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The relationship of psychiatric illnesses and seizures

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Abstract

The relationship between epilepsy and behavioral disturbances has been a subject of controversy since the 19th century. Affective changes may occur prior, during, or after the ictal discharge. Depression is the most prevalent comorbidity. Anxiety, panic attacks, and pseudoseizures may resemble complex partial seizures, and their diagnosis and treatment may be confusing, even to experienced clinicians. Epilepsy-related psychosis is less common, manifesting occasionally with symptoms that are indistiguishable from schizophrenia. There is no clear evidence of a distinct "epileptoid" personality, and interictal violence is extremely rare. Pharmacologic treatment with anticonvulsants remains the cornerstone of treatment. In case of psychiatric comorbidities or refractory seizures, the diagnosis should be re-examined.

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References and Recommended Reading

  1. Falret J: De l’ ètat mental des èpileptiques. Arch Gen Med 1860, 16:661–679.

    Google Scholar 

  2. Gowers WR: Epilepsy and Other Chronic Convulsive Diseases: Their Causes, Symptoms and Treatment. New York: Dover Publications; 1964:15–136.

    Google Scholar 

  3. Trimble MR: Epilepsy and behaviour. Epilepsy Res 1991, 10:71–79.

    Article  PubMed  CAS  Google Scholar 

  4. Victoroff JI: DSM-III-R psychiatric diagnoses in candidates for epileptic surgery: lifetime prevalence. Neuropsychiatry Neuropsychol Behav Neurol 1994, 7:87–97.

    Google Scholar 

  5. Hauser WA, Annegers JF, Rocca WA: Descriptive epidemiology of epilepsy: contributions of population-based studies from Rochester, Minnesota. Mayo Clin Proc 1996, 71:576–586. The most widely cited epidemiologic study in the American literature, in which patients have been followed for over 50 years. The Minnesota study provides important data regarding patterns of incidence and prevalence of convulsive disorders, and useful insights about taxonomy of epilepsy.

    PubMed  CAS  Google Scholar 

  6. Annegers JF: Epidemiology and genetics of epilepsy. Neurol Clin 1994, 12:15–29.

    PubMed  CAS  Google Scholar 

  7. Salinsky M, Kanter R, Dasheiff RM: Effectiveness of multiple EEGs in supporting the diagnosis of epilepsy: an operational curve. Epilepsia 1987, 28:331–334.

    PubMed  CAS  Google Scholar 

  8. Trimble MR: Serum prolactin in epilepsy and hysteria. Br Med J 1978, 2:1682.

    PubMed  CAS  Google Scholar 

  9. Collins WCJ, Lanigan O, Callaghan N: Plasma prolactin concentrations following epileptic and pseudoseizures. J Neurol Neurosurg Psychiatry 1983, 46:505–508.

    PubMed  CAS  Google Scholar 

  10. Wroe SJ, Henlen R, John R, Richens A: The clinical value of Serum prolactin measurement in the differential diagnosis of complex partial seizures. Epilepsy Res 1989, 3:248–252.

    Article  PubMed  CAS  Google Scholar 

  11. Wyllie E, Luders H, MacMillan JP, Gupta M: Serum prolactin levels after epileptic seizures. Neurology 1984, 34:1601–1604.

    PubMed  CAS  Google Scholar 

  12. Lancman M: Psychosis and peri-ictal confusional states. Neurology 1999, 53(suppl_2):S33-S38.

    PubMed  CAS  Google Scholar 

  13. Sachdev P: Schizophrenia-like psychosis and epilepsy: the status of the association. Am J Psychiatry 1998, 155:325–336. Excellent review article on the putative association of epilepsy and schizophrenia-like psychosis, underscores the methodologic and conceptual limitations of the subject, and attempts to address the issue in view of the most recent studies and technologic advances. Models suitable to both epileptic psychosis and schizophrenia are discussed.

