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Postictal psychosis

Melissa Maguire, Jasvinder Singh, Anthony Marson
The psychoses of epilepsy can be classified according to their temporal relationship with seizures, namely as ictal, postictal and interictal psychosis. Interictal psychosis is the most common and may resemble schizophrenia. They can be challenging to diagnose and to manage, especially given the perception that some antipsychotic drugs may exacerbate seizures, while some antiepileptic medications may worsen psychosis. The current uncertainty around their best management means that some patients may not receive appropriate care...
April 2018: Practical Neurology
Jordan S Farrell, Roberto Colangeli, Marshal D Wolff, Alexandra K Wall, Thomas J Phillips, Antis George, Paolo Federico, G Campbell Teskey
A recent article by Farrell et al. characterizes the phenomenon, mechanisms, and treatment of a local and severe hypoperfusion/hypoxia event that occurs in brain regions following a focal seizure. Given the well-established role of cerebral ischemia/hypoxia in brain damage and behavioral dysfunction in other clinical settings (e.g., stroke, cerebral vasospasm), we put forward a new theory: postictal hypoperfusion/hypoxia is responsible for the negative consequences associated with seizures. Fortunately, inhibition of two separate molecular targets, cyclooxygenase-2 (COX-2) and l-type calcium channels, can prevent the expression of postictal hypoperfusion/hypoxia...
September 2017: Epilepsia
Christine Holland, Karen-Leigh Edward, Jo-Ann Giandinoto
Focal seizures are divided into simple and dyscognitive, with the latter resulting in the alteration of consciousness. In the ictal and postictal stages, patients may present with confusion, delirium, and psychosis, presenting a risk of safety to themselves and others. This article presents 3 case studies where patients have been admitted for visual and electroencephalographic monitoring. Seizure activity is provoked for the diagnosis and development of a management plan. These cases illustrate the unique nursing implications when caring for patients experiencing focal dyscognitive seizures, highlighting the unique circumstances for the neuroscience nurse regarding risk management, safe administration of radioactive isotopes, detection of subtle seizure manifestation, and use of family as experts in patient-centered care...
June 2017: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Johan Zelano, Elinor Ben-Menachem
Epileptic emergencies are frequently encountered and include ictal events as status epilepticus or seizure clusters, and non-ictal situations like postictal psychosis or acute drug side effects. The aim of this review was to describe recent pharmacological advances in the treatment of epileptic emergencies. Areas covered: Based on clinically relevant questions, a literature search was performed. The search showed that most pharmacological advances have been made in management of status epilepticus, where substantial literature has accumulated on several AEDs with potentially less side-effects than the traditional choices...
October 14, 2016: Expert Opinion on Pharmacotherapy
Andres M Kanner, Ana Maria Rivas-Grajales
Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which potential etiopathogenic mechanisms are believed to be closely related to a seizure disorder. POE can present as interictal psychotic episodes, which may often differ semiologically from primary schizophrenic disorder. They may present as ictal or postictal psychotic episodes and may be the expression of an iatrogenic process to pharmacologic and/or surgical interventions.Epilepsy and POE have a complex and bidirectional relation, as not only are patients with epilepsy at greater risk of developing a psychotic disorder, but patients with a primary psychotic disorder are also at greater risk of developing epilepsy...
June 2016: CNS Spectrums
Jingyi Ma, L Stan Leung
BACKGROUND: A paradox in epilepsy and psychiatry is that temporal lobe epilepsy is often predisposed to schizophrenic-like psychosis, whereas convulsive therapy can relieve schizophrenic symptoms. We have previously demonstrated that the nucleus accumbens is a key structure in mediating postictal psychosis induced by a hippocampal electrographic seizure. OBJECTIVE/HYPOTHESIS: The purpose of this study is to test a hypothesis that accumbens kindling cumulating in a single (1-time) or repeated (5-times) convulsive seizures have different effects on animal models of psychosis...
September 2016: Brain Stimulation
B de Toffol, K Kanemoto
Psychosis in epilepsy can be categorized in relation to seizures in two main categories: interictal psychosis and postictal psychosis. Postictal psychosis (PIP) is a specific syndrome in relation to seizure activity: a clear temporal relation exists between the psychotic state of sudden onset and a precipitating bout of complex partial or generalized seizures. However, this very specific syndrome is not included as such within the DSM-5, and PIP belongs to the category "Psychotic disorder due to another medical condition"...
