Psychosis and seizure disorder: challenges in diagnosis and treatment

Risperidone for successful treatment of postictal psychosis refractory to olanzapine

Postictal psychosis (PIP) in patients with epilepsy is often mistaken for other primary psychiatric disorders. Depending on its severity, PIP often prompts empiric treatment with atypical antipsychotics, which are balanced against the risk of lowered seizure thresholds. Here we present a case of olanzapine-resistant PIP, where risperidone was used as a safe and effective abortive treatment.

Psychiatric comorbidities in epilepsy

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.

Forced normalization: An overlooked entity in epileptic patients

The "forced normalization" phenomenon is characterized by acute/subacute onset of psychotic symptoms in the early post-ictal period with dramatic improvement of electrophysiological epileptiform activity. A 56 years old female with going on personality changes, maladaptive behaviours and a mild cognitive impairment since last seizure which was forty-five days ago has been admitted. An evident increase was observed in her maladaptive behaviours with the use of levetiracetam. She began describing visual hallucinations and déjàvu. Control EEG performed 24h after the seizure was completely normal. Levetiracetam therapy was replaced with phenytoin. Quetiapine therapy was also administered. Psychotic symptoms disappeared.