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Drapier D. Schizophrenia and epileptic comorbidity. Rev Neurol (Paris) 2024; 180:308-313. [PMID: 38503587 DOI: 10.1016/j.neurol.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024]
Abstract
Epileptic seizures have been widely considered as a complication of external or iatrogenic factors in schizophrenia. However, epidemiologic, neurodevelopmental and genetic data have changed regards on this topic considering the complexity of the bidirectional link between epilepsy and schizophrenia. We will examine these data constituting the pathophysiological aspects of this particular association and detail the particular impact of antipsychotics on the occurence of epileptic seizure in schizophrenia as well as the management strategies.
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Affiliation(s)
- D Drapier
- University of Rennes, rue du Thabor, 35000 Rennes, France; Centre hospitalier Guillaume-Regnier, 108, avenue Général-Leclerc, 35703 Rennes, France.
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Revdal E, Morken G, Bakken IJ, Bråthen G, Landmark CJ, Brodtkorb E. Bidirectionality of antiseizure and antipsychotic treatment: A population-based study. Epilepsy Behav 2022; 136:108911. [PMID: 36126553 DOI: 10.1016/j.yebeh.2022.108911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 08/29/2022] [Accepted: 09/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE To study the prevalence and directionality of comorbid epilepsy and psychosis in Norway. METHODS The Norwegian Prescription Database (NorPD) provided individual-based information on all antiseizure medications (ASMs) and antipsychotic drugs (APDs) dispensed during 2004-2017. Subjects were ≥18 years of age at the end of the study period. Diagnosis-specific reimbursement codes from the 10th revision of the International Classification of Diseases/2nd edition of the International Classification of Primary Care (ICD-10/ICPC-2) combined with ATC codes were used as indicators of diagnosis. Subjects had collected ASMs for epilepsy or APDs for psychosis at least four times, at least once issued with an ICD-10 code from the specialist healthcare service. Directionality was analyzed in subjects receiving both treatments. To reduce prevalent comorbidity bias, we employed a four-year comorbidity-free period (2004-2007). The use of specific ASMs and APDs was analyzed. RESULTS A total of 31,289 subjects had collected an ASM for epilepsy at least four times, 28,889 an APD for psychosis. Both the prevalence of treatment for epilepsy and of treatment for psychosis was 0.8%. Further, 891 subjects had been treated for both conditions; 2.8% with epilepsy had been treated for psychosis, and 3.1% with psychosis had been treated for epilepsy. Among 558 subjects included in the analyses of directionality, 56% had collected the first APD before an ASM, whereas 41% had collected an ASM first. During the last year prior to comorbidity onset, levetiracetam, topiramate, or zonisamide had been used for epilepsy by approximately 40%, whereas olanzapine and quetiapine were most used in patients with psychosis, and clozapine in 13%. CONCLUSION The proportion of patients with prior antipsychotic treatment at onset of epilepsy is higher than previously acknowledged, as demonstrated in this nation-wide study. Apart from a shared neurobiological susceptibility, the bidirectionality of epilepsy and psychosis may be influenced by various environmental factors, including the interaction of pharmacodynamic effects. APDs may facilitate seizures; ASMs may induce psychiatric symptoms. In patients with combined treatment, these potential drug effects should receive ample attention, along with the psychosocial consequences of the disorders. A prudent multi-professional approach is required.
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Affiliation(s)
- Eline Revdal
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Gunnar Morken
- Department of Psychiatry, St. Olav University Hospital, Trondheim, Norway; Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | | | - Geir Bråthen
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Cecilie Johannesen Landmark
- Department of Pharmacy, Oslo Metropolitan University, Oslo, Norway; The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway; Department of Pharmacology, Oslo University Hospital, Oslo, Norway.
| | - Eylert Brodtkorb
- Department of Neurology and Clinical Neurophysiology, St. Olav University Hospital, Trondheim, Norway; Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway.
