No abstract

Objectives-Psychopathology has been reported to be prevalent both before and after surgical treatment for medically intractable temporal lobe epilepsy. Individual patients were evaluated prospectively to assess the eVect of anterior temporal lobectomy (ATL) on prevalence and severity of psychiatric disease. Methods-Psychiatric status was assessed in a consecutive series of epilepsy patients before and 6 months after ATL using a structured psychiatric interview, psychiatric rating scales, and self report mood measures. Results-A DSM-III-R axis I diagnosis was present in 65% of patients before and after surgery. The most common diagnoses were depression, anxiety, and organic mood/personality disorders. There was a trend for major psychiatric diagnoses to be more common in patients with right compared to left temporal lobe seizure focus, both before and after surgery. The apparent stability in the overall rate of psychiatric dysfunction concealed onset of new psychiatric problems in 31% of patients in the months shortly after surgery, and resolution of psychiatric diagnoses in 15% of patients. In the group as a whole, the severity of psychiatric symptoms was lower at 6 months postsurgery than before temporal lobectomy. Conclusions-The overall prevalence of psychiatric dysfunction was comparably high before and after ATL, but individual changes in psychiatric status and changes in severity of symptoms occurred in many patients in the 6 months after surgery. (J Neurol Neurosurg Psychiatry 2000;68:53-58)

ECT is safe and effective for the treatment of affective and catatonic disorders in patients with most neurological and medical diseases, including elderly and debilitated patients with multiple illnesses, if the specific medical risks are carefully evaluated in each case, and appropriate modifications of technique are used to reduce the risk of potential complications. Apart from its use in psychiatry, ECT has been reported to have therapeutic effects in Parkinson's disease, neuroleptic malignant syndrome, aggressive behavioral disorders following brain injury, certain forms of epilepsy, and some forms of delirium due to toxic or metabolic encephalopathies. The potential for ECT to play an active role in the clinical management of patients with these disorders, many of whom are presently refractory to maximal medical treatment, should be evaluated by systematic studies.

It is proposed that these groups represent different expressions of mania in brain injured persons, and that these expressions range through a spectrum of phenomenology, included elated mania, irritable mania, episodic psychosis and explosive organic personality disorder. The DSM-III-R classification of these disorders, and approaches to their clinical management, are discussed.