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Psychosis of epilepsy: a multifaceted neuropsychiatric disorder

Published online by Cambridge University Press:  20 June 2016

Andres M. Kanner  and
Ana Maria Rivas-Grajales
Andres M. Kanner*
Affiliation:
Department of Neurology, Comprehensive Epilepsy Centerand Division of Epilepsy, University of Miami, Miller School of Medicine, Miami, Florida, USA
Ana Maria Rivas-Grajales
Affiliation:
Institute of Cognitive Neuroscience, University College, London, UK
*
*Address for correspondence: Andres M. Kanner, MD, FANA, Department of Neurology, University of Miami, Miller School of Medicine, 1120 NW, 14th Street, Room 1324, Miami, FL 33136, USA. (Email: [email protected])
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Abstract

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. The prevalence of POE is more than 7 times higher than the frequency of primary schizophreniform disorders in the general population. While POE has been associated with focal epilepsy of temporal and frontal lobe origin, its etiology and pathophysiology of POE have yet to be established.The treatment of all forms of POE, with the exception of ictal psychotic episodes, requires the use of antipsychotic drugs, preferably the atypical antipsychotic agents with a very low or negligible potential to lower the seizure threshold (eg, risperidone, apiprazole), starting at a low dose with stepwise increments.

Keywords

Alternative psychosisinterictal psychosisneuroleptic drugspostictal psychosistemporal lobe epilepsytreatment-resistant epilepsy
Type
Review Articles
Information
CNS Spectrums , Volume 21 , Special Issue 3: Neuropsychiatry , June 2016 , pp. 247 - 257
Copyright
© Cambridge University Press 2016 

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