatric comorbidities have on these patients. Identifying and treating these comorbidities in epilepsy patients is just as important as seizure treatment.
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Affiliation(s)
- Leslie A Rudzinski
- Emory University School of Medicine, 80 Jesse Hill Jr Drive Southeast, Atlanta, Georgia 30300, USA.
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21
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Lit L, Belanger JM, Boehm D, Lybarger N, Haverbeke A, Diederich C, Oberbauer AM. Characterization of a dopamine transporter polymorphism and behavior in Belgian Malinois. BMC Genet 2013; 14:45. [PMID: 23718893 PMCID: PMC3680094 DOI: 10.1186/1471-2156-14-45] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 05/22/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Belgian Malinois dog breed (MAL) is frequently used in law enforcement and military environments. Owners have reported seizures and unpredictable behavioral changes including dogs' eyes "glazing over," dogs' lack of response to environmental stimuli, and loss of behavioral inhibition including owner-directed biting behavior. Dogs with severe behavioral changes may be euthanized as they can represent a danger to humans and other dogs. In the dog, the dopamine transporter gene (DAT) contains a 38-base pair variable number tandem repeat (DAT-VNTR); alleles have either one or two copies of the 38-base pair sequence. The objective of this study was to assess frequency of DAT-VNTR alleles, and characterize the association between DAT-VNTR alleles and behavior in MAL and other breeds. RESULTS In an American sample of 280 dogs comprising 26 breeds, most breeds are predominantly homozygous for the DAT-VNTR two-tandem-repeat allele (2/2). The one-tandem-repeat allele is over-represented in American MAL (AM-MAL) (n = 144), both as heterozygotes (1/2) and homozygotes (1/1). All AM-MAL with reported seizures (n = 5) were 1/1 genotype. For AM-MAL with at least one "1" allele (1/1 or 1/2 genotype, n = 121), owners reported higher levels of attention, increased frequency of episodic aggression, and increased frequency of loss of responsiveness to environmental stimuli. In behavior observations, Belgian Military Working Dogs (MWD) with 1/1 or 1/2 genotypes displayed fewer distracted behaviors and more stress-related behaviors such as lower posture and increased yawning. Handlers' treatment of MWD varied with DAT-VNTR genotype as did dogs' responses to handlers' behavior. For 1/1 or 1/2 genotype MWD, 1) lower posture after the first aversive stimulus given by handlers was associated with poorer obedience performance; 2) increased aversive stimuli during protection exercises were associated with decreased performance; 3) more aversive stimuli during obedience were associated with more aversive stimuli during protection; and 4) handlers used more aversive stimuli in protection compared with obedience exercises. CONCLUSIONS The single copy allele of DAT-VNTR is associated with owner-reported seizures, loss of responsiveness to environmental stimuli, episodic aggression, and hyper-vigilance in MAL. Behavioral changes are associated with differential treatment by handlers. Findings should be considered preliminary until replicated in a larger sample.
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Affiliation(s)
- Lisa Lit
- Department of Animal Science, University of California Davis, Davis, CA 95616, USA.
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Abstract
At present there is considerable variability in the psychiatric evaluation and follow-up of patients in epilepsy surgery programs globally. There is a large body of research now demonstrating heightened risk for psychological disturbance in surgically remedial patients before and after surgery. This evidence provides a compelling case for the routine provision of psychiatric and psychological treatment to optimize the benefits of epilepsy surgery and patient outcomes. In a comprehensive model of care, presurgical psychiatric and psychosocial evaluation plays an integral role in shaping the team's understanding of surgical candidacy and the patient's capacity for informed consent. After surgery, efficacious treatment of psychiatric comorbidity increases the likelihood of seizure freedom as well as optimizes psychosocial functioning and quality of life. By contrast, failure to treat can allow psychiatric comorbidity to persist or psychological difficulties to develop as the patient adjusts to life after surgery.
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Butler T, Weisholtz D, Isenberg N, Harding E, Epstein J, Stern E, Silbersweig D. Neuroimaging of frontal-limbic dysfunction in schizophrenia and epilepsy-related psychosis: toward a convergent neurobiology. Epilepsy Behav 2012; 23:113-22. [PMID: 22209327 PMCID: PMC3339259 DOI: 10.1016/j.yebeh.2011.11.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/28/2011] [Accepted: 11/06/2011] [Indexed: 12/27/2022]
Abstract
Psychosis is a devastating, prevalent condition considered to involve dysfunction of frontal and medial temporal limbic brain regions as key nodes in distributed brain networks involved in emotional regulation. The psychoses of epilepsy represent an important, though understudied, model relevant to understanding the pathophysiology of psychosis in general. In this review, we (1) discuss the classification of epilepsy-related psychoses and relevant neuroimaging and other studies; (2) review structural and functional neuroimaging studies of schizophrenia focusing on evidence of frontal-limbic dysfunction; (3) report our laboratory's PET, fMRI, and electrophysiological findings; (4) describe a theoretical framework in which frontal hypoactivity and intermittent medial temporal hyperactivity play a critical role in the etiopathology of psychosis both associated and unassociated with epilepsy; and (5) suggest avenues for future research.
