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Am J Psychiatry 1995; 152:224-231
Copyright © 1995 by American Psychiatric Association
Postictal and chronic psychoses in patients with temporal lobe epilepsy
D Umbricht, G Degreef, WB Barr, JA Lieberman, S Pollack and N Schaul
Psychiatric Research Department, Hillside Hospital, Glen Oaks, NY 11004.
OBJECTIVE: This study sought to elucidate the relation of clinical,
neuropsychological, and seizure variables to chronic and postictal
psychoses in patients with temporal lobe epilepsy. METHOD: Forty-four
patients with treatment-refractory temporal lobe epilepsy were given formal
psychiatric evaluations; 29 patients had no psychiatric disorder or a
nonpsychotic disorder, eight patients had postictal psychoses, and seven
patients had chronic psychoses. Comparisons of clinical,
neuropsychological, magnetic resonance imaging, and seizure variables were
made between the nonpsychotic and the psychotic patients and, secondarily,
between the patients with transient postictal psychoses and those with
chronic psychoses. RESULTS: Bitemporal seizure foci, clustering of
seizures, and absence of febrile convulsions were associated with both
postictal psychoses and chronic psychoses. Younger age at onset of epilepsy
and lower verbal and full-scale IQs differentiated the patients with
chronic psychoses from those with postictal psychoses. CONCLUSIONS:
Patients with temporal lobe epilepsy with chronic and postictal psychoses
show similar profiles of clinical and seizure variables, suggesting shared
etiologic factors. These factors may increase the propensity to develop
psychotic symptoms, while other factors, such as time of onset of epilepsy
and underlying neuropathology, may determine whether transient or chronic
psychotic symptoms develop. Even among patients with treatment-refractory
temporal lobe epilepsy, a specific subgroup of patients, characterized by
bitemporal seizure foci, an absence of febrile convulsions, and a history
of clustering of seizures, appears to be particularly prone to develop
psychotic disorders. A process similar to secondary epileptogenesis may be
involved in the development of the psychoses.
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