    PubMed  CAS  Google Scholar 

  14. Scholtes FB, Renier WO, Meinardi H: Non-convulsive status epilepticus: causes, treatment, and outcome in 65 patients. J Neurol Neurosurg Psychiatry 1996, 61:93–95.

    PubMed  CAS  Google Scholar 

  15. Porter RJ, Penry JK: Petit mal status. In Advances in Neurology, vol. 34. Edited by Delgado-Esqueta AV, Wasterlain CG, Treiman DM, Porter RJ. New York: Raven Press; 1983:61–67.

    Google Scholar 

  16. Lee SI: Nonconvulsive status epilepticus. Ictal confusion in later life. Arch Neurol 1985, 42:778–781.

    PubMed  CAS  Google Scholar 

  17. Engel J Jr, Bandler R, Griffith NC, Caldecott-Hazard S: Neurobiological evidence for epilepsy-induced interictal disturbances. In Advances in Neurology, vol 55. Edited by Smith D, Treiman D, Trimble M. New York: Raven Press; 1991:97–111.

    Google Scholar 

  18. Logsdail SJ, Toone BK: Post-ictal psychoses. A clinical and phenomenological description. Br J Psychiatry 1988, 152:246–252.

    PubMed  CAS  Google Scholar 

  19. Schmitz B, Wolf P: Psychoses in epilepsy. In Epilepsy and Behavior. Edited by Devinsky O, Theodore WH. New York, Liss-Wiley; 1991:97–128.

    Google Scholar 

  20. Kanner AM, Stagno S, Kotagal P, Morris HH: Postictal psychiatric events during prolonged video-electroencephalographic monitoring studies. Arch Neurol 1996, 53:258–263.

    PubMed  CAS  Google Scholar 

  21. Kanemoto K, Kawasaki J, Kawai I: Postictal psychosis: a comparison with acute interictal and chronic psychoses. Epilepsia 1996, 37:551–556. Interesting study addressing the issue of distinguishing postictal psychosis from both acute interictal and chronic psychosis among 104 patients with evidence of CPS or temporal EEG epileptogenic activity. The results were in agreement with the classic Logsdail and Tune [18] study advocating that postictal psychosis does not occur only in the context of a postictal confusional state and lacks frank Schneiderian symptoms. Moreover, secondary delusions accompanied by markedly abnormal mood were prominent. These features may contrast with acute and chronic interictal states, which occur in clear sensorium and first-rank Schneiderian symptoms are more common.

    Article  PubMed  CAS  Google Scholar 

  22. Devinsky O, Abramson H, Alper K, et al.: Postictal psychosis: a case control series of 20 patients and 150 controls. Epilepsy Res 1995, 20:247–253.

    Article  PubMed  CAS  Google Scholar 

  23. Gotman J, Marciani MG: Electroencephalographic spiking activity, drug levels, and seizure occurrence in epileptic patients. Ann Neurol 1985, 17:597–603.

    Article  PubMed  CAS  Google Scholar 

  24. Perrin K and Congett S: Neurobehaviral problems in epilepsy. Neurol Clin 1994, 12:129–152.

    Google Scholar 

  25. Slater E, Beard AW: The schizophrenia-like psychoses of epilepsy: psychiatric aspects. Br J Psychiatry 1963, 109:95–112.

    PubMed  CAS  Google Scholar 

  26. Mendez M, Grau R, Doss R, Taylor JL: Schizophrenia in epilepsy: seizure and psychosis variables. Neurology 1993, 43:1073–1077.

    PubMed  CAS  Google Scholar 

  27. Perez MM, Trimble MR: Epileptic psychosis: diagnostic comparison with process schizophrenia. Br J Psychiatry 1980, 137:245–249.

    PubMed  CAS  Google Scholar 

  28. Bruton CJ, Stevens JR, Frith CD: Epilepsy, psychosis, and schizophrenia: clinical and neuropathological correlations. Neurology 1994, 44:34–42.