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Affiliation(s)
- Tracy Butler
- NYU Comprehensive Epilepsy Center, Department of Neurology, New York University School of Medicine, New York, NY, USA.
| | - Daniel Weisholtz
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Nancy Isenberg
- Division of Behavioral Neurology, New Jersey Neuroscience Institute, Edison, NJ
| | - Elizabeth Harding
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jane Epstein
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily Stern
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David Silbersweig
- Functional Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Needham E, Hamelijnck J. Temporal lobe epilepsy masquerading as psychosis--a case report and literature review. Neurocase 2012; 18:400-4. [PMID: 22124330 DOI: 10.1080/13554794.2011.627338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
The psychoses of epilepsy are well recognized complications of seizure disorders, diagnosed easily from the history. However, in the absence of recognized seizures, the diagnosis can be challenging. We present a 27-year-old female, who suffered a treatment refractory psychosis for 6 years. She did not report, or display, any seizure activity, and extensive investigation was unremarkable. The onset of new symptoms prompted a repeat work-up which clinched the diagnosis of psychosis of epilepsy. Treatment with Lamotrigine and Amisulpiride achieved an excellent response, and she has remained symptom free for 7 months. We conclude with a brief literature review.
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Epilepsy, mental health disorder, or both? EPILEPSY RESEARCH AND TREATMENT 2011; 2012:163731. [PMID: 22934158 PMCID: PMC3420407 DOI: 10.1155/2012/163731] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/02/2011] [Indexed: 01/28/2023]
Abstract
Temporal lobe epilepsy (TLE), a subset of the seizure disorder family, represents a complex neuropsychiatric illness, where the neurological presentation may be complemented by varying severity of affective, behavioral, psychotic, or personality abnormalities, which, in turn, may not only lead to misdiagnosis, but also affect the management. This paper outlines a spectrum of mental health presentations, including psychosis, mood, anxiety, panic, and dissociative states, associated with epilepsy that make the correct diagnosis a challenge.
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26
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Psychosis after epilepsy surgery: report of three cases. Epilepsy Behav 2011; 22:804-7. [PMID: 22040845 DOI: 10.1016/j.yebeh.2011.09.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 09/17/2011] [Accepted: 09/25/2011] [Indexed: 11/23/2022]
Abstract
Temporal lobe epilepsy surgery has become a successful alternative in patients with refractory epilepsy. However, the outcome of epilepsy surgery may be affected by the occurrence of postsurgical psychiatric symptoms, such as psychosis. This report describes three cases of refractory temporal lobe epilepsy and hippocampal sclerosis, which, after anterior temporal lobectomy, presented with acute psychosis. One of them had a history of acute psychosis, and all of them met criteria for Cluster A personality disorder (schizoid/schizotypal) during psychiatric assessment prior to surgery. The three cases had a good seizure outcome (Engel I), but, on follow-up during the first year after surgery, developed an acute psychotic episode compatible with schizoaffective disorder; brief psychotic disorder; and a delusional disorder, respectively, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Treatment with low-dose risperidone was successful.
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27
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Belaizi M, Mehssani J, Yahyaoui M, Fajri A. [Psychotic disorder revealing epilepsy linked to a dysembryoma of the left hippocampus]. Rev Neurol (Paris) 2010; 167:221-4. [PMID: 20822785 DOI: 10.1016/j.neurol.2010.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 05/28/2010] [Accepted: 07/07/2010] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Psychotic symptoms are a rare but well-known complication of epilepsy. The prevalence is estimated between 4 and 9%. PATIENT We report a case of a 40-year-old patient, unrecognized epileptic, who presented an acute psychotic syndrome which seemed to be of functional origin, the EEG performed during the episode, and the cerebral CT scan being normal. Nevertheless, the clinical presentation, especially the sudden ending of delusions, led to further investigations. Careful history taking and repeated EEG recordings allowed the diagnosis of partial epilepsy that had begun 17 years earlier and symptomatic of a dysembryoplastic tumour of the left hippocampus revealed by MRI. DISCUSSION AND CONCLUSION Search for an epileptic origin of an acute psychotic syndrome must always be undertaken by systematic EEG. The possibility of a symptomatic temporal tumor must not be overlooked.
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Affiliation(s)
- M Belaizi
- Faculté de médecine et de pharmacie de Rabat, Rabat institut, avenue Mohammed Belarabi Elalaoui, BP 6203, Rabat, Morocco.