October 2016: L'Encéphale
Frank Besag, Rochelle Caplan, Albert Aldenkamp, David W Dunn, Giuseppe Gobbi, Matti Sillanpää
Psychosis related to epilepsy or antiepileptic treatment can occur in teenagers and very rarely in children. Postictal, interictal and antiepileptic-drug-induced psychosis have all been reported in young people. Whether ictal psychosis occurs in this age group remains open to debate. Neuronal antibody encephalitis such as anti-NMDA receptor encephalitis can present with seizures and psychosis, both of which can resolve with prompt, appropriate immunotherapy. In addition, there have been several reports in which the terms psychosis or psychotic features have been used loosely to describe behavioural disturbance in children with epilepsy; in these cases there have apparently been no diagnostic features of psychosis, implying that these terms should not have been used...
May 16, 2016: Epileptic Disorders: International Epilepsy Journal with Videotape
Eva Hilger, Friedrich Zimprich, Ekaterina Pataraia, Susanne Aull-Watschinger, Rebekka Jung, Christoph Baumgartner, Silvia Bonelli
We retrospectively analyzed data of patients with epilepsy (n=1434) evaluated with prolonged EEG monitoring in order to estimate the prevalence of postictal psychosis (PP) and interictal psychosis (IP), to investigate a potential association of psychosis subtype with epilepsy type, and to assess differences between PP and IP. The overall prevalence of psychosis was 5.9% (N=85); prevalence of PP (N=53) and IP (N=32) was 3.7% and 2.2%, respectively. Of patients with psychosis, 97.6% had localization-related epilepsy (LRE)...
July 2016: Epilepsy & Behavior: E&B
Shahar Arzy, Roey Schurr
Religious experiences have long been documented in patients with epilepsy, though their exact underlying neural mechanisms are still unclear. Here, we had the rare opportunity to record a delusional religious conversion in real time in a patient with right temporal lobe epilepsy undergoing continuous video-EEG. In this patient, a messianic revelation experience occurred several hours after a complex partial seizure of temporal origin, compatible with postictal psychosis (PIP). We analyzed the recorded resting-state EEG epochs separately for each of the conventional frequency bands...
July 2016: Epilepsy & Behavior: E&B
M R Trimble
The relationship between epilepsy and behavior disorders will be briefly outlined, and an initial distinction between periictal and interictal disorders made. This paper will concentrate on the periictal disorders. These include the ictally driven psychoses, such as complex partial seizure status and absence status. There will then be a discussion of the postictal psychoses. It will be noted how these form a constant clinical picture, which sometimes goes unrecognized. The phenomenology may be typically paranoid or schizophrenia-like, andpatients often present in a setting of clear consciousness...
December 1999: Acta Neuropsychiatrica
Janice M Buelow, Patricia Shafer, Ruth Shinnar, Joan Austin, Sandra Dewar, Lucretia Long, Kathryn O'Hara, Nancy Santilli
Seizure clusters in epilepsy can result in serious outcomes such as missed work or school, postictal psychosis, emergency room visits, or hospitalizations, and yet they are often not included in discussions between health-care professionals (HCPs) and their patients. The purpose of this paper was to describe and compare consumer (patient and caregivers) and professional understanding of seizure clusters and to describe how consumers and HCPs communicate regarding seizure clusters. We reviewed social media discussion sites to explore consumers' understanding of seizure clusters...
April 2016: Epilepsy & Behavior: E&B
Bertrand de Toffol
This paper presents the first complete description of postictal psychosis, made by the French psychiatrist Jules Falret. This description, written in 1861, was the first to fulfill modern diagnostic criteria. We will examine why this syndrome, well defined in the 19th century, was forgotten for over a century.
January 2016: Epilepsy & Behavior: E&B
Daniel Rosenberg, Julius G S Latorre
INTRODUCTION: Palinacousis or auditory perseveration is a form of acquired auditory perceptual disorder that occurs rarely due to an acute intracranial process. The condition mimics psychotic hallucination, seizure, or other behavioral disorders, potentially causing management delay. We describe an unusual form of palinacousis resulting from acute lobar intracerebral hemorrhage. CASE REPORT: A 70-year-old right-handed white man with history of hypertension, ischemic cardiomyopathy, and atrial fibrillation on anticoagulation developed a rare form of palinacousis, on which he hears the previous speaker's voice on the current speaker's speech due to right parietal intracranial hemorrhage...