    PubMed  CAS  Google Scholar 

  29. Roberts GW, Done DJ, Bruton C, Crow TJ: A "mock up" schizophrenia: temporal lobe epilepsy and schizophrenia-like psychosis. Biol Psychiatry 1990, 28:127–143.

    Article  PubMed  CAS  Google Scholar 

  30. Flor-Henry P: Psychosis and temporal lobe epilepsy: a controlled investigation. Epilepsia 1969, 10:363–395.

    PubMed  CAS  Google Scholar 

  31. Flor-Henry P: Determinants of psychosis in epilepsy: laterality and forced normalization. Biol Psychiatry 1983, 18:1045–1057.

    PubMed  CAS  Google Scholar 

  32. Bruens JH: Psychoses in epilepsy. Psychiatr Neurol Neurochir 1971, 114:338–343.

    Google Scholar 

  33. Matsuura M: Epileptic psychoses and anticonvulsant drug treatment. J Neurol Neurosurg Psychiatry 1999, 67:231–233.

    PubMed  CAS  Google Scholar 

  34. Messing RO, Glosson RG, Simon RP: Drug induced seizures: A ten year experience. Neurology 1984, 34:1582–1586.

    PubMed  CAS  Google Scholar 

  35. Itil TM, Soldatos C: Epileptogenic side effects of psychotropic drugs: practical recommendations. JAMA 1980, 244:1460–1463.

    Article  PubMed  CAS  Google Scholar 

  36. Popli AP, Cando JC, Pillay SS, et al.: Occurrence of seizures related to psychotropic medication among psychiatric inpatients. Psychiatric Serv 1995, 46:486–488.

    CAS  Google Scholar 

  37. Remick PA, Fine SH: Antipsychotic drugs and seizures. J Clin Psychiatry 1979, 40:78–80.

    PubMed  CAS  Google Scholar 

  38. Mendez M, Cummings JL, Benson DF: Epilepsy: psychiatric aspects and use of psychotropics. Psychosomatics 1984, 25:883–894.

    PubMed  CAS  Google Scholar 

  39. Devinsky O, Honigfeld G, Patin J: Clozapine-related seizures. Neurology 1991, 41:369–371.

    PubMed  CAS  Google Scholar 

  40. Liukkonen J, Koponen HJ, Nousiainen U: Clinical picture and long-term course of epileptic seizures that occur during clozapine treatment. Psychiatry Res 1992, 44:107–112.

    Article  PubMed  CAS  Google Scholar 

  41. Casey DE: Side effect profiles of new antipsychotic agents. J Clin Psychiatry 1996 57(suppl 11):40–45.

    PubMed  CAS  Google Scholar 

  42. Hyde TM, Weinberger DR: Seizures and schizophrenia. Schiz Bull 1997, 23:611–622.

    CAS  Google Scholar 

  43. Meduna LJ: Über experimentelle campherepilepsie. Arch Psych Nervenkr 1934, 102:333–339.

    Article  Google Scholar 

  44. Fink M: Meduna and the origins of convulsive therapy. Am J Psychiatry 1984, 141:1034–1039.

    PubMed  CAS  Google Scholar 

  45. Landolt H: Some clinical electroencephalographical correlations in epileptic psychoses (twilight states). Electroencephalogr Clin Neurophysiol 1953, 5:121.

    Google Scholar 

  46. Goddard GV, McIntyre GC, Leech CK: A permanent change in brain function resulting from daily electrical stimulation. Exp Neurol 1969, 25:295–330.

    Article  PubMed  CAS  Google Scholar 

  47. Sato M: Long-lasting hypersensitivity to methamphetamine following amygdaloid kindling in cats: the relationship between limbic epilepsy and the psychotic state. Biol Psychiatry 1983, 18:525–536.

    PubMed  CAS  Google Scholar 

  48. Adamec RE, Stark-Adamec C: Limbing kindling and animal behavior: implications for human psychopathology associated with complex partial seizures. Biol Psychiatry 1983, 18:269–294.

