1/42. Attempted child-stealing: post-ictal psychosis and psychological distress.Baby-stealing is probably one of the more taboo crimes in our society. Its connection with psychological distress, while generally acknowledged, is not always well understood. In this paper we present an unusual and complex case of a woman who attempted to steal young babies while in a state of extreme psychological distress following epileptic seizures. While the post-epileptic state was characterized as 'psychotic' there were clear psychological antecedents to explain the form in which the postical psychosis was expressed. Treatment strategies included modification of medication regime and use of cognitive therapy to ameliorate the impact of postictal confusion.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
2/42. Is schizophrenia a risk factor for epilepsy or acute symptomatic seizures?PURPOSE: The precise prevalence of epilepsies and seizures in patients with schizophrenia remains unclear. methods: To assess the prevalence of epilepsy and of acute symptomatic seizures in schizophrenics, we conducted a survey in a urban sector of Marseilles that includes 56,910 inhabitants, among whom 1,154 had been treated for psychiatric disorders, including 460 for schizophrenia or paranoid disorder (PD) (DSM III-R 295 and 297.1, respectively; mean age, 41.9 years; range, 17-79 years; 215 men and 245 women). RESULTS: All 460 patients were receiving long-term neuroleptic drug therapy, and 397 had been hospitalized at least once in the past year, whereas 63 were followed up as outpatients only. seizures were present in the history of 12 patients: five had various forms of chronic epilepsy (four men, one woman; DSM III-R 295.1, one case; 295.3, two cases; 295.9, two cases), and three of these experienced seizures only after the onset of their psychiatric condition; five had acute symptomatic seizures (four men, one woman; 295.1, two cases; 295.3, 295.9, and 297.1, one case), and two had only pseudoepileptic events (both 295.3). CONCLUSIONS: This survey shows that the prevalence of epilepsy and acute symptomatic seizures is comparatively low in patients with schizophrenia or PD (10.8 per thousand each, respectively), and that the prevalence of a history of seizures (21.7 per thousand in this study) is not particularly increased in this middle-aged population. In contrast to childhood-onset autistic disorders, schizophrenia or PD are not major risk factors for epilepsy or acute symptomatic epileptic seizures.- - - - - - - - - - ranking = 2.3147295147933keywords = schizophrenia (Clic here for more details about this article) |
3/42. Psychotic episodes during zonisamide treatment.Several articles have appeared over the last years devoted to mental side effects during zonisamide (ZNS) treatment. In this study, we were particularly interested in psychotic episodes. Seventy-four epileptic patients with a history of ZNS treatment were surveyed retrospectively over the period spanning 1 March 1984 to 30 June 1994. They were divided into two groups according to the presence or absence of psychotic episodes during ZNS treatment. We analysed various factors pertaining to psychotic episodes during ZNS treatment. Of the 74 patients 14 had psychotic episodes. We found that the incidence of psychotic episodes during ZNS treatment was several times higher than the previously reported prevalence of epileptic psychosis, and that the risk of psychotic episodes was higher in young patients. In 13 patients, psychotic episodes occurred within a few years of commencement of ZNS. In children, obsessive-compulsive symptoms appeared to be related to psychotic episodes. It is important to terminate ZNS as soon as possible if psychotic episodes develop and never restart, even if seizures become worse. It cannot definitely be proved that ZNS causes psychotic episodes, as information on mental side effects during ZNS monotherapy is scant, but it does appear likely that ZNS contributes to psychotic episodes during polytherapy.- - - - - - - - - - ranking = 11keywords = psychotic (Clic here for more details about this article) |
4/42. Treatment of the interictal psychoses.BACKGROUND: The interictal "schizophrenia-like" psychoses of epilepsy conventionally are treated with antipsychotic medication with uncertain results. In patients with these psychoses, a preceding and concomitant dysphoric disorder usually can be documented. Effectiveness of the pharmacologic treatment by the combination of drugs that is effective for severe interictal dysphoric disorders is demonstrated in a series of patients with interictal psychosis. METHOD: Patients were treated with the combination of a tricyclic antidepressant and a selective serotonin reuptake inhibitor, enhanced if necessary by a small amount of the atypical neuroleptic risperidone. The series consisted of 8 consecutive patients with interictal psychosis seen over a 20-month period. Two additional patients seen over the past 10 years who required a different therapeutic intervention were also included. RESULTS: Five of the 8 consecutive patients achieved full remission of their psychosis; 3 patients could not be reached for the full treatment effort. One patient with a malignant psychosis had been treated successfully (prior to the series reported) by surgical removal of a left frontal epileptogenic zone; a second patient (treated after the series) recovered only upon elimination of the antiepileptic drug that had suppressed clinical seizures but had resulted in an alternating psychosis. CONCLUSION: Interictal psychoses can be viewed as severe interictal dysphoric disorders with psychotic features. The same combination of psychotropic medication that is effective for severe interictal dysphoric disorders serves as the primary therapy for interictal psychoses. The interictal psychiatric disorders presumably result from seizure-suppressing mechanisms that are the targets of the proconvulsant drugs. Upon suppression of seizures, some patients with interictal psychosis may require modification of the antiepileptic medication responsible for excessive inhibition. Complete surgical removal of the epileptogenic zone can eliminate a chronic interictal psychosis upon postoperative fading of inhibitory mechanisms.- - - - - - - - - - ranking = 2.2893411893492keywords = psychotic, schizophrenia (Clic here for more details about this article) |
