Original Article

Psychosis of Epilepsy: A 10-Year Iranian Clinical Survey

Abstract

Objective: Psychoses of epilepsy usually have an acute onset, accompanied by brief symptom duration and a risk of recurrence. Managing these conditions can be challenging due to the potential for seizures associated with certain antipsychotic medications, as well as exacerbating psychosis resulting from some antiepileptic medications. Our objective in this study was to assess the occurrence of psychosis among patients with epilepsy, as well as identify the factors linked to the presence and severity of psychosis in this population.
Method: In this study, we included a total of 514 subjects diagnosed with epilepsy referring to our neuropsychiatry clinic affiliated with Tehran University of Medical Sciences from April 2011 to December 2021, among whom 57 patients showed psychotic presentations. We compared baseline and clinical characteristics between patients with psychosis of epilepsy and non-psychosis patients who also had epilepsy.
Results: Marital status was the sole demographic factor that displayed a statistically significant difference between the psychosis and non-psychosis groups (P = 0.019). There was no significant difference observed between the two groups regarding family history of epilepsy and age at the onset of the epilepsy. Patients with psychosis experienced significantly more frequent seizures and generalized type (P < 0.001). Participants were matched for demographics and other clinical factors between the refractory and controlled psychosis groups, except for the psychosis frequency (P = 0.007). The type of epilepsy was significantly associated with psychosis when adjusted for the covariates (P < 0.001).
Conclusion: Patients with psychosis of epilepsy experienced more episodes of epilepsy than non-psychotics. We identified generalized epilepsy as an independent risk factor for the development of psychosis. Additional cohorts are warranted to explore the factors associated with epilepsy-related psychosis across diverse populations.