    PubMed  CAS  Google Scholar 

  49. Ramani SV, Quesney LF, Olson D, Gumnit RJ: Diagnosis of hysterical seizures in epileptic patients. Am J Psychiatry 1980, 137:705–709.

    PubMed  CAS  Google Scholar 

  50. Desai BT, Porter RJ, Penry JK: Psychogenic seizures: a study of 42 attacks in six patients with intensive monitoring. Arch Neurol 1982, 39:202–209.

    PubMed  CAS  Google Scholar 

  51. Krumholz A, Niedermayer E: Psychogenic seizures: A clinical study with follow up data. Neurology 1983, 33:498–502.

    PubMed  CAS  Google Scholar 

  52. Lesser RP, Lueders H, Dinner DS: Evidence for epilepsy is rare in patients with psychogenic seizures. Neurology 1983, 33:502–504.

    PubMed  CAS  Google Scholar 

  53. Lembert T, Schmidt D: Natural history and outcome of psychogenic seizures. J Neurol 1990, 237:35–38.

    Article  Google Scholar 

  54. Bowman ES: Pseudoseizures. Psych Clin 1988, 21:649–657.

    Google Scholar 

  55. Alper K, Devinsky O, Perrine K, et al.: Nonepileptic seizures and childhood sexual and physical abuse. Neurology 1993, 43:1950–1953.

    PubMed  CAS  Google Scholar 

  56. Bowman ES: Etiology and clinical course of pseudoseizures: relationship to trauma, depression and dissociation. Psychosomatics 1993, 34:333–342.

    PubMed  CAS  Google Scholar 

  57. Pakalnis A, Miles DE Jr, Phillips B: Neuropsychiatric aspects of psychogenic status epilepticus. Neurology 1991, 41:1104–1106.

    PubMed  CAS  Google Scholar 

  58. Vanderzant CW, Giordani B, Berent S, et al.: Personality of patients with pseudoseizures. Neurology 1986, 36:664–668.

    PubMed  CAS  Google Scholar 

  59. Boon PA, Williamson PD: The diagnosis of pseudoseizures. Clin Neurol Neurosurg 1993, 95:1–8.

    Article  PubMed  CAS  Google Scholar 

  60. Leis AA, Ross MA, Summers AK: Psychogenic seizures: ictal characteristics and diagnostic pitfalls. Neurology 1992, 42:95–99.

    PubMed  CAS  Google Scholar 

  61. Bazil CW, Kothari M, Luciano D, et al.: Provocation of nonepileptic seizures by suggestion in a general seizure population. Epilepsia 1994, 35:768–770.

    Article  PubMed  CAS  Google Scholar 

  62. Slater JD, Brown MC, Jacobs W, Ramsay RE: Induction of pseudoseizures with intravenous saline placebo. Epilepsia 1995, 36:580–585.

    Article  PubMed  CAS  Google Scholar 

  63. Bowman ES, Markand ON: Psychodynamics and psychiatric diagnoses of pseudoseizure subjects. Am J Psychiatry 1996, 153:57–63.

    PubMed  CAS  Google Scholar 

  64. Shen W, Bowman ES, Markand ON: Presenting the diagnosis of pseudoseizure. Neurology 1990, 40:756–759.

    PubMed  CAS  Google Scholar 

  65. Ettinger AB, Devinsky O, Weisbort DM, et al.: A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia 1999, 40:1292–1298.

    Article  PubMed  CAS  Google Scholar 

  66. Wiegartz P, Seidenberg M, Woodard A, et al.: Co-morbid psychiatric disorder in chronic epilepsy: Recognition and etiology of depression. Neurology 1999, 53(Suppl2):S3-S8.