5/42. Postictal psychosis with forced normalization.A 22-year-old female patient with epilepsy for more than six years who had prominent psychiatric manifestations, including paranoia, delusions and hallucinations, after a series of major seizure attacks caused by sudden withdrawal of anticonvulsant medication was monitored. This reported episode of psychosis occurred eight hours after the last seizure attack and lasted for two weeks. The psychosis gradually disappeared after administration of lorazepam. The electroencephalogram (EEG) performed during the period of psychosis showed intermittent slow activity in the bilateral frontal regions of the brain. There were active bisynchronous epileptiform discharges bisynchronously in both frontotemporal regions after the resolution of the psychotic episode. The clinical picture and course were consistent with the diagnosis of "postictal psychosis", and the transient near normal EEG during psychosis was most likely a phenomenon known as "forced normalization". The patient has not had a similar psychotic attack since the one reported here.- - - - - - - - - - ranking = 2keywords = psychotic (Clic here for more details about this article) |
6/42. Left temporal rhythmic electrical activity: a correlate for psychosis? A case report.It is well recognized that epileptic patients are at higher risk for acute or chronic psychotic states than non-epileptic subjects. Here we present intracranial depth electrode recordings during a psychotic episode in a 20-year-old woman who was referred for presurgical evaluation. Unrelated to her seizures, she presented acoustic hallucinations and delusions and became agitated for a duration of 18-24 hours. During this period, a new unusual pattern of sharp slow waves was seen semi-rhythmically every 2-3 sec from left anterior neocortical temporal areas. Her condition responded well to a treatment with haloperidol, but not with benzodiazepines. Ictal and interictal scalp- and depth-EEG recordings outside the psychotic episode as well as MRI-based volumetry, PET, SPECT and neuropsychological testing gave evidence of bilateral temporal and frontal dysfunction. This case report suggests that psychosis in epileptic patients may be based on a bilateral cerebral dysfunction linked together in a pathological network, but with a focal (here: left temporal) driving mechanism.- - - - - - - - - - ranking = 3keywords = psychotic (Clic here for more details about this article) |
7/42. Three children with a syndrome of obesity and overgrowth, atypical psychosis, and seizures: a problem in neuropsychopharmacology.Three children presented with a complex syndrome of atypical psychotic and extremely immature behavior, obesity and overgrowth, borderline retardation, and seizures (prominent in two). Weight overgrowth exceeded height overgrowth and was stratospheric (up to 8 SD above mean). obesity seemed related to lack of satiety. The cases fit no known condition: hypothalamic damage, Sotos' syndrome, and prader-willi syndrome were excluded. Empirical treatment with anticonvulsants (carbamazepine and acetazolamide) together with psychotropic agents (selective serotonin reuptake inhibitors and risperidone) controlled seizures, improved behavior, and stopped weight gain in each patient. We have not found this syndrome previously described. The etiology is unknown: perinatal encephalopathy could be a factor in the two patients with prominent seizures; in the third, familial major affective disorder is implicated. Medication responses suggest a low-serotonin state underlying the lack of satiety, an imbalance of serotonin and noradrenergic modulation in the hypothalamus, and epileptogenic disorders (or affective disorder responsive to anticonvulsants in one case) involving these same systems.- - - - - - - - - - ranking = 1keywords = psychotic (Clic here for more details about this article) |
8/42. Transient ictal psychosis.Transient psychotic episodes may result from continuous cerebral epileptiform discharges unaccompanied by clinically observed seizures. Such episodes may mimic depressive, hysterical and schizophrenic psychosis and delirium. I describe two patients here and review eight patient histories from the literature. diagnosis is established by use of electroencephalography during the psychotic episode. Correct diagnosis is essential because specific treatment is available and additional episodes may be prevented by appropriate long-term anticonvulsant therapy.- - - - - - - - - - ranking = 2keywords = psychotic (Clic here for more details about this article) |
9/42. Progression of postictal to interictal psychosis.PURPOSE: To describe a case series of patients with both postictal psychosis (PIP) and chronic interictal psychosis (IIP). methods: We retrospectively reviewed the records of 43 patients with PIP from a comprehensive epilepsy center to find evidence of both PIP and IIP in the same patient. RESULTS: Six (13.9%) of the 43 patients met all the criteria for both PIP and IIP. Five of our six patients had multiple documented PIPs before they became chronically psychotic. The range of length of time between PIP and IIP was 7 to 96 months. Postictal and interictal psychotic behavior was similar or identical in five of six cases. CONCLUSIONS: The results of this study suggest a progression from PIP to IIP: there is a similarity between the symptoms of the two psychoses, a history of multiple PIPs before the first IIP, and a period of months to years between PIP and IIP onset.- - - - - - - - - - ranking = 2keywords = psychotic (Clic here for more details about this article) |
10/42. Acute psychotic disorders induced by topiramate: report of two cases.We report on two epileptic patients who developed acute psychosis after the use of topiramate (TPM). One patient exhibited severe psychomotor agitation, heteroaggressiveness, auditory and visual hallucinations as well as severe paranoid and mystic delusions. The other patient had psychomotor agitation, depersonalization, derealization, severe anxiety and deluded that he was losing his memory. Both patients had to be taken to the casualty room. After interruption of TPM in one patient and reduction of dose in the other, a full remission of the psychotic symptoms was obtained without the need of antipsychotic drugs. Clinicians should be aware of the possibility of development of acute psychotic symptoms in patients undergoing TPM treatment.- - - - - - - - - - ranking = 7keywords = psychotic (Clic here for more details about this article) |
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