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28
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Jones NC, Martin S, Megatia I, Hakami T, Salzberg MR, Pinault D, Morris MJ, O'Brien TJ, van den Buuse M. A genetic epilepsy rat model displays endophenotypes of psychosis. Neurobiol Dis 2010; 39:116-25. [DOI: 10.1016/j.nbd.2010.02.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/21/2009] [Accepted: 02/03/2010] [Indexed: 12/22/2022] Open
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Verhoeven WMA, Egger JIM, Gunning WB, Bevers M, de Pont BJHB. Recurrent schizophrenia-like psychosis as first manifestation of epilepsy: a diagnostic challenge in neuropsychiatry. Neuropsychiatr Dis Treat 2010; 6:227-31. [PMID: 20520786 PMCID: PMC2877604 DOI: 10.2147/ndt.s11104] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since the 1950s, several studies have been carried out to investigate the occurrence of schizophrenia-like psychoses in epilepsy. The psychopathological profile comprises symptoms from the affective, schizophrenic, and cognitive domains and the prevalence varies between 2% to 20%. Classification of such conditions is performed according to their temporal relationship with the seizure itself. Although it is well known that epilepsy may be associated with psychotic disorders, it is less widely recognized that relapsing psychotic phenomena may be the first and only symptom of epilepsy. In this research, two patients are described who were initially referred for recurrent episodes of bipolar affective disorder and schizophrenic psychosis, respectively. In both patients, a diagnosis of relapsing postictal psychotic states due to previously undiagnosed epilepsy was made and consequently, treatment with antiepileptics was started. During follow up over several months, they remained free of both epileptic and psychotic symptoms. Given the kaleidoscopic nature of the postictal psychosis and full recovery from this, such psychoses best meet the criteria for a cycloid psychosis. These observations illustrate diagnostic and therapeutic pitfalls due to the conceptual disintegration emerging from the inadequate separation between psychiatry and neurology. Therefore, the importance of a neuropsychiatric viewpoint should be promoted.
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Affiliation(s)
- Willem M A Verhoeven
- Vincent van Gogh Institute for Psychiatry, Centre of Excellence for Neuropsychiatry, Venray, The Netherlands.
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30
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Marino J, Augsten A, Henry J. Postictal Psychosis Successfully Treated with Quetiapine: A Case Report. Ann Pharmacother 2009; 43:1544. [DOI: 10.1345/aph.1m208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Jehan Marino
- College of Pharmacy Nova Southeastern University 3200 South University Drive Fort Lauderdale, FL 33328
| | | | - Joseph Henry
- Leonard M Miller School of Medicine University of Miami Miami, FL
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31
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de Toffol B. [Postictal psychosis]. Rev Neurol (Paris) 2009; 165:769-73. [PMID: 19683323 DOI: 10.1016/j.neurol.2009.07.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Revised: 07/03/2009] [Accepted: 07/08/2009] [Indexed: 11/29/2022]
Abstract
In epilepsy patients, psychotic states are related to a group of psychotic disorders with a specific phenomenology in which potential pathophysiological mechanisms are believed to be closely related to the epileptic disorder itself. Postictal psychosis is a very specific syndrome in relation to seizure activity: a clear temporal relationship exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures, with a characteristic lucid interval which lasts from two to 120h. The psychotic state may be related to the withdrawal of anticonvulsants, often in connection with video-EEG monitoring. The phenomenology of the psychotic state is often pleomorphic, with abnormal mood, paranoid delusions and hallucinations, with some clouding of consciousness or no evidence of impaired consciousness. The outcome is characterized by a remission of the psychotic symptoms over several days (mean: 1 week), with or without neuroleptic treatment. The majority of the patients suffer from complex partial seizures with frequent psychic auras that secondarily become generalized. In the majority of cases, prepsychotic EEG abnormalities persist during the psychosis. Frequent bitemporal foci are recorded on the EEG and MRI abnormalities (including mesial temporal sclerosis) are seen in more than half of the cases. The results of clinical, morphologic and metabolic available studies will be briefly discussed.
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Affiliation(s)
- B de Toffol
- Clinique neurologique, CHU Bretonneau, Tours, France.
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D'Alessio L, Giagante B, Papayannis C, Oddo S, Silva W, Solís P, Donnoli V, Kauffman M, Consalvo D, Zieher LM, Kochen S. Psychotic disorders in Argentine patients with refractory temporal lobe epilepsy: a case-control study. Epilepsy Behav 2009; 14:604-9. [PMID: 19236954 DOI: 10.1016/j.yebeh.2009.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 02/15/2009] [Accepted: 02/18/2009] [Indexed: 10/21/2022]
Abstract
The issue of psychotic disorders in epilepsy has given rise to great controversy among professionals; however, there are not many studies in this area and the physiopathological mechanisms remain unknown. The aim of this study was to describe the spectrum of psychotic disorders in an Argentine population with refractory temporal lobe epilepsy (RTLE) and to determine the risk factors associated with psychotic disorders. Clinical variables of the epileptic syndrome were compared among a selected population with RTLE with and without psychotic disorders (DSM-IV/Ictal Classification of psychoses). Logistic regression was performed. Sixty-three patients with psychotic disorders (Psychotic Group, PG) and 60 controls (Control Group, CG) were included. The most frequent psychotic disorders were brief psychotic episodes (35%) (DSM-IV) and interictal psychosis (50%) (Ictal Classification). Risk factors for psychotic disorders were bilateral hippocampal sclerosis, history of status epilepticus, and duration of epilepsy greater than 20 years.