1. Ghosh S, Sinha JK, Khan T, Devaraju KS, Singh P, Vaibhav K, et al. Pharmacological and Therapeutic Approaches in the Treatment of Epilepsy. Biomedicines. 2021;9(5).
2. Espinosa-Jovel C, Toledano R, Aledo-Serrano Á, García-Morales I, Gil-Nagel A. Epidemiological profile of epilepsy in low income populations. Seizure. 2018;56:67-72.
3. Beghi E. The Epidemiology of Epilepsy. Neuroepidemiology. 2020;54(2):185-91.
4. Fiest KM, Sauro KM, Wiebe S, Patten SB, Kwon CS, Dykeman J, et al
5. . Prevalence and incidence of epilepsy: A systematic review and meta-analysis of international studies. Neurology. 2017;88(3):296-303.
6. Global, regional, and national burden of neurological disorders, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Neurol. 2019;18(5):459-80.
7. Singh G, Sander JW. The global burden of epilepsy report: Implications for low- and middle-income countries. Epilepsy Behav. 2020;105:106949.
8. Maguire M, Singh J, Marson A. Epilepsy and psychosis: a practical approach. Pract Neurol. 2018;18(2):106-14.
9. 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;14:75.
10. Kanner AM, Rivas-Grajales AM. Psychosis of epilepsy: a multifaceted neuropsychiatric disorder. CNS Spectr. 2016;21(3):247-57.
11. Wotton CJ, Goldacre MJ. Coexistence of schizophrenia and epilepsy: record-linkage studies. Epilepsia. 2012;53(4):e71-4.
12. Chang YT, Chen PC, Tsai IJ, Sung FC, Chin ZN, Kuo HT, et al. Bidirectional relation between schizophrenia and epilepsy: a population-based retrospective cohort study. Epilepsia. 2011;52(11):2036-42.
13. Briellmann RS, Kalnins RM, Hopwood MJ, Ward C, Berkovic SF, Jackson GD. TLE patients with postictal psychosis: mesial dysplasia and anterior hippocampal preservation. Neurology. 2000;55(7):1027-30.
14. Tebartz Van Elst L, Baeumer D, Lemieux L, Woermann FG, Koepp M, Krishnamoorthy S, et al. Amygdala pathology in psychosis of epilepsy: A magnetic resonance imaging study in patients with temporal lobe epilepsy. Brain. 2002;125(Pt 1):140-9.
15. Guarnieri R, Wichert-Ana L, Hallak JE, Velasco TR, Walz R, Kato M, et al. Interictal SPECT in patients with mesial temporal lobe epilepsy and psychosis: a case-control study. Psychiatry Res. 2005;138(1):75-84.
16. Chen Z, Lusicic A, O'Brien TJ, Velakoulis D, Adams SJ, Kwan P. Psychotic disorders induced by antiepileptic drugs in people with epilepsy. Brain. 2016;139(Pt 10):2668-78.
17. Piedad J, Rickards H, Besag FM, Cavanna AE. Beneficial and adverse psychotropic effects of antiepileptic drugs in patients with epilepsy: a summary of prevalence, underlying mechanisms and data limitations. CNS Drugs. 2012;26(4):319-35.
18. Lu E, Pyatka N, Burant CJ, Sajatovic M. Systematic Literature Review of Psychiatric Comorbidities in Adults with Epilepsy. J Clin Neurol. 2021;17(2):176-86.
19. Irwin LG, Fortune DG. Risk factors for psychosis secondary to temporal lobe epilepsy: a systematic review. J Neuropsychiatry Clin Neurosci. 2014;26(1):5-23.
20. Nadkarni S, Arnedo V, Devinsky O. Psychosis in epilepsy patients. Epilepsia. 2007;48 Suppl 9:17-9.
21. Hesdorffer DC, Ishihara L, Mynepalli L, Webb DJ, Weil J, Hauser WA. Epilepsy, suicidality, and psychiatric disorders: a bidirectional association. Ann Neurol. 2012;72(2):184-91.
22. Swinkels WA, Kuyk J, van Dyck R, Spinhoven P. Psychiatric comorbidity in epilepsy. Epilepsy Behav. 2005;7(1):37-50.
23. Jensen I, Larsen JK. Mental aspects of temporal lobe epilepsy. Follow-up of 74 patients after resection of a temporal lobe. J Neurol Neurosurg Psychiatry. 1979;42(3):256-65.
24. Adelöw C, Andersson T, Ahlbom A, Tomson T. Hospitalization for psychiatric disorders before and after onset of unprovoked seizures/epilepsy. Neurology. 2012;78(6):396-401.
25. de Araújo Filho GM, da Silva JM, Mazetto L, Marchetti RL, Yacubian EM. Psychoses of epilepsy: a study comparing the clinical features of patients with focal versus generalized epilepsies. Epilepsy Behav. 2011;20(4):655-8.
26. Van Os J, Driessen G, Gunther N, Delespaul P. Neighbourhood variation in incidence of schizophrenia. Evidence for person-environment interaction. Br J Psychiatry. 2000;176:243-8.
27. Zimbrón J, Ruiz de Azúa S, Khandaker GM, Gandamaneni PK, Crane CM, González-Pinto A, et al. Clinical and sociodemographic comparison of people at high-risk for psychosis and with first-episode psychosis. Acta Psychiatr Scand. 2013;127(3):210-6.
28. Behere PB, Rao ST, Verma K. Effect of marriage on pre-existing psychoses. Indian J Psychiatry. 2011;53(4):287-8.
29. Nyer M, Kasckow J, Fellows I, Lawrence EC, Golshan S, Solorzano E, et al. The relationship of marital status and clinical characteristics in middle-aged and older patients with schizophrenia and depressive symptoms. Ann Clin Psychiatry. 2010;22(3):172-9.
30. Pinckaers FME, Boon ME, Majoie M. Risk factors predisposing to psychotic symptoms during levetiracetam therapy: A retrospective study. Epilepsy Behav. 2019;100(Pt A):106344.
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IssueVol 18 No 4 (2023) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v18i4.13634
Keywords
Epilepsy Generalized Epilepsy Health Survey Partial Epilepsy Psychotic Disorders

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How to Cite
1.
Shafie M, Darijani J, Mirsepassi Z, Razavi A, Mayeli M, Arbabi M, Aghamollaii V. Psychosis of Epilepsy: A 10-Year Iranian Clinical Survey. Iran J Psychiatry. 2023;18(4):476-483.