Epileptic, organic and genetic vulnerabilities for timing of the development of interictal psychosis

Abstract

Early development of interictal psychosis in people with epilepsy may reflect other individual vulnerabilities to psychosis rather than epilepsy-related damage.

Psychoses in epilepsy: A comparison of postictal and interictal psychoses

“…We failed to observe the previously reported association of IP with an earlier epilepsy onset [17,18], although mean age at epilepsy onset in groups with PP and IP was found to be within the range reported in prior studies [3,7,8,[16][17][18]25,26]. In accordance with the literature [17,18], no significant group differences were seen in gender, age at evaluation, family history of epilepsy, type and frequency of seizures, intellectual status, MRI findings, and laterality of ictal or interictal epileptiform activity; however, MRI data and seizure frequency were not included as variables in these studies.…”

“…Mean ages for psychosis onset in our patients were 33.9 years (PP) and 29.0 years (IP). These figures are fairly in line with those previously reported [3,8,[16][17][18]]. Yet even with the group differences, they contrast with the usual onset of schizophrenia without epilepsy which most often is in adolescence or early adulthood.…”

“…Interictal psychosis was diagnosed in accordance with the ICD-10 [5] and the operational criteria for IP consistently used in the relevant literature [7,8]: i) presence of hallucinations, delusions or a limited number of severe behavioral abnormalities (related to the criteria for organic hallucinosis: F06.0, organic catatonic disorder: F06.1 or organic delusional disorder: F06.2); ii) no temporal relation of psychosis to seizure activity; iii) first occurrence of psychosis after the onset of epilepsy; and (iv) duration of at least 24 h in a state of clear consciousness. Interictal psychosis included chronic psychosis (at least one episode lasting ≥ 1 month) and brief (acute) IP (episodes resolving within 1 month).…”

“…Some authors use the two terms synonymously and suggest that alternating psychosis and PP may have similar pathomechanisms with the brain's inhibitory processes in response to seizures having a key role [39]. Since no standard criteria of IP subclassification have been established, our group with IP comprised both patients with brief IP and patients with chronic IP (as was the case in previous comprehensive studies on this topic [8,15,18]). However, variables that may precipitate or modulate psychosis such as distinct EEG phenomena, changes in AEDs, or adverse psychotropic effects of certain AEDs were not specifically investigated.…”

Levetiracetam-Induced Psychosis in a Pregnant Woman with Prior Substance Abuse

“…She had experienced recurrence of seizures, however, and was again brought back to the emergency department, where blood work revealed a phenytoin level of 0.7 (normal range [10][11][12][13][14][15][16][17][18][19][20]. The patient acknowledged noncompliance with this medication due to fatigue but was amenable to restarting it with outpatient neurology follow-up.…”