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Angelopoulos E, Gatzonis S, Siatouni A, Angelakis E, Sakas DE. Remission of drug-resistant epileptic psychosis following left selective amygdalohippocampectomy. Epilepsy Behav 2009; 14:393-5. [PMID: 18706520 DOI: 10.1016/j.yebeh.2008.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2008] [Revised: 07/23/2008] [Accepted: 07/26/2008] [Indexed: 11/30/2022]
Abstract
We describe two female patients with drug-resistant mesial temporal lobe epilepsy and chronic drug-resistant psychosis. In both patients, MRI scans revealed left mesial temporal sclerosis. After clinical assessment, ictal video/EEG monitoring, and a neuropsychological evaluation including Wada testing, the patients underwent selective left amygdalohippocampectomy. Since the operation, the two patients have remained free of seizures for 17 and 15 months. During the same period, both patients have sustained a full remission of the psychosis.
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Affiliation(s)
- Elias Angelopoulos
- Department of Psychiatry, University of Athens Medical School, Eginition Hospital, Athens, Greece.
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Ekinci O, Titus JB, Rodopman AA, Berkem M, Trevathan E. Depression and anxiety in children and adolescents with epilepsy: prevalence, risk factors, and treatment. Epilepsy Behav 2009; 14:8-18. [PMID: 18804186 DOI: 10.1016/j.yebeh.2008.08.015] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 08/21/2008] [Accepted: 08/26/2008] [Indexed: 11/19/2022]
Abstract
Among the psychiatric comorbid conditions in children and adolescents with epilepsy, depression and anxiety disorders require further attention because they carry the risk of reduced quality of life and life-threatening complications (e.g., suicide). Research in recent years has shed light on both the prevalence of emotional problems in youth with epilepsy and the safety and efficacy of treatment options. A number of challenges exist in treating patients with epilepsy. This is particularly true when seizures are difficult to control and medication regimens are more complex. Some pharmaceutical options may provide assistance with both seizures and emotional distress, but care is needed when considering such treatment approaches. In addition, integration of mental health professionals into the care of patients is necessary when cases are complicated and risk factors are high. Thorough methods to accurately diagnose emotional conditions and regular monitoring of symptoms can help prevent serious problems that can negatively affect the success of children and adolescents in everyday life. Collaboration between disciplines offers the best hope for early identification and treatment of these conditions.
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Affiliation(s)
- Ozalp Ekinci
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey.
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35
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García-Morales I, de la Peña Mayor P, Kanner AM. Psychiatric Comorbidities in Epilepsy: Identification and Treatment. Neurologist 2008; 14:S15-25. [DOI: 10.1097/01.nrl.0000340788.07672.51] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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[Postictal psychosis syndrome: a clinical entity to be recognized]. Rev Neurol (Paris) 2008; 165:155-63. [PMID: 18817939 DOI: 10.1016/j.neurol.2008.07.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 06/03/2008] [Accepted: 07/02/2008] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Post-ictal psychosis syndrome (PIP) belongs to the group of epileptic psychoses which, according to the most commonly used classification, is to be distinguished from ictal psychoses, on one hand, and from inter-ictal psychoses, on the other. OBJECTIVES The present paper aims to review recent data concerning the clinical, therapeutic and pathophysiological aspects of PIP. METHODS We report four cases of PPI, which involved four patients hospitalized at the Salpêtrière hospital between 2001 and 2005, and discuss these cases in light of the relevant literature. RESULTS The PIP fit generally occurs in patients suffering from intractable temporal lobe epilepsy which started several years before. The psychiatric disorders suddenly take hold after a series of complex partial seizures with frequent secondarily generalized tonic clonic seizures. During the episode, EEG recordings do not show any epileptic activity. Psychiatric symptoms consist of persecutory delusive ideas, verbal and visual hallucinations, agitation, and aggressiveness. Mood disorders are variable from one patient to another and exhibit intraindividual fluctuation. In most patients given antipsychotic drugs, the short-term outcome of PIP is favorable . In the long-term, even if recurrence is the main long-term risk, progression to severe mood disorders or to poor prognosis inter-ictal psychosis is possible. Accordingly, the clinician must be aware of this syndrome in order to correctly diagnose PIP since effective treatment with antipsychotic drugs is available. CONCLUSION The short-term prognosis of PPI is usually favorable but this syndrome can potentially develop in the long-term to more severe psychiatric disorders. It is, therefore, important to recognize PIP syndromes which respond more readily to pharmacological treatments than other types of psychoses.
