Skip to main content
SpringerLink
Log in

Psychosis and Seizure Disorder: Challenges in Diagnosis and Treatment

  • Complex Medical-Psychiatric Issues (MB Riba, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Psychosis temporally related to seizure episodes has been a recognized entity with much clinical attention, yet there are less clear guidelines for treatment. Presence of perceptual disturbances and cognitive impairment symptoms make the differentiation between primary psychoses and seizure- related psychoses blurred. Moreover, there are only a few reported cases describing clinical presentation, diagnostic dilemma and treatment challenges when these two entities are present at the same time, with overlapping symptomatology. We describe such a case where the presence of these two problems complicated the diagnoses and the patient’s subsequent management required a very intricate collaboration between psychiatry and neurology. In addition, we review available published articles including case reports, studies, and review articles regarding the diagnosis and treatment of this complicated clinical presentation. Some of the analyses were reviewed in detail and resulting outcomes are discussed. Finally, we review the diagnostic and treatment guidelines in the context of the presenting case.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Sachdev P. Schizophrenia like psychosis and epilepsy: the status of the association. Am J Psychiatry. 1998;155:3.

    Google Scholar 

  2. Qin P, Xu H, Laursen TM, et al. Risk for schizophrenia and schizophrenia –like psychosis among patients with epilepsy: population based cohort study. Br Med J. 2005;331:23.

    Article  Google Scholar 

  3. Toone BK, Gerralda ME, Ron MA. The Psychoses of epilepsy. J Neurol Neurosurg Psychiatry. 2000;69:1–4.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  4. Schmitz B., Psychoses in Epilepsy. In: Devinsky O, Theodore W, editors. Epilepsy Behav 1991:97-128.

  5. Getz K, Hermann B, Seidenberg M, et al. Negative symptoms in temporal lobe epilepsy. Am J Psychiatry. 2002;159(4):644–51.

    Article  PubMed  Google Scholar 

  6. Slater E, Beard AW. The schizophrenia-like psychoses of epilepsy. Br J Psychiatry. 1963;109:95–150.

    Article  PubMed  CAS  Google Scholar 

  7. Nandkarni S, Arnedo V, Devinsky O. Psychosis in epilespy patients. Epilepsia. 2007;48(Suppl9):17–9.

    Article  Google Scholar 

  8. Logsdail S, Toone BK. Post-ictal psychosis: a clinical and phenomenological description. Br J Psychaitry. 1998;152:246–52.

    Article  Google Scholar 

  9. Alper K, Davinsky O, Westbrook L, et al. Premorbid psychiatric risk factors for post-ictal psychosis. J Neuropsychiatr Clin Neurosci. 2001;13:492–9.

    Article  CAS  Google Scholar 

  10. Gerard ME, Spitz MC, Towbin JA, et al. Subacute post-ictal aggression. Neurology. 1998;50:384–8.

    Article  PubMed  CAS  Google Scholar 

  11. Adachi N, Matsuura M, Hara T, et al. Psychoses and epilepsy: are inter-ictal and post-ictal psychoses distinct clinical entities? Epilepsia. 2002;43:1574–82.

    Article  PubMed  Google Scholar 

  12. Devinsky O. Post-ictal psychosis: common. Dangerous and treatable. Epilepsy Curr. 2008;8:31–4.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kanemoto K, Kawasaki J, Kawai I. Post-ictal psychosis: a comparison with acute inter-ictal and chronic psychosis. Epilepsia. 1996;37:551–6.

    Article  PubMed  CAS  Google Scholar 

  14. Kanemoto K, Takenchi J, Kawasaki J, et al. Characteristics of temporal lobe epilepsy with mesial temporal sclerosis, with special reference to psychotic episodes. Neurology. 1996;47:1199–203.

    Article  PubMed  CAS  Google Scholar 

  15. Tebartz Van Eslt L, Baeumer D, Lemieux L, et al. Amygdala pathology in psychosis of epilepsy a magnetic resonance imaging study in patients with temporal lobe epilepsy. Brain. 2002;125:140–9.

    Article  Google Scholar 

  16. Sato M. Long-lasting hypersensitivity to methamphetamine following amygdaloid kindling in cats: the relationship between limbic epilepsy and psychotic state. Biol Psychiatry. 1983;18:525–36.

    PubMed  CAS  Google Scholar 

  17. Ring HA, Trimble MR, Costa DC, et al. Striatal dopamine receptor binding in epileptic psychosis. Biol Psychiatry. 1994;35:375–80.

    Article  PubMed  CAS  Google Scholar 

  18. Meldrum BS, Neurochemical Substrates of Ictal Behavior, In Neurobehavioral Problems in Epilepsy. Adv Neurol 1991; 35-45.

  19. Sutula T, He X, Cavazos J, et al. Synaptic reorganization in the hippocampus induced by abnormal functional activity. Science. 1988;239:1147–50.

    Article  PubMed  CAS  Google Scholar 

  20. Babb TL, Kupfer WR, Pretorius JK, et al. Synaptic reorganization of mossy fibers into molecular layer in human epileptic fascia dentata. Soc Neurosci. 1988;88:351.