    PubMed  CAS  Google Scholar 

  67. Kanner AM, Nieto JCR: Depressive disorders in epilepsy. Neurology 1999, 53(suppl2):S26-S32.

    PubMed  CAS  Google Scholar 

  68. Blanchet P, Frommer GP: Mood change preceding epileptic seizures. J Nerv Ment Dis 1986, 174:471–476.

    Article  PubMed  CAS  Google Scholar 

  69. Williams D: The structure of emotions reflected in epileptic experiences. Brain 1956, 79:29–67.

    Article  PubMed  CAS  Google Scholar 

  70. Ardia A, Montanez P, Bernal P: Partial psychic seizures and brain organization. Int J Neurosci 1986, 30:23–32.

    Article  Google Scholar 

  71. Mendez MF, Doss R: Ictal and psychiatric aspects of suicide among epileptics. Int J Psychiatry Med 1992, 22:231–238.

    Article  PubMed  CAS  Google Scholar 

  72. Mendez MF, Lanska DJ, Manon-Espaillet R, Burnstine TH: Causative factors for suicide attempts by overdose in epileptics. Arch Neurol 1989, 46:1065–1068.

    PubMed  CAS  Google Scholar 

  73. Robertson MM, Trimble MR, Townsend HRA, et al.: The phenomenology of depression in epilepsy. Epilepsia 1987, 28:364–372.

    PubMed  CAS  Google Scholar 

  74. Mathews WS, Barabas G: Suicide and epilepsy: a review of the literature. Psychosomatics 1981, 22:515–524.

    Google Scholar 

  75. Barraclough BM: The suicide rate of epilepsy. Acta Psychiatr Scand 1987, 76:339–345.

    PubMed  CAS  Google Scholar 

  76. Adamec RE: Corticotropin releasing factor-a peptide link between stress and psychopathology associated with epilepsy. J Psychopharmacol 1991, 5:96–104.

    Article  Google Scholar 

  77. Edeh J, Toone BK: Antiepileptic therapy, folate deficiency, and psychiatric morbidity: a general practice survey. Epilepsia 1985, 26:434–440.

    PubMed  CAS  Google Scholar 

  78. Robinson RG, Kubos KL, Starr LB, et al.: Mood disorders in stroke patients: importance of location of lesion. Brain 1984, 107:81–93.

    Article  PubMed  Google Scholar 

  79. Robertson MM: Depression in patients with epilepsy: an overview. Semin Neurol 1991, 11:182–189.

    Article  PubMed  CAS  Google Scholar 

  80. Victoroff JI, Benson F, Grafton ST, et al.: Depression in complex partial seizures: Electroencephalography and cerebral metabolic correlates. Arch Neurol 1994, 51:155–163. This is a retrospective trial of 53 epileptic patients with intractable CPS studied with video EEG and positron emission tomography. High-degree interictal temporal lobe hypometabolism and left lateralization was associated with increased frequency of depressive episodes in this population. Selection biases and lack of control group limit the extrapolation of the results.

    PubMed  CAS  Google Scholar 

  81. Bromfield EB, Altshuler LL, Leiderman DB, et al.: Cerebral metabolism and depression in patients with complex partial seizures. Arch Neurol 1992, 49:617–623.

    PubMed  CAS  Google Scholar 

  82. Jick H, Dinan BJ, Hunter JR, et al.: Tricyclic antidepressants and convulsions. J Clin Psychopharm 1983, 3:82–185.

    Article  Google Scholar 

  83. Rosenstein D, Nelson JC, Jacobs SC: Seizures associated with antidepressants: a review. J Clin Psychiatry 1993, 54:289–299.

    PubMed  CAS  Google Scholar 

  84. Preskorn S, Fast G: Tricyclic antidepressant induced seizures and plasma drug concentration. J Clin Psychiatry 1992, 53:160–162.

    PubMed  CAS  Google Scholar 

  85. Blumer D: Antidepressant and double antidepressant treatment for the affective disorder of epilepsy. J Clin Psychiatry 1997, 58:3–11.

    PubMed  CAS  Google Scholar 

  86. Lyketsos CG, Stoline AM, Longstreet P, et al.: Mania in temporal lobe epilepsy. Neuropsychiatry Neuropsychol Behav Neurol 1993, 6:19–25.