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Psychiatric co-morbidity in 75 patients undergoing epilepsy surgery: Lack of correlation with pathological findings. Epilepsy Res 2008; 80:158-62. [DOI: 10.1016/j.eplepsyres.2008.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2008] [Revised: 03/14/2008] [Accepted: 03/23/2008] [Indexed: 11/19/2022]
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Abstract
Frontal lobe epilepsy is an unusual form of complex partial seizures associated with behavioral changes including fear, agitation, kicking, and screaming. The seizures are often missed or mistaken for psychiatric problems or sleep disorders. We report 2 unusual patients presenting with psychosis who were found to have frequent frontal lobe seizures. Treatment of the seizures with carbamazepine resulted in complete resolution of their psychiatric symptoms. The relationship between frontal lobe seizures and psychosis is explored.
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Affiliation(s)
- D Barry Sinclair
- Comprehensive Epilepsy Program, University of Alberta, Edmonton, Alberta, Canada.
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Luat AF, Asano E, Rothermel R, Sood S, Chugani HT. Psychosis as a manifestation of frontal lobe epilepsy. Epilepsy Behav 2008; 12:200-4. [PMID: 17981091 DOI: 10.1016/j.yebeh.2007.09.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2007] [Revised: 08/31/2007] [Accepted: 09/05/2007] [Indexed: 10/22/2022]
Abstract
A 7-year-old girl presented with a cluster of seizures occurring in one day and followed by the development of paranoid delusions. Her electroencephalogram (EEG) revealed a psychomotor variant. Cranial MRI was normal, but the 2-deoxy-2-[(18)F]fluoro-D-glucose (FDG) positron emission tomography (PET) scan showed hypometabolism in the left inferior frontal cortex. Her psychotic symptoms occurred episodically. Three years later, she developed hypermotor seizures associated with a fearful look. Video/EEG monitoring captured seizures of left frontotemporal onset. Her seizures became drug resistant and she underwent epilepsy surgery. Intracranial electrocorticography captured spontaneous and electrically induced seizures with onset in the left inferior frontal region, which was resected. She became seizure-free and her psychosis resolved. This case illustrates that frontal lobe epilepsy can present solely with psychotic symptoms, which may delay the diagnosis of epilepsy. We suggest that these cases may be underdiagnosed. When epilepsy is suspected and if MRI fails to demonstrate an abnormality, FDG PET scanning and video/EEG monitoring should be considered.
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Affiliation(s)
- Aimee F Luat
- Children's Hospital of Michigan-Detroit Medical Center/Wayne State University, Detroit, MI 48201, USA
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40
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Bortolato M, Frau R, Orrù M, Piras AP, Fà M, Tuveri A, Puligheddu M, Gessa GL, Castelli MP, Mereu G, Marrosu F. Activation of GABA(B) receptors reverses spontaneous gating deficits in juvenile DBA/2J mice. Psychopharmacology (Berl) 2007; 194:361-9. [PMID: 17604981 DOI: 10.1007/s00213-007-0845-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2007] [Accepted: 05/30/2007] [Indexed: 10/23/2022]
Abstract
RATIONALE Gamma-amino-butyric acid (GABA)(B) receptors play a key role in the pathophysiology of psychotic disorders. We previously reported that baclofen, the prototypical GABA(B) agonist, elicits antipsychotic-like effects in the rat paradigm of prepulse inhibition (PPI) of the startle, a highly validated animal model of schizophrenia. OBJECTIVES We studied the role of GABA(B) receptors in the spontaneous PPI deficits displayed by DBA/2J mice. MATERIALS AND METHODS We tested the effects of baclofen (1.25-5 mg/kg, intraperitoneal [i.p.]) in DBA/2J and C57BL/6J mice, in comparison to the antipsychotic drugs haloperidol (1 mg/kg, i.p.) and clozapine (5 mg/kg, i.p.). Furthermore, we investigated the expression of GABA(B) receptors in the brain of DBA/2J and C57BL/6J mice by quantitative autoradiography. RESULTS Baclofen dose-dependently restored PPI deficit in DBA/2J mice, in a fashion similar to the antipsychotic clozapine (5 mg/kg, i.p.). This effect was reversed by pretreatment with the GABA(B) antagonist SCH50211 (50 mg/kg, i.p.). In contrast, baclofen did not affect PPI in C57BL/6J mice. Finally, quantitative autoradiographic analyses assessed a lower GABA(B) receptor expression in DBA/2J mice in comparison to C57BL/6J controls in the prefrontal cortex and hippocampus but not in other brain regions. CONCLUSIONS Our data highlight GABA(B) receptors as an important substrate for sensorimotor gating control in DBA/2J mice and encourage further investigations on the role of GABA(B) receptors in sensorimotor gating, as well as in the pathophysiology of psychotic disturbances.
