Psych · Foundations — EEG and clinical neurophysiology
EEG and clinical neurophysiology in psychiatry
Also known as EEG in psychiatry · Clinical neurophysiology psychiatry · Electroencephalography psychiatric practice · qEEG psychiatry · Event-related potentials psychiatry · P300 MMN schizophrenia · Nonconvulsive status epilepticus psychiatry · Clozapine EEG seizures
Exam-exhaustive fellowship foundation on EEG and clinical neurophysiology for psychiatrists: indications and yield, frequency bands and report literacy, NCSE and continuous EEG, psychotropic and clozapine effects, ERPs (P300/MMN) and qEEG as research tools, anti-NMDA patterns, and epilepsy–psychiatry interface essentials. FRANZCP-primary, globally tagged.
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Target exams
Red flags
- Fluctuating awareness, mutism, or new behavioural change without recovery of full consciousness — exclude nonconvulsive status epilepticus with urgent EEG, not psychiatry alone
- New psychosis or catatonia with fever, seizures, dysautonomia, or focal neurology — organic/autoimmune work-up including EEG and imaging
- Seizure cluster followed by lucid interval then psychosis — treat as postictal psychosis until proven otherwise; high short-term risk
- Psychiatric worsening after sudden seizure freedom or EEG improvement — consider forced normalisation
- New seizures or marked EEG epileptiform change on clozapine — review dose, levels, interactions; do not abandon clozapine without a joint plan if still indicated
- A normal EEG does not exclude epilepsy, encephalitis, or primary psychiatric illness — never use a single normal tracing as proof of 'functional only'
- Do not base DSM/ICD diagnosis or involuntary treatment on commercial qEEG brain maps alone
Meet the patient — one ward has labelled "uncooperative"
A 41-year-old man on clozapine, three weeks into a dose escalation, has stopped answering questions. Nursing staff report he was "fine yesterday", then vague, then mute. He is not posturing. He is not febrile. He looks, to a tired team, like someone refusing to engage.[1][6]
His attention is not merely poor — it fluctuates within your single interview. He half-tracks the door, then loses you mid-sentence. Nobody has seen a convulsion, so nobody has thought about seizures.[6][7]
Two questions are now live, and both have an EEG in the answer: is this nonconvulsive status epilepticus, and is the clozapine implicated? Everything below exists so that you ask them at 2am rather than at the mortality meeting.[6][9][10]
References14ShowHide
- [1]O'Sullivan SS, Mullins GM, Cassidy EM, et al. The role of the standard EEG in clinical psychiatry Hum Psychopharmacol, 2006.PMID 16783810
- [2]Boutros NN A review of indications for routine EEG in clinical psychiatry Hosp Community Psychiatry, 1992.PMID 1516903
- [3]Jefsen OH, et al. The clinical use of electroencephalography in a general psychiatric setting Nord J Psychiatry, 2023.PMID 36927234
- [4]Sand T, Bjørk MH, Vaaler AE Is EEG a useful test in adult psychiatry? Tidsskr Nor Laegeforen, 2013.PMID 23759782
- [5]Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications J Clin Neurophysiol, 2015.PMID 25626778
- [6]Beniczky S, Hirsch LJ, Kaplan PW, et al. Unified EEG terminology and criteria for nonconvulsive status epilepticus Epilepsia, 2013.PMID 24001066
- [7]Claassen J, Mayer SA, Kowalski RG, et al. Detection of electrographic seizures with continuous EEG monitoring in critically ill patients Neurology, 2004.PMID 15159471
- [8]Hirsch LJ, Fong MWK, Leitinger M, et al. American Clinical Neurophysiology Society's Standardized Critical Care EEG Terminology: 2021 Version J Clin Neurophysiol, 2021.PMID 33475321
- [9]Centorrino F, Price BH, Tuttle M, et al. EEG abnormalities during treatment with typical and atypical antipsychotics Am J Psychiatry, 2002.PMID 11772698
- [10]Pacia SV, Devinsky O Clozapine-related seizures: experience with 5,629 patients Neurology, 1994.PMID 7991106
- [11]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
- [12]Umbricht D, Krljes S Mismatch negativity in schizophrenia: a meta-analysis Schizophr Res, 2005.PMID 15927795
- [13]Schmitt SE, Pargeon K, Frechette ES, et al. Extreme delta brush: a unique EEG pattern in adults with anti-NMDA receptor encephalitis Neurology, 2012.PMID 22933737
- [14]Dalmau J, Gleichman AJ, Hughes EG, et al. Anti-NMDA-receptor encephalitis: case series and analysis of the effects of antibodies Lancet Neurol, 2008.PMID 18851928