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Adachi N, Ito M. Epilepsy in patients with schizophrenia: Pathophysiology and basic treatments. Epilepsy Behav 2022; 127:108520. [PMID: 34999502 DOI: 10.1016/j.yebeh.2021.108520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 11/03/2022]
Abstract
Schizophrenia is a chronic psychiatric disorder that may lead to epilepsy. However, there are limited findings on the issues. This narrative review aimed to provide a practical perspective on epilepsy in patients with schizophrenia using the current treatment systems for epilepsy. While there has been a debate on the relationship between epilepsy and schizophrenia, i.e., antagonism, affinity, and coincidence, recent large cohort studies have revealed a high frequency of epilepsy in patients with schizophrenia (4-5 times higher than that of general population). The high incidence observed is likely to be due to the bidirectionality between epilepsy and schizophrenia and additional schizophrenia-related conditions, e.g., antipsychotic drugs (APD), substance abuse, and head injury. As for symptomatology of epilepsy, only one small-size study showed that seizures of patients with schizophrenia are equivalent to those of patients without schizophrenia. Patients with schizophrenia exhibit the first seizure in their twenties or later, which are mostly focal seizures. Most of seizures in patients with schizophrenia can be controlled with conventional antiepileptic drugs. Few patients with schizophrenia develop treatment-resistant epilepsy. However, since drug interactions can be more complicated due to multiple conditions, such as pre-existing polypharmacy, heavy smoking, irregular eating, and comorbid metabolic disorders, cautious monitoring for clinical symptoms is required. To improve seizure control and adherence, non-pharmacological approaches are also recommended. Thus far, for seizure treatments in patients with schizophrenia, we have to use many empirical findings or substitute certain findings from population without schizophrenia because evidence is insufficient. The accumulation of clinical findings may contribute to the development of efficient treatment systems.
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Affiliation(s)
- Naoto Adachi
- Adachi Mental Clinic, Sapporo, Japan; Jozen Clinic, Sapporo, Japan.
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Nakken EI, Grinde F, Vaaler A, Drange OK, Brodtkorb E, Sæther SG. Epilepsy and other seizure disorders in acute psychiatric inpatients. BMC Psychiatry 2021; 21:626. [PMID: 34911471 PMCID: PMC8672464 DOI: 10.1186/s12888-021-03619-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is well known that patients with epilepsy have a high rate of psychiatric comorbidity. However, studies exploring epilepsy in psychiatric cohorts are scarce. The aim of this study was to examine the prevalence of seizure disorders in acute psychiatric inpatients. METHODS This is a cross-sectional study performed in a catchment-area based acute psychiatric department. All patients (age > 18) admitted during September 2011 - March 2012 were eligible for inclusion. Consenting patients were screened for a life-time history of epilepsy or seizures using self-reported questionnaire data and diagnostic codes for epilepsy in hospital and National registries. Patients scoring positive to one or more of these screening criteria underwent a thorough diagnostic validation (chart review), and the seizure disorders were classified as epilepsy, acute symptomatic seizures and/or psychogenic non-epileptic seizures according to current definitions. RESULTS A total of 380 out of 591 (64.3%) consecutively admitted patients consented to participate in the study. Eighty-nine patients (23.4%) scored positive to one or more screening criteria. Fifteen (3.9%) were classified with epilepsy, 21 (5.5%) with acute symptomatic seizures and 9 (2.4%) with psychogenic non-epileptic seizures. CONCLUSIONS This is the first study to report on the prevalence of seizure disorders in acute psychiatric inpatients. The life-time prevalence of epilepsy in this cohort of patients is five - six times as high as reports in the general population. These findings underscore the need for the clinical psychiatrist to have comprehensive knowledge on the interface between epileptology and psychiatry. TRIALS REGISTRATION ClinicalTrials.gov identifier NCT01415323 .