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Affiliation(s)
- Marco Bortolato
- Department of Neuroscience "Bernard B. Brodie", University of Cagliari, Cittadella Universitaria, S.S.554 Km 4,500, 09042, Monserrato (CA), Italy.
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41
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Sharp FR, Hendren RL. Psychosis: atypical limbic epilepsy versus limbic hyperexcitability with onset at puberty? Epilepsy Behav 2007; 10:515-20. [PMID: 17416210 PMCID: PMC2680611 DOI: 10.1016/j.yebeh.2007.02.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 02/18/2007] [Accepted: 02/22/2007] [Indexed: 11/20/2022]
Abstract
Phencyclidine (PCP), ketamine (Special K), and MK-801 are noncompetitive N-methyl-d-aspartate (NMDA) antagonists that produce acute psychosis in humans. The psychosis produced by these psychomimetic drugs is indistinguishable from schizophrenia and includes both positive and negative symptoms. This drug-induced psychosis occurs after puberty in humans. On the basis of the MK-801-induced spike-and-wave activity in rats and increased blood flow and metabolism in brain of patients with psychosis caused by these psychomimetics, this brief review argues that this psychosis is an atypical form of limbic epilepsy. Moreover, there is a specific limbic thalamcortical psychosis circuit that mediates cell injury in limbic cortex of rodents and may mediate this PCP-induced psychosis in humans. It is proposed that this thalamocortical psychosis circuit develops at puberty and can mediate PCP and ketamine-mediated psychosis and possibly the psychosis of schizophrenia, bipolar disease and other disorders that have their onset at puberty. Finally, based on this developmentally regulated psychosis/epilepsy-related thalamocortical circuitry, it is proposed that antiepileptic drugs that promote GABAergic mechanisms may decrease the probability of episodic psychosis from any cause.
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Affiliation(s)
- Frank R Sharp
- Department of Neurology, MIND Institute, University of California at Davis, Wet Labs Room 2416, 2805 50th Street, Sacramento, CA 95817, USA.
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42
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Pestana EM, Gupta A. Fluctuating Kluver-Bucy syndrome in a child with epilepsy due to bilateral anterior temporal congenital malformations. Epilepsy Behav 2007; 10:340-3. [PMID: 17218157 DOI: 10.1016/j.yebeh.2006.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 11/07/2006] [Accepted: 11/09/2006] [Indexed: 11/27/2022]
Abstract
An 11-year-old boy with epilepsy due to congenital bilateral anterior temporal lobe malformations presented with fluctuating Kluver-Bucy syndrome (KBS). Since the age of 2, he had experienced clusters of three or four daily complex partial seizures over 2-3 days in a month, followed by a seizure-free interval of 3-4 weeks. During the seizure-free period, the patient exhibited hyperorality, sniffing, irritability alternating with placidity, anxiety, unsolicited sexual gestures, and unusual calmness after eating. KBS features escalated up to the onset of the seizure cluster, and remitted after the seizures. Brain MRI revealed bilateral anterior temporal cortical dysplasia with enlarged and dysmorphic amygdalar-hippocampal complex. Brain [(18)F]fluorodeoxyglucose positron emission tomography PET showed bilateral anterior and mesial temporal hypometabolism. Video/EEG monitoring revealed independent right and left temporal lobe seizures. This is the first reported case of KBS due to congenital bitemporal malformations. Also, KBS behavior phenotype in this patient fluctuated, with escalation during the seizure-free period and remission induced by the monthly seizure cluster. This fluctuating pattern could represent forced normalization.
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Affiliation(s)
- Elia M Pestana
- Section of Pediatric Epilepsy, Epilepsy Center, Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Rothenhäusler HB. [Clinical features, diagnosis, and treatment of dysphoric states and psychoses associated with epilepsy]. DER NERVENARZT 2006; 77:1381-91; quiz 1392. [PMID: 17061130 DOI: 10.1007/s00115-006-2186-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Although dysphoric states and psychoses represent clinically relevant psychiatric complications in patients with epilepsy, their symptomatologies are complex and therefore frequently underrecognized and undertreated in daily psychiatric routine. Detecting dysphoric states and psychoses secondary to the psychotropic effects of various antiepileptic drugs is often challenging, even for the most experienced psychiatrists. This article gives an overview of epidemiology, clinical features, diagnosis, and therapy of interictal, peri-ictal, and alternative dysphoric states and psychoses in patients with epilepsy. Further, potential drug interactions between antiepileptic and psychiatric medications are discussed.
