Psychosis in Epilepsy

Psychosis develops in 2–7% of people with epilepsy (PWE). Psychotic syndromes in PWE have traditionally been classified according to their temporal relationship to seizure events: ictal, postictal, and interictal. There are several risk factors for developing a psychosis of epilepsy. Temporal lobe epilepsy appears to be more closely associated with psychosis. Ictal psychosis is a psychosis concurrently associated with epileptic discharges in the brain. The proposed two mechanisms of ictal psychosis are the positive and negative effects of ictal discharges. Experiential phenomena in ictal psychosis are likely to be due to positive effects, whereas automatisms may be caused by positive or negative effects. The definition of interictal psychosis is a psychotic disorder that would fulfill diagnostic criteria for schizophrenia if epilepsy was not present. Interictal psychosis can develop when seizures are fully controlled. These psychoses last from days to weeks. The forced normalization is that the EEG of PWE looks less pathological when their behavior deteriorates. The definition of postictal psychosis (PIP) is a psychosis that develops immediately after a seizure or within 1 week of return to apparently normal mental function. The psychosis must last for a minimum length of 24 h and a maximum length of 3 months. Postictal psychosis is a brief affective and psychotic episode with behavioral disturbances and occurs in patients with long-lasting, mostly refractory focal epilepsy. Aside from seizures, antiepileptic drugs may also result in psychosis in PWE. Acute psychosis can be controlled using benzodiazepine and antipsychotics.