Hostname: page-component-84b7d79bbc-5lx2p Total loading time: 0 Render date: 2024-07-25T10:10:41.341Z Has data issue: false hasContentIssue false
  • English
  • Français

Treatment of interictal psychiatric disorder in epilepsy. II. Chronic psychosis

Published online by Cambridge University Press:  24 June 2014

Cm van der Feltz-Cornelis
Cm van der Feltz-Cornelis*
Affiliation:
Department of Psychiatry, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Interictal psychosis is a serious comorbid condition in epilepsy patients that would benefit from treatment with psychotropic medication.

Objective:

This paper gives an overview of the pathophysiology, symptomatology and treatment of the schizophrenia-like psychosis of epilepsy. Use of the term ‘interictal chronic psychosis’ is suggested, to conform to current DSM-IV classification of schizophrenia.

Methods:

Literature review supplemented by clinical experience. There is a lack of randomized control trials (RCTs) concerning effectiveness and side-effects of neuroleptics in epilepsy patients.

Results:

Hypotheses concerning the pathophysiology of the interictal chronic psychosis are discussed. The concept of forced normalization and alternative psychosis is based on case descriptions, and was not substantiated by systematic research. The kindling hypothesis seems promising, but was never confirmed in humans. A third theory, supported by some studies, suggests that inhibitory cerebral mechanisms enhance psychotic symptoms in epilepsy patients. Treatment strategies are based on case studies and open studies by lack of RCTs. Treatment should consider the optimalization of the dosage of antiepileptics in combination with one or two antidepressants, mood stabilizers and/or atypical neuroleptics. Surgery plays no significant role in the treatment of treatment-refractive epilepsy with interictal chronic psychotic symptoms.

Conclusion:

There is a prominent role of antidepressant or double antidepressant treatment strategies in patients with epilepsy and interictal chronic psychosis compared with treatment guidelines of chronic psychotic patients in general psychiatry.