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Affiliation(s)
- H-B Rothenhäusler
- Universitätsklinik für Psychiatrie der Medizinischen Universität Graz, Auenbruggerplatz 31, 8036 Graz.
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44
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Morrow EM, Lafayette JM, Bromfield EB, Fricchione G. Postictal psychosis: presymptomatic risk factors and the need for further investigation of genetics and pharmacotherapy. Ann Gen Psychiatry 2006; 5:9. [PMID: 16859554 PMCID: PMC1555577 DOI: 10.1186/1744-859x-5-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2005] [Accepted: 07/21/2006] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Postictal psychosis (PIP), an episode of psychosis occurring after a cluster of seizures, is common and may be associated with profound morbidity, including chronic psychosis. Symptoms are often pleomorphic, involving a range of psychotic symptoms, including hallucinations and disorders of thought. PIP is treatable and may be averted if presymptomatic risk factors are considered in susceptible patients and treatment is initiated. CASE PRESENTATION In this report, we present an illustrative case of PIP. The patient, Mr. R, presented to our emergency room with delusions and disordered thought process following a cluster of seizures. He recovered after admission, sedation and treatment with antipsychotic medication. DISCUSSION A list of presymptomatic risk factors is established based on review of current literature. Identification of such risk factors may potentially help with prophylactic treatment; however, little empirical research exists in this area and treatment guidelines are thus far largely based on expert opinion. Further, while the neurobiology of schizophrenia is advancing at a rapid pace, largely due to advances in genetics, the pathophysiology of PIP remains largely unknown. Considering the progress in schizophrenia research in the context of the clinical features of PIP and existing studies, potential neurobiological mechanisms for PIP are herein proposed, and further genetic analyses, which may help identify those susceptible, are warranted. CONCLUSION While PIP is an important problem that may present first to general hospital psychiatrists, as in the case presented, this topic is under-represented in the medical psychiatry literature. As discussed in this article, further research is needed to develop presymptomatic screens and treatment pathways to help prevent morbidity.
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Affiliation(s)
- Eric M Morrow
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
| | | | - Edward B Bromfield
- Division of Epilepsy and EEG, Department of Neurology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Gregory Fricchione
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
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45
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Caplan R, Siddarth P, Bailey CE, Lanphier EK, Gurbani S, Donald Shields W, Sankar R. Thought disorder: A developmental disability in pediatric epilepsy. Epilepsy Behav 2006; 8:726-35. [PMID: 16678493 DOI: 10.1016/j.yebeh.2006.03.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2005] [Revised: 03/12/2006] [Accepted: 03/16/2006] [Indexed: 11/28/2022]
Abstract
This study compared thought disorder (i.e., impaired use of language to formulate and organize thoughts) in 93 children with complex partial seizures (CPSs) and 56 children with primary generalized epilepsy with absence (PGE) and its relationship to age, seizure, cognitive, and linguistic variables. By the use of psychopathology, social competence, academic achievement, and school problem measures, the functional implications of thought disorder in these two groups were compared. When demographic variables were controlled for, there were no significant differences in thought disorder scores between the CPS and PGE groups. However, the profile of age, gender, seizure, and cognitive variables related to thought disorder differed in the CPS and PGE groups. Within each group, different aspects of thought disorder were associated with different seizure variables. Thought disorder was related to psychopathology, school problems, decreased academic achievement, and poor peer interaction in the CPS group, but with school problems in the PGE group. These findings suggest that CPS and PGE affect the normal maturation of children's discourse skills, albeit through different mechanisms. The relationship of thought disorder to behavioral, academic, and social problems implies that these discourse deficits are one component of the developmental disabilities or comorbidities associated with pediatric CPS and PGE.
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Affiliation(s)
- Rochelle Caplan
- Department of Psychiatry, David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, CA, USA.
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46
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Joshi CN, Booth FA, Sigurdson ES, Bolton JM, Shah NS. Postictal psychosis in a child. Pediatr Neurol 2006; 34:388-91. [PMID: 16648000 DOI: 10.1016/j.pediatrneurol.2005.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2005] [Revised: 09/01/2005] [Accepted: 10/10/2005] [Indexed: 11/28/2022]
Abstract
Postictal psychosis is a state of psychosis following repeated or prolonged complex partial seizures with or without secondary generalization and is well described in adult epilepsy literature. It is sparsely reported in the pediatric literature. This report describes a 12-year-old male presenting with status epilepticus who developed psychotic symptoms. Diagnosis of postictal psychosis was made after correlating clinical symptoms with video-electroencephalographic monitoring. The clinical course of this illness is profiled, and the literature reviewed.
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Affiliation(s)
- Charuta N Joshi
- Division of Pediatric Neurology, Children's Hospital, Winnipeg, Manitoba, Canada.