January 2016: Neurologist
Saeed Farooq, Akhtar Sherin
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 4, 2008.People suffering from epilepsy have an increased risk of experiencing psychotic symptoms. The psychotic syndromes associated with epilepsy have generally been classified as ictal, postictal, and interictal psychosis. Anticonvulsant drugs have been reported to precipitate psychosis. Moreover, all antipsychotic drugs have the propensity to cause paroxysmal electroencephalogram abnormalities and induce seizures...
December 21, 2015: Cochrane Database of Systematic Reviews
Stephan Eisenschenk, Harry Krop, Orrin Devinsky
Postictal psychosis is characterized by a fluctuating combination of thought disorder, auditory and visual hallucinations, delusions, paranoia, affective change, and aggression including violent behavior. We present a case of homicide following a cluster of seizures. The patient's history and postictal behavior were his consistent with postictal psychosis. Contributing factors resulting in homicide may have included increased seizure frequency associated with a change in his AED regimen seizure frequency. The AED change to levetiracetam may also have increased impulsiveness with diminished mood regulation following discontinuation of carbamazepine...
2014: Epilepsy & Behavior Case Reports
Tomohiro Oshima, Etsushi Kato, Yukari Tadokoro, Kousuke Kanemoto
Epilepsy has an association with nearly all types of psychiatric problems and psychiatric symptoms are common clinical manifestations seen in epilepsy patients. For example, interictal depression in individuals with epilepsy is more prevalent than in the general population or among patients with other chronic disorders. The high frequency of depression and clinical impact of psychosis in epilepsy have been well documented in recent studies, indicating the importance of diagnosing and treating psychiatric implications in affected patients...
May 2014: Nihon Rinsho. Japanese Journal of Clinical Medicine
T A Pollak, T R Nicholson, J D C Mellers, A Vincent, A S David
Postictal psychosis (PIP) is a serious psychiatric complication of epilepsy that occurs in approximately 6% of patients following multiple complex partial or generalized seizures. The psychosis is classically described as having a pleomorphic phenomenology, including paranoid, grandiose, and religious delusions as well as multimodal hallucinations with prominent affective changes and agitation. Little is understood about the pathophysiology of the condition. There has been a recent increase in interest in the relevance of autoimmunity to the pathogenesis of both epilepsy and psychosis...
July 2014: Epilepsy & Behavior: E&B
Maurice J Clancy, Mary C Clarke, Dearbhla J Connor, Mary Cannon, David R Cotter
BACKGROUND: Epilepsy has long been considered to be a risk factor for psychosis. However there is a lack of consistency in findings across studies on the effect size of this risk which reflects methodological differences in studies and changing diagnostic classifications within neurology and psychiatry. The aim of this study was to assess the prevalence of psychosis in epilepsy and to estimate the risk of psychosis among individuals with epilepsy compared with controls. METHODS: A systematic review and meta-analysis was conducted of all published literature pertaining to prevalence rates of psychosis in epilepsy using electronic databases PUBMED, OVIDMEDLINE, PsychINFO and Embase from their inception until September 2010 with the following search terms: prevalence, incidence, rate, rates, psychosis, schizophrenia, schizophreniform illness, epilepsy, seizures, temporal lobe epilepsy...
March 13, 2014: BMC Psychiatry
Sylvain Rheims, Philippe Ryvlin
PURPOSE OF REVIEW: Long-term video-electroencephalography monitoring (LTM) in epilepsy monitoring units (EMUs) exposes patients to a variety of serious adverse events (SAEs) and safety issues, which have recently caught attention and are summarized in this review. RECENT FINDINGS: SAEs observed during LTM affect about 10% of patients and include secondary generalized tonic-clonic seizures, seizure clusters and status epilepticus, unusual for the patient; seizure-related falls, injuries, fractures, and aspiration; postictal psychosis; and cardiorespiratory distress, including sudden unexpected death in epilepsy (SUDEP) and near-SUDEP, which were encountered by more than 10% of European and Australian EMUs...
April 2014: Current Opinion in Neurology
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