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Affiliation(s)
- Erlend Iversen Nakken
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Frithjof Grinde
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Vaaler
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Healthcare, St. Olavs University Hospital, Trondheim, Norway
| | - Ole Kristian Drange
- grid.5947.f0000 0001 1516 2393Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway ,grid.52522.320000 0004 0627 3560Department of Acute Psychiatry, Division of Mental Healthcare, St. Olavs University Hospital, Trondheim, Norway ,grid.417290.90000 0004 0627 3712Department of Psychiatry, Sørlandet Hospital HF, Kristiansand, Norway
| | - Eylert Brodtkorb
- grid.52522.320000 0004 0627 3560Department of Neurology and Clinical Neurophysiology, St. Olavs University Hospital, Trondheim, Norway ,grid.5947.f0000 0001 1516 2393Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
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Maggu G, Dhamija S, Chaudhury S, Rohatgi S, Saldanha D, Jain S. Behavioral presentations of focal onset seizures: A case series. Ind Psychiatry J 2021; 30:S204-S209. [PMID: 34908691 PMCID: PMC8611604 DOI: 10.4103/0972-6748.328869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/17/2021] [Accepted: 06/19/2021] [Indexed: 11/04/2022] Open
Abstract
Seizures can have varied presentations and may have different etiological factors. A multidisciplinary approach should be used to treat them. It becomes difficult to diagnose seizures if they have an atypical presentation, particularly so when they manifest as behavioral disturbances. This case series demonstrates four cases with different psychiatric and behavioral manifestations of seizures where the diagnosis had to be done in a multi-disciplinary approach. Two of the cases highlight the fact that in the light of normal investigations, paying attention to detailed history is of prime importance.
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Affiliation(s)
- Gaurav Maggu
- Department of Psychiatry, NTR University, Vijaywada, Uttar Pradesh, India
| | - Sana Dhamija
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India.,Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India.,Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Shalesh Rohatgi
- Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Daniel Saldanha
- Department of Psychiatry, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India.,Department of Neurology, Dr. D. Y. Patil Medical College, Hospital, Pune, Maharashtra, India
| | - Shobhit Jain
- Department of Psychiatry, Heritage Institute of Medical Sciences, Varanasi, Uttar Pradesh, India
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Kanemoto K. Psychotic Disorders in Epilepsy: Do They Differ from Primary Psychosis? Curr Top Behav Neurosci 2021; 55:183-208. [PMID: 34426945 DOI: 10.1007/7854_2021_234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Any attempt to compare the definitions of symptoms listed for "primary psychoses" with those adopted in studies of psychoses in patients with epilepsy (PWE) will encounter problems of heterogeneity within both conditions. In this manuscript, five psychotic illnesses listed in Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM-5), that is, brief psychotic illness, schizophreniform disorder, schizophrenia, delusional disorder, and schizoaffective disorder are compared with postictal (or periictal) and interictal psychotic disorders in PWE. After examining definitions of primary psychoses, definitions of psychoses adopted in the papers dealing with postictal and interictal psychoses are summarized. Further, diagnostic criteria of five types of psychotic disorders in PWE proposed in 2007 by Krishnamoorthy et al. are also discussed, which include postictal psychosis, comorbid schizophrenia, iatrogenic psychosis caused by antiepileptic drugs (AEDs) (AED-induced psychotic disorder: AIPD), and forced normalization. Evidently, a comparison between postictal psychosis and schizophrenia is pointless. Likewise, schizophrenia may not be an appropriate counterpart of forced normalization and AIPD, given their acute or subacute course.Based on these preliminary examinations, three questions are selected to compare primary psychoses and psychoses in PWE: Is postictal psychosis different from a brief psychotic disorder? Does epilepsy facilitate or prevent the development of psychosis or vice versa? Is interictal psychosis of epilepsy different from process schizophrenia? In conclusion, antagonism between psychosis and epileptic seizures in a later stage of active epilepsy seems not to be realized without reorganization of the nervous system promoted during an earlier stage. Both genetic predisposition and the summated effects of epileptic activity must be taken into consideration as part of a trial to explain interictal psychosis. Interictal psychosis is an aggregate of miscellaneous disorders, that is, co-morbid schizophrenia, AED-induced psychotic disorders, forced normalization, and "epileptic" interictal psychosis. Data are lacking to conclude whether differences exist between process schizophrenia and "epileptic" interictal psychosis in terms of negative symptoms, specific personal traits, and the "bizarre-ness" of delusory-hallucinatory contents. These discussions may shed light on the essence of process schizophrenia, thus allowing it stand out and receive increased focus.
