Epilepsy and psychiatry

Meet the patient

A 34-year-old man with fifteen years of temporal lobe epilepsy is admitted after a cluster of four seizures in a day. He recovers, talks normally to his mother, eats dinner, and sleeps.[1][3]

Thirty-six hours later the night nurse calls: he is convinced the ward is a testing facility, that his mother has been replaced, and that God has instructed him to leave. He is frightened, physically strong, and looking at the fire door.[1][15]

The gap between the seizures and the psychosis is the diagnosis. That lucid interval is the highest-yield discriminator in this entire topic, and it is also the thing a tired registrar records as "seemed fine yesterday" and then never mentions again.[1][3]

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1. [1]Logsdail SJ, Toone BK Post-ictal psychoses. A clinical and phenomenological description Br J Psychiatry, 1988.PMID 3167343
2. [2]Tellez-Zenteno JF, Patten SB, Jetté N, Williams J, Wiebe S Psychiatric comorbidity in epilepsy: a population-based analysis Epilepsia, 2007.PMID 17662062
3. [3]Clancy MJ, Clarke MC, Connor DJ, Cannon M, Cotter DR The prevalence of psychosis in epilepsy; a systematic review and meta-analysis BMC Psychiatry, 2014.PMID 24625201
4. [4]Krishnamoorthy ES, Trimble MR, Sander JW, Kanner AM Forced normalization at the interface between epilepsy and psychiatry Epilepsy Behav, 2002.PMID 12609326
5. [5]Hesdorffer DC, Hauser WA, Olafsson E, Ludvigsson P, Kjartansson O Depression and suicide attempt as risk factors for incident unprovoked seizures Ann Neurol, 2006.PMID 16217743
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9. [9]Kerr MP, Mensah S, Besag F, et al. International consensus clinical practice statements for the treatment of neuropsychiatric conditions associated with epilepsy Epilepsia, 2011.PMID 21955156
10. [10]Alper K, Schwartz KA, Kolts RL, Khan A Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports Biol Psychiatry, 2007.PMID 17223086
11. [11]Pisani F, Oteri G, Costa C, Di Raimondo G, Di Perri R Effects of psychotropic drugs on seizure threshold Drug Saf, 2002.PMID 11888352
12. [12]Mula M Epilepsy and Psychiatric Comorbidities: Drug Selection Curr Treat Options Neurol, 2017.PMID 29046989
13. [13]Maguire MJ, Marson AG, Nevitt SJ Antidepressants for people with epilepsy and depression Cochrane Database Syst Rev, 2021.PMID 33860531
14. [14]Lu E, Pyatka N, Burant CJ, Sajatovic M Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy J Clin Neurol, 2021.PMID 33835737
15. [15]de Toffol B, Trimble M, Hesdorffer DC, et al. Pharmacotherapy in patients with epilepsy and psychosis Epilepsy Behav, 2018.PMID 30241054
16. [16]Mula M Suicidality and antiepileptic drugs in people with epilepsy: an update Expert Rev Neurother, 2022.PMID 35394392