    Google Scholar 

  87. Howland H: Bipolar disorder associated with primary generalized epilepsy. Br J Psychiatry 1993, 162:699–700.

    PubMed  CAS  Google Scholar 

  88. Barczac P, Edmunds E, Betts T: Hypomania following complex partial seizures: a report of three cases. Br J Psychiatry 1998, 152:137–139.

    Google Scholar 

  89. Spitz MC: Panic disorder in seizure patients: diagnostic pitfall. ilepsia 1991, 32:33–38.

    CAS  Google Scholar 

  90. Young GB, Chandarama PC, Blume WT, et al: Mesial temporal lobe seizures presenting as anxiety disorders. J Neuropsychiatry Clin Neurosci 1995, 7:352–357.

    PubMed  CAS  Google Scholar 

  91. Edlund MJ, Swann AC, Clothier J: Patients with panic attacks and abnormal EEG results. Am J Psychiatry 1987, 144:508–509.

    PubMed  CAS  Google Scholar 

  92. Waxman SG, Geschwind N: The interictal behavioral syndrome of temporal lobe epilepsy. Arch Gen Psychiatry 1975, 32:1580–1586.

    PubMed  CAS  Google Scholar 

  93. Bear DM, Fedio P: Quantitative analysis of interictal behavior in temporal lobe epilepsy. Arch Neurol 1977, 34:454–467.

    PubMed  CAS  Google Scholar 

  94. Wilkus RJ, Dodrill CB, Thompson PM: Intensive EEG monitoring and psychological studies of patients with pseudoepileptic seizures. Epilepsia 1984, 25:100–107.

    PubMed  CAS  Google Scholar 

  95. Swanson SJ, Rao SM, Grafman J, et al.: The relationship between seizure type and interictal personality. Results from the Vietnam Head Injury Study. Brain 1995, 118:91–103. This is a large well-controlled study of personality and behavioral abnormalities in a cohort of 467 Vietnam veterans with penetrating head injuries (PHI), and 84 uninjured veterans. The authors concluded that 1) there is no evidence to support the existence of a distinct interictal personality syndrome in patients with CPS; 2) epileptics as a result of PHI have greater frequency of personality and psychiatric disturbance than matched controls; and 3) epileptic patients demonstrate more psychopathology than normal control subjects.

    Article  PubMed  Google Scholar 

  96. Devinsky O, Najjar S: Evidence against the existence of a temporal lobe epilepsy personality syndrome. Neurology 1999, 53(suppl 2):S13-S25.

    PubMed  CAS  Google Scholar 

  97. Mungas D: An empirical analysis of specific syndromes of violent behavior. J Nerv Ment Dis 1983, 171:354–361.

    Article  PubMed  CAS  Google Scholar 

  98. Pincus JH: Can violence be a manifestation of epilepsy? Neurology 1980, 30:304–307.

    PubMed  CAS  Google Scholar 

  99. Whitman S, Coleman TE, Patmon C, et al.: Epilepsy in prison: elevated prevalence and no relationship to violence. Neurology 1984, 34:775–782.

    PubMed  CAS  Google Scholar 

  100. Herzberg JL, Fenwick BR: The etiology of aggression in temporal lobe epilepsy. Br J Psychiatry 1984, 153:50–55.

    Article  Google Scholar 

  101. Mendez MF, Doss RC, Taylor JL: Interictal violence in epilepsy. Relationship to behavior and seizure variables. J Nerv Ment Dis 1993, 181:566–569.

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Psychiatry, Brigham and Women’s Hospital, 75 Francis Street, 02115, Boston, MA, USA

    Nicholas D. Tsopelas MD, Ralph Saintfort MD & Gregory L. Fricchione MD

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Tsopelas, N.D., Saintfort, R. & Fricchione, G.L. The relationship of psychiatric illnesses and seizures. Curr Psychiatry Rep 3, 235–242 (2001). https://doi.org/10.1007/s11920-001-0059-1

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