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MacDonald KE, Cozza KL, Vythilingam M. Epilepsy-Related Psychosis: A Case Report and Brief Review of Literature. PSYCHOSOMATICS 2019; 61:400-404. [PMID: 31836195 DOI: 10.1016/j.psym.2019.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 11/08/2019] [Accepted: 11/08/2019] [Indexed: 11/16/2022]
Affiliation(s)
- Kelly E MacDonald
- Department of Behavioral Health, United States Army Medical Activity, Fort Drum, NY.
| | - Kelly L Cozza
- Department of Psychiatry, Uniformed Services University, and Walter Reed National Military Medical Center, Bethesda, MD
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Hamed SA, Attiah FA. Psychosis in adults with epilepsy and its relationship to demographic, clinical and treatment variables. Neurol Res 2019; 41:959-966. [PMID: 31280704 DOI: 10.1080/01616412.2019.1638017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objectives: Psychiatric symptoms and disorders are commonly reported with epilepsy. This study aimed to determine the prevalence of interictal psychosis (IIP) in adults with epilepsy and its risk predictors. Methods: The study included 710 patients (mean age: 36.40 years; age at onset: 13.58 years; duration of epilepsy: 22.80 years). All underwent neurological and psychiatric interviewing, electroencephalography and brain imaging. Results: IIP was reported in 20.65%, of them 50% had temporal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic, 42.47% had frontal lobe epilepsy with impaired awareness and/or to bilateral tonic clonic and 7.53% had generalized tonic-clonic seizures. Compared to patients without psychosis, patients with psychosis were older at age of examination, had earlier age at onset, frequent seizures, longer duration of epilepsy and long-term antiepileptic drugs therapy and many relatives with epilepsy. Nearly 76.71% had history of postictal psychosis (PIP). The mean age of onset of IIP was 30.45 years and its mean duration was 3.84 months. Approximately 22% of patients with IIP had family history of psychosis. Patients developed IIP 10 years or more after epilepsy onset. Multivariate logistic regression analyses showed that predictors for IIP were the age at onset and duration of epilepsy, number of seizures, family history of epilepsy or psychosis, history of PIP and different types of epilepsy. Conclusion: IIP is not infrequent with chronic epilepsy regardless to its type. These findings emphasize the importance of optimizing patients' treatment and early recognition and management of IIP. Abbreviations: IIP: interictal psychosis; PIP: post-ictal psychosis; TLE: temporal lobe epilepsy; FLE: frontal lobe epilepsy; GTC: generalized tonic clonic; AEDs: antiepileptic drugs; CBZ: carbamazepine; VPA: valproate; LEV: levetiracetam; APDs: antipsychotic drugs.
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Affiliation(s)
- Sherifa Ahmed Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
| | - Fadia Ahmed Attiah
- Department of Neurology and Psychiatry, Assiut University Hospital , Assiut , Egypt
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Allebone J, Kanaan R, Wilson SJ. Systematic review of structural and functional brain alterations in psychosis of epilepsy. J Neurol Neurosurg Psychiatry 2018; 89:611-617. [PMID: 29275328 DOI: 10.1136/jnnp-2017-317102] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/18/2017] [Accepted: 10/25/2017] [Indexed: 11/04/2022]
Abstract
This systematic review critically assesses structural and functional neuroimaging studies of psychosis of epilepsy (POE). We integrate findings from 18 studies of adults with POE to examine the prevailing view that there is a specific relationship between temporal lobe epilepsy (TLE) and POE, and that mesial temporal lobe pathology is a biomarker for POE. Our results show: (1) conflicting evidence of volumetric change in the hippocampus and amygdala; (2) distributed structural pathology beyond the mesial temporal lobe; and (3) changes in frontotemporal functional network activation. These results provide strong evidence for a revised conceptualisation of POE as disorder of brain networks, and highlight that abnormalities in mesial temporal structures alone are unlikely to account for its neuropathogenesis. Understanding POE as a disease of brain networks has important implications for neuroimaging research and clinical practice. Specifically, we suggest that future neuroimaging studies of POE target structural and functional networks, and that practitioners are vigilant for psychotic symptoms in all epilepsies, not just TLE.
