Schizophrenia-Like Psychosis and Epilepsy: The Status of the Relationship

  • Perminder Sachdev
Conference paper


The association between epilepsy and psychosis has attracted the attention of psychiatrists since the nineteenth century, but most aspects of this relationship remain contentious (Trimble 1991; Sachdev 1998). Some of the controversies relate to a lack of clarity of conceptual issues, while others result from inadequate data. In this chapter, I try to summarize the current state of knowledge about the relationship between epilepsy and schizophrenia-like psychosis (SLP) and to arrive at a synthetic view that may lead to a better understanding in the future. In trying to conceptualize this field, some principles need to be stated at the outset, the relevance of which will become clearer later. These concepts are as follows:
  • The term psychosis must be strictly and narrowly defined in any analysis. Some of the problems in the literature relate to varying definitions of psychosis. For this analysis, only psychosis with predominantly schizophreniform features and occurring in clear consciousness are included.

  • It must be appreciated that both epilepsy and schizophrenia are heterogeneous disorders. The question is, therefore, the relationship between which epilepsy and what kind of psychosis?

  • The similarity between temporal lobe phenomena and psychotic symptoms does not necessarily mean that they have a common origin.

  • The two themes that have dominated psychiatric thought on the association are (1) they occur together more often than chance (“affinity”) and (2) they are “antagonistic” to each other. These seemingly incompatible observations must be reconciled.

  • The epileptic brain is not normal between clinical seizures. The association is with epilepsy and not seizures alone. Moreover, epilepsy is not a static process, and the brain of the epileptic patient is undergoing structural and neurochemical change, before and after the development of seizures, to which ictal events actually contribute (Engel 1996). The same is probably true for schizophrenia (Olney and Farber 1995).


Temporal Lobe Epilepsy Epileptic Patient Temporal Lobe Epilepsy Patient Clear Consciousness Schizophrenic Brain 
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Copyright information

© Springer Japan 2001

Authors and Affiliations

  • Perminder Sachdev
    • 1
  1. 1.The Prince of Wales HospitalSchool of Psychiatry, University of New South Wales, and Neuropsychiatric InstituteSydneyAustralia

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