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Forced normalization and psychosis

Published online by Cambridge University Press:  13 August 2021

M.T. Valadas  and
R. Mota Freitas
M.T. Valadas*
Affiliation:
Serviço De Psiquiatria, Unidade Local de Saúde do Baixo Alentejo, Beja, Portugal
R. Mota Freitas
Affiliation:
Departamento De Psiquiatria E Saúde Mental, Hospital do Espírito Santo de Évora, Évora, Portugal
*
*Corresponding author.

Abstract

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Introduction

Epilepsy is associated with a wide range of psychiatric manifestations. Forced normalization occurs when the establishment of improved seizure control in a patient with previous uncontrolled epilepsy leads to the emergence of psychiatric symptoms, which include, among others, psychotic phenomena.

Objectives

We aim to review the literature regarding the phenomenon of forced normalization and its association with psychosis.

Methods

We performed an updated review in the PubMed database using the terms “forced normalization” and “psychosis”. The included articles were selected by title and abstract.

Results

Psychosis is the most common behavioural disturbance in forced normalization, usually manifested as delusions and hallucinations. Forced normalization is more frequent in young female patients with drug‐resistant focal epilepsy. Antiepileptic drug treatment and epilepsy surgery are the most common triggers. Institution of antipsychotics and management of antiepileptic drugs are part of the treatment. Prognosis seems to be better in women, children and patients with generalized epilepsy, among other factors.

Conclusions

Forced normalization is an overlooked entity, the pathophysiology of which remains largely uncertain. The recognition of forced normalization by psychiatrists is crucial for adequate patient treatment including pharmacological management and consultation with a neurologist

Keywords

psychosisEpilepsy
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S235
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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