    Google Scholar 

  21. Scheibel AB, Kovelman JA, et al. Disorientation of the Hippocampal pyramidal cell and its process in the schizophrenic patient. Biol Psychiatry. 1981;16:101–2.

    Google Scholar 

  22. Restak R, Complex Partial Seizures: Present Diagnostic Challenge. Psychiatr Times 1995.

  23. Lertxundi U, Hernandez R, Medrano J, et al. Antipsychotics and seizures: higher risk with atypicals? Seizure. 2013;22:141–3. Case /non case study comparing FGA versus SGA risk of seizure.

    Article  PubMed  Google Scholar 

  24. Alldredge BK. Seizure risk associated with psychotropics: clinical and pharmacokinetic considerations. Neurology. 1999;53:S68–75.

    PubMed  CAS  Google Scholar 

  25. Remington G, Agid O, Foussias G, et al. Clozapine and therapeutic drug monitoring: is there sufficient evidence for an upper threshold? Psychopharmacology (Berl). 2013;225(3):505–18.

    Article  CAS  Google Scholar 

  26. Momcilović-Kostadinović D, Simonović P, Kolar D, et al. Chlorpromazine induced status epilepticus: a case report. Srp Arh Celok Lek. 2013;141(9–10):667–70.

    Article  PubMed  Google Scholar 

  27. Thabet FI, Sweis RT. Aripiprazole induced seizure in a 3 year old child: a case report and literature review. Clin Neuropharmacol. 2013;36(1):29–30.

  28. Centorrino F, Price BH, Tuttle M, et al. EEG abnormalities during treatment with typical and atypical antipsychotics. Am J Psychiatry. 2002;159(1):109–15.

    Article  PubMed  Google Scholar 

  29. Mitsutoshi O, Masumi I, Masaaki K, et al. Effect of antipsychotics in epilepsy patients with psychiatric symptoms. Neurol Asia. 2010;15(Supplement 1):55.

    Google Scholar 

  30. Sander JWAS, Hart YM, Trimble MR, et al. Vigabantrin and psychosis. J Neurol Neurosurgey Psychiatry. 1991;54:435–9.

    Article  CAS  Google Scholar 

  31. Matsura M, Trimble MR. Zonisamide and psychosis. J Epilepsy. 1997;10:52–4.

    Article  Google Scholar 

  32. Pakalnis A, Drake JK, John K, et al. Forced normalization: acute psychosis after seizure control in seven patients. Arch Neurol. 1987;44:289–92.

    Article  PubMed  CAS  Google Scholar 

  33. Banwari GH, Parmar C, Kandre D. Alternative psychosis – is it a defined clinical entity? Ind J Psychol Med. 2013;35:84–6.

    Article  Google Scholar 

  34. Adachi N, Kanemoto K, de Toffol B, et al. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia. 2013;54:19–33. Describes treatment recommendations for all types of seizure related psychosis, with recommendation about choice of antipsychotics and dosage.

    Article  PubMed  CAS  Google Scholar 

  35. Adachi N, Akanuma N, Ito M, et al. Interictal psychotic episodes in epilepsy: duration and associated clinical factors. Epilepsia. 2012;53:1088–94.

    Article  PubMed  Google Scholar 

  36. Henning O, Nakken KO. Epilepsy-related psychoses. Tidsskr Nor Laegeforen. 2013;133(11):1205–9.

    Article  PubMed  Google Scholar 

  37. Turan AB, Seferoglu M, Taskapilioglu O, et al. Vulnerability of an epileptic case to psychosis: sodium valproate with lamotrigine, forced normalization, postictal psychosis or all? Neurol Sci. 2012;33(5):1161–3.

    Article  PubMed  CAS  Google Scholar 

Download references

Compliance with Ethics Guidelines

ᅟ

Conflict of Interest

Kamalika Roy, Richard Balon, Varma Penumetcha, and B. Harrison Levine declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Neurosciences, Wayne State University, WSU Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 5A, Detroit, MI, 48201, USA

    Kamalika Roy

  2. Departments of Psychiatry and Behavioral Neurosciences and Anesthesiology, Wayne State University, WSU Tolan Park Medical Building, 3901 Chrysler Service Drive, Suite 3A, Detroit, MI, 48201, USA

    Richard Balon

  3. Department of Psychiatry, St. Mary Mercy Hospital, 36475 Five Mile Road, Livonia, MI, 48154, USA

    Varma Penumetcha

  4. 3570 E. 12th Ave, Denver, CO, 80206, USA

    B. Harrison Levine

Authors
  1. Kamalika Roy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Richard Balon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Varma Penumetcha
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Harrison Levine
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kamalika Roy.

Additional information

This article is part of the Topical Collection on Complex Medical-Psychiatric Issues

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Roy, K., Balon, R., Penumetcha, V. et al. Psychosis and Seizure Disorder: Challenges in Diagnosis and Treatment. Curr Psychiatry Rep 16, 509 (2014). https://doi.org/10.1007/s11920-014-0509-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-014-0509-1

Keywords

Search

Navigation