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Affiliation(s)
- James Allebone
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard Kanaan
- Department of Psychiatry, University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Brain Research Institute (Austin Campus), Melbourne, Victoria, Australia
| | - Sarah J Wilson
- Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia.,Florey Institute of Neuroscience and Mental Health, Brain Research Institute (Austin Campus), Melbourne, Victoria, Australia.,Comprehensive Epilepsy Programme, Austin Health, Melbourne Brain Centre, Melbourne, Victoria, Australia
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Adachi N, Akanuma N, Fenwick P, Ito M, Okazaki M, Ishida S, Sekimoto M, Kato M, Onuma T. Seizure activity and individual vulnerability on first-episode interictal psychosis in epilepsy. Epilepsy Behav 2018; 79:234-238. [PMID: 29249448 DOI: 10.1016/j.yebeh.2017.10.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Accepted: 10/07/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Despite a theoretical consensus that interictal psychosis (IIP) is related to various epilepsy-related factors, the impact of seizure activity on development of IIP remains inconclusive. This is the first controlled study using quantitative seizure-activity measures at the onset of IIP. METHODS One hundred and eighty-one patients with epilepsy who exhibited first-episode IIP (IIP group) and 427 patients with epilepsy without psychotic episodes (control group) were enrolled. The control group was matched for age, epilepsy type, and duration of epilepsy. The two seizure-activity indices (seizure frequency at the time of onset of first-episode IIP and the number of seizures before the onset of IIP) were evaluated and compared between the IIP and control groups. Logistic regression analysis was used for extracting risk variables to develop first-episode IIP. RESULTS The sum of previous seizures was greater in the IIP than in control groups. This was particularly the case in the patients with partial epilepsies (PE). Higher seizure frequency in the patients with PE was associated with the development of first-episode IIP while no association was found in the whole cohort or in the patients with generalized epilepsies (GE). Subsequent multivariate analysis revealed the sum of previous seizures and family history of psychosis as risk variables to first-episode IIP. CONCLUSIONS The accumulation of seizure-related damages and family history of psychosis is associated with the onset of IIP episodes, particularly in the patients with PE. Seizure activity and individual vulnerability to psychosis are likely to be interacted for as the development of IIP in patients with epilepsy.
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Affiliation(s)
- Naoto Adachi
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Adachi Mental Clinic, Sapporo, Japan.
| | - Nozomi Akanuma
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; South London & Maudsley NHS Foundation Trust, London, UK
| | - Peter Fenwick
- South London & Maudsley NHS Foundation Trust, London, UK.
| | - Masumi Ito
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Jozen Clinic, Sapporo, Japan.
| | - Mitsutoshi Okazaki
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Shiro Ishida
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan.
| | - Masanori Sekimoto
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Musashino Kokubunji Clinic, Tokyo, Japan.
| | - Masaaki Kato
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Musashino Kokubunji Clinic, Tokyo, Japan.
| | - Teiichi Onuma
- National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan; Musashino Kokubunji Clinic, Tokyo, Japan.