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Abstract
Most people with epilepsy can live outwardly normal lives, but fear about impending seizures, driving restrictions, lack of independence, employment and social problems, medication-related adverse effects and the presence of cognitive or psychiatric complications are all concerns readily identified by affected individuals. While seizure control is the overriding goal of treatment, it is essential to realize the importance that patients place on other aspects of daily functioning. While many of the concerns identified by patients can only be managed by improved social support, others (e.g. neuropsychological impairment, medication-related adverse events, cognitive impairment, sleep disturbance) may be amenable to therapy (if available) or to the selection of a more appropriate antiepileptic drug. Each antiepileptic drug has a unique pharmacodynamic and tolerability profile. Awareness by the treating clinician of the pharmacological profile of each drug may help to minimize unwanted treatment-related effects and possibly improve the outcome of treatment from an epilepsy patient's perspective. Therefore, in order to achieve true treatment success, clinicians need to understand how individuals perceive their disorder and, where possible, address those factors that adversely affect patient quality of life. For the person with epilepsy, successful treatment involves beneficial effects on social, vocational and psychological function. This extends beyond seizure control to freedom from the fear associated with seizures, confidence in pharmacological therapy and improvements in health-related quality of life.
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Affiliation(s)
- J W Sander
- Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, UK.
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48
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Swinkels WAM, Kuyk J, van Dyck R, Spinhoven P. Psychiatric comorbidity in epilepsy. Epilepsy Behav 2005; 7:37-50. [PMID: 15975853 DOI: 10.1016/j.yebeh.2005.04.012] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 04/26/2005] [Indexed: 10/25/2022]
Abstract
Many studies on psychiatric comorbidity in epilepsy have been performed using many different patient groups and diagnostic instruments. This methodological heterogeneity complicates comparison of the findings. In this article, psychiatric disorders in epilepsy are reviewed from the perspective of the DSM classification system. The empirical findings of axis I clinical disorders and axis II personality disorders are described separately. Furthermore, the existence and specificity of conditions such as interictal dysphoric disorder, interictal behavior syndrome, and psychosis of epilepsy are discussed. From the many studies that have been performed on this topic it can be learned that there is a need for well-controlled studies using representative patient groups and valid and standardized diagnostic instruments. So far, the majority of the studies have concerned axis I disorders; relatively little research has been performed on axis II personality disorders. More research on personality disorders, as well as on the relative contributions of the different (brain- and non-brain-related) factors to the relationship between epilepsy and psychiatric disorders, is recommended.
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Affiliation(s)
- W A M Swinkels
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands.
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49
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Abstract
Many patients with epilepsy have warning symptoms prior to seizure onset, and some of these individuals report the ability to abort or prevent these seizures. We investigated the clinical characteristics of perceived self-control of seizures in 174 patients with uncontrolled partial epilepsy. The warning symptoms were categorized as premonitory (prodrome) and as initial symptoms of simple partial seizure onset, depending on the relationship between the warning events and the ensuing seizures. About 50% of the patients with simple partial seizure onset and about 70% of those with prodrome or premonitory symptoms reported that they could abort or prevent their seizures by various self-developed techniques. Patients who attempted to abort or prevent their seizures reported success rates as high as 80%. The proportion of patients with secondary generalized seizures was significantly lower in patients who tried to abort their seizures than in those who did not (p<0.05). The ability to prevent seizures was significantly higher in patients with brain lesions on MRI than in those without lesions (p<0.05). These results suggest that spontaneously developed methods are helpful in controlling seizures in some patients with uncontrolled partial epilepsy and that the potential success of self-control methods may be influenced by structural abnormalities on brain MRI.
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Affiliation(s)
- Sang-Ahm Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, 388-1 Pungnap-dong, Songpa-gu, Seoul 138 736, Republic of Korea.
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50
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Pellock JM. Defining the problem: psychiatric and behavioral comorbidity in children and adolescents with epilepsy. Epilepsy Behav 2004; 5 Suppl 3:S3-9. [PMID: 15351340 DOI: 10.1016/j.yebeh.2004.06.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2004] [Accepted: 06/30/2004] [Indexed: 11/26/2022]
Abstract
A variety of comorbid psychiatric conditions are frequently identified in children and adolescents with epilepsy, including depression, anxiety, psychosis, and attention-deficit hyperactivity disorder. Data regarding the epidemiology and precise prevalence of comorbid disorders in childhood epilepsy are incomplete and just now beginning to be compiled. Psychiatric and behavioral comorbidities are believed to affect approximately 40-50% of children and adolescents with epilepsy. Optimal diagnosis, clinical evaluation, and choice of treatment are predicated on the proper identification of coexisting psychiatric and behavioral disorders. Comorbid conditions in children and adolescents with epilepsy should be evaluated and treated as soon as they are recognized.
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Affiliation(s)
- John M Pellock
- Division of Child Neurology, Department of Neurology, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, USA.
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