Keywords

epilepsypsychiatryinterictal chronic psychosisschizophreniatreatment
Type
Review Article
Information
Acta Neuropsychiatrica , Volume 14 , Issue 1 , February 2002 , pp. 44 - 48
Copyright
Copyright © Acta Neuropsychiatrica 2002 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cummings, JL.Epilepsy: ictal and interictal behavioral alterations. Clin Neuropsychiatry 1985;111:95–117. Google Scholar
American Psychiatric Association (APA). Diagnostic and statistical manual of mental disorders, 4th edn. Washington, DC: APA, 1994. Google ScholarPubMed
Van der Feltz-Cornelis, CM.Treatment of interictal psychiatric disorder in epilepsy. I – Affective and anxiety disorders. Acta Neuropsychiatrica 2002. Google Scholar
Diehl, LW.Schizophrenic syndromes in epilepsies. Psychopathology 1989;22:65–140.CrossRefGoogle ScholarPubMed
Sachdev, P.Schizophrenia-like psychosis and epilepsy: the status of the association. Am J Psychiatry 1998;155:325–336.CrossRefGoogle ScholarPubMed
Mellers, JD, Toone, BK, Lishman, WA.A neuropsychological comparison of schizophrenia and schizophrenia-like psychosis of epilepsy. Psychol Med 2000;30:25–35. CrossRefGoogle ScholarPubMed
Pond, DA.Psychiatric aspects of epilepsy. J Ind Med Prof 1957;3:1441–1451. Google Scholar
Wolf, P, Trimble, MR.Biological antagonism and epileptic psychosis. Br J Psychiatry 1985;146:272–276.CrossRefGoogle ScholarPubMed
Wolf, P.Acute behavioral symptomatology at disappearance of epileptiform EEG abnormality: paradoxical or ‘forced’ normalization. Adv Neurol 1991;55:127–142.Google ScholarPubMed
Trimble, MR.The relationship between epilepsy and schizophrenia: a biochemical hypothesis. Biol Psychiatry 1977;12:299–304.Google ScholarPubMed
Lamprecht, F.Epilepsy and schizophrenia: a neurochemical bridge. J Neural Transm 1977;40:159–170.CrossRefGoogle ScholarPubMed
Beard, AW.The schizophrenia-like psychoses of epilepsy. ii. Physical aspects. Br J Psychiatry 1963;109:113–129. CrossRefGoogle Scholar
Slater, E, Beard, AW.The schizophrenia-like psychoses of epilepsy. i. Psychiatric aspects. Br J Psychiatry 1963;109:95–105. CrossRefGoogle Scholar
Umbricht, D, Degreef, G, Barr, WBet al. Postictal and chronic psychoses in patients with temporal lobe epilepsy. Am J Psychiatry 1995;152:224–231.Google ScholarPubMed
Stevens, JR.Epilepsy, psychosis and schizophrenia. Schizophr Res 1988;1:79–89.CrossRefGoogle Scholar
Adamec, RE.Does kindling model anything clinically relevant? Biol Psychiatry 1990;27:249–279.CrossRefGoogle ScholarPubMed
Krishnamoorty, ES, Trimble, R.Forced normalization: clinical and therapeutic relevance. Epilepsia 1999;40 (Suppl. 10):S57–S64. CrossRefGoogle Scholar
Roberts, GW, Done, DJ, Bruton, C, Crow, TJ.A ‘mock up’ of schizophrenia: temporal lobe epilepsy and schizophrenia-like psychosis. Biol Psychiatry 1990;28:127–143.CrossRefGoogle Scholar
Perez, MM, Trimble, MR.Epileptic psychosis-diagnostic comparison with process schizophrenia. Br J Psychiatry 1980;137:245–249.CrossRefGoogle ScholarPubMed
Smith, PF, Darlington, CL.The development of psychosis in epilepsy: a re-examination of the kindling hypothesis. Behav Brain Res 1996;75:59–66.CrossRefGoogle Scholar
Smith, PF, Darlington, CL.Neural mechanisms of psychiatric disturbances in patients with epilepsy. In: McConnell, HW, Snyder, PJ, eds. Psychiatric comorbidity in epilepsy. Basic mechanisms, diagnosis, and treatment, Chapter 2. Washington, DC: APA, 1998: 15–35. Google Scholar
Hyde, TM, Weinberger, DR.Seizures and schizophrenia. Schizophr Bull 1997;23: 611–622.CrossRefGoogle Scholar
Blumer, D. The psychiatric disorders of epilepsy: recognition and treatment. Course 29, Psychiatric disorders related to epilepsy. APA 151st Annual Meeting, 30 May−4 June, Toronto (5–30–4), 1999. Google Scholar
Stevens, JR.Epilepsy, schizophrenia, and the extended amygdala. Ann NY Acad Sci 1999;877:548–561.CrossRefGoogle ScholarPubMed
Cockerell, OC, Moriarty, J, Trimble, MR, Sander, JW, Shorvon, SD.Acute psychological disorders in patients with epilepsy: a nation-wide study. Epilepsy Res 1996;25:119–131.CrossRefGoogle ScholarPubMed
Trimble, MR.New antiepileptic drugs and psychopathology. Neuropsychobiol, 1998;38:149–151. CrossRefGoogle Scholar
Kanemoto, K, Tsuji, T, Kawasaki, J.Reexamination of interictal psychoses based on DSM-IV psychosis classification and international epilepsy classification. Epilepsia 2001;42:98–103.DOI: 10.1046/j.1528-1157.2001.09000.xCrossRefGoogle ScholarPubMed
Reynolds, EH.Schizophrenia-like psychoses of epilepsy and disturbances of folate and vitamin B12 metabolism induced by anticonvulsant drugs. Br J Psychiatry 1967;501:911–919. CrossRefGoogle Scholar
Glithero, E, Slater, E.The schizophrenia-like psychoses of epilepsy. iv. Follow-up record and outcome. Br J Psychiatry 1963;109:134–142. CrossRefGoogle Scholar
Ojemann, LM, Baugh-Bookman, C, Dudley, DL.Effect of psychotropic medications on seizure control in patients with epilepsy. Neurology 1987;37:1525–1527.CrossRefGoogle ScholarPubMed
Jann, MW, Ereshefsky, L, Saklad, SRet al. Effects of carbamazepine on plasma haloperidol levels. J Clin Psychopharmacol 1985;5:106–109.CrossRefGoogle ScholarPubMed
Lane, HY, Chang, WH, Chou, JC.Seizure during risperidone treatment in an elderly woman treated with concomitant medications. J Clin Psychiatry 1998;59:81–82.CrossRefGoogle Scholar
Munro, J, Goddard, N.Psychosis, epileptiform abnormalities and clozapine. Br J Psychiatry 1992;161:283–287.CrossRefGoogle ScholarPubMed
Sajatovic, M, Meltzer, HY.Clozapine-induced myoclonus and generalized seizures. Biol Psychiatry 1996;39:367–370.CrossRefGoogle ScholarPubMed
Ravasia, S, Dickson, RA.Seizure on low-dose clozapine. Can J Psychiatry 1998;43:420.Google ScholarPubMed
Welch, J, Manschreck, T, Redmond, D.Clozapine-induced seizures and EEG changes. J Neuropsychiatr Clin Neurosci 1994;6:250–256. Google ScholarPubMed
Blumer, D.Antidepressant and double antidepressant treatment for the affective disorder of epilepsy. J Clin Psychiatry 1997;58:3–11.CrossRefGoogle Scholar
Blumer, D, Wakhlu, S, Montouris, G, Wyler, AR.Treatment of the interictal psychoses. J Clin Psychiatry 2000;61:110–122.CrossRefGoogle Scholar
Kahn, DA, Carpenter, D, Docherty, JP, Frances, A.The expert consensus guideline series: treatment of bipolar disorder. J Clin Psychiatry 1996;57 (Suppl. 12A):. Google Scholar
Mulrow, CD, Williams, JW Jr., Chiquette, E, et al. Evidence report/technology assessment no. 7. Treatment of depression: newer pharmacotherapies. AHCPR publication no. 99-E014. Rockville, MD: Agency for Health Care Policy and Research, US Department of Health and Human Services, 1999Google Scholar
McEvoy, JP, Scheifler, PL, Frances, A, eds. (1999) The Expert consensus guideline series: treatment of schizophrenia. J Clin Psychiatry 1996;57 (Suppl. 12 B): .Google Scholar
Reutens, DC, Savard, G, Andermann, F, Dubeau, F, Olivier, A.Results of surgical treatment in temporal lobe epilepsy with chronic psychosis. Brain 1997;11:1929–1936. CrossRefGoogle Scholar