Psychoses in epilepsy: A comparison of postictal and interictal psychoses

• Published in: Epilepsy & behavior Vol. 60; pp. 58 - 62
• Main Authors: Hilger, Eva, Zimprich, Friedrich, Pataraia, Ekaterina, Aull-Watschinger, Susanne, Jung, Rebekka, Baumgartner, Christoph, Bonelli, Silvia
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-07-2016
• Subjects: Adult; Age of Onset; Electroencephalography; Epilepsy; Epilepsy - complications; Epilepsy - epidemiology; Epilepsy - psychology; Epilepsy, Temporal Lobe - complications; Epilepsy, Temporal Lobe - epidemiology; Female; Humans; Incidence; Interictal psychosis; Male; Middle Aged; Neurobiology; Neurology; Postictal psychosis; Prevalence; Psychotic Disorders - epidemiology; Psychotic Disorders - etiology; Psychotic Disorders - psychology; Retrospective Studies; Seizures - complications; Seizures - epidemiology; Seizures - psychology; Socioeconomic Factors; Violence - psychology; Young Adult; Interictal psychosis; Prevalence; Epilepsy; Postictal psychosis; Neurobiology
• ISSN: 1525-5050; 1525-5069
• DOI: 10.1016/j.yebeh.2016.04.005

Abstract We retrospectively analyzed data of patients with epilepsy (n = 1434) evaluated with prolonged EEG monitoring in order to estimate the prevalence of postictal psychosis (PP) and interictal psychosis (IP), to investigate a potential association of psychosis subtype with epilepsy type, and to assess differences between PP and IP. The overall prevalence of psychosis was 5.9% ( N = 85); prevalence of PP ( N = 53) and IP ( N = 32) was 3.7% and 2.2%, respectively. Of patients with psychosis, 97.6% had localization-related epilepsy (LRE). Prevalence of psychosis was highest (9.3%) in patients with temporal lobe epilepsy (TLE). When comparing PP with IP groups on demographic, clinical, and psychopathological variables, patients with IP were younger at occurrence of first psychosis ( P = 0.048), had a shorter interval between epilepsy onset and first psychosis ( P = 0.002), and more frequently exhibited schizophreniform traits (conceptual disorganization: P = 0.008; negative symptoms: P = 0.017) than those with PP. Postictal psychosis was significantly associated with a temporal seizure onset on ictal EEG ( P = 0.000) and a higher incidence of violent behavior during psychosis ( P = 0.047). To conclude, our results support the presumption of a preponderance of LRE in patients with psychosis and that of a specific association of TLE with psychosis, in particular with PP. Given the significant differences between groups, PP and IP may represent distinct clinical entities potentially with a different neurobiological background.