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11
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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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Martin RC, Faught E, Richman J, Funkhouser E, Kim Y, Clements K, Pisu M. Psychiatric and neurologic risk factors for incident cases of new-onset epilepsy in older adults: Data from U.S. Medicare beneficiaries. Epilepsia 2014; 55:1120-7. [DOI: 10.1111/epi.12649] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Roy C. Martin
- Department of Neurology; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Edward Faught
- Department of Neurology; Emory University; Atlanta Georgia U.S.A
| | - Joshua Richman
- Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Ellen Funkhouser
- Division of Preventive Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Yongin Kim
- Division of Preventive Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Kay Clements
- Department of Health Services Administration; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Maria Pisu
- Division of Preventive Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
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Hamilton KT, Anderson CT, Dahodwala N, Lawler K, Hesdorffer D, French J, Pollard JR. Utilization of care among drug resistant epilepsy patients with symptoms of anxiety and depression. Seizure 2014; 23:196-200. [DOI: 10.1016/j.seizure.2013.11.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 11/09/2013] [Accepted: 11/17/2013] [Indexed: 11/26/2022] Open
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Adachi N, Kanemoto K, de Toffol B, Akanuma N, Oshima T, Mohan A, Sachdev P. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia 2013; 54 Suppl 1:19-33. [PMID: 23458463 DOI: 10.1111/epi.12102] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
In patients with epilepsy, coexisting psychoses, either interictal (IIP) or postictal (PIP), are associated with serious disturbance in psychosocial function and well-being, and often require the care of a specialist. Unfortunately, evidence-based treatment systems for psychosis in patients with epilepsy have not yet been established. This article aims to propose concise and practical treatment procedures for IIP and PIP based on currently available data and international consensus statements, and primarily targeting nonpsychiatrist epileptologists who are often the first to be involved in the management of these complex patients. Accurate and early diagnosis of IIP and PIP and their staging in terms of acuity and severity form the essential first step in management. It is important to suspect the presence of psychosis whenever patients manifest unusual behavior. Knowledge of psychopathology and both individual and epilepsy-related vulnerabilities relevant to IIP and PIP facilitate early diagnosis. Treatment for IIP involves (1) obtaining consent to psychiatric treatment from the patient, whenever possible, (2) optimization of antiepileptic drugs, and (3) initiation of antipsychotic pharmacotherapy in line with symptom severity and severity of behavioral and functional disturbance. Basic psychosocial interventions will help reinforce adherence to treatment and should be made available. Due consideration must be given to patients' ability to provide informed consent to treatment in the short term, with the issue being revisited regularly over time. Given the often prolonged and recurrent nature of IIP, treatment frequently needs to be long-term. Treatment of PIP consists of two aspects, that is, acute protective measures and preventive procedures in repetitive episodes. Protective measures prioritize the management of risk in the early stages, and may involve sedation with or without the use of antipsychotic drugs, and the judicious application of local mental health legislation if appropriate. As for preventative procedures, optimizing seizure control by adjusting antiepileptic drugs or by surgical treatment is necessary.
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Abstract
Epilepsy is a common neurological disorder that is complicated by psychiatric, cognitive, and social comorbidities that have become a major target of concern and investigation in view of their adverse effect on the course and quality of life. In this report we define the specific psychiatric, cognitive, and social comorbidities of paediatric and adult epilepsy, their epidemiology, and real life effects; examine the relation between epilepsy syndromes and the risk of neurobehavioural comorbidities; address the lifespan effect of epilepsy on brain neurodevelopment and brain ageing and the risk of neurobehavioural comorbidities; consider the overarching effect of broader brain disorders on both epilepsy and neurobehavioural comorbidities; examine directions of causality and the contribution of selected epilepsy-related characteristics; and outline clinic-friendly screening approaches for these problems and recommended pharmacological, behavioural, and educational interventions.
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Affiliation(s)
- Jack J. Lin
- Department of Neurology, University of California at Irvine, Irvine, California, USA
| | - Marco Mula
- Amedeo Avogadro University, Novara, Italy
| | - Bruce P. Hermann
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Hesdorffer DC, Ishihara L, Mynepalli L, Webb DJ, Weil J, Hauser WA. Epilepsy, suicidality, and psychiatric disorders: A bidirectional association. Ann Neurol 2012; 72:184-91. [DOI: 10.1002/ana.23601] [Citation(s) in RCA: 370] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 02/11/2012] [Accepted: 03/23/2012] [Indexed: 11/08/2022]
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Diagnostic challenge in neuropsychiatry: two case reports. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0151-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
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Diagnostic challenge in neuropsychiatry: two case reports. Open Med (Wars) 2012. [DOI: 10.2478/s11536-011-0141-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
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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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