The clinical characteristics of interictal schizophrenia-like psychosis in epilepsy_Journal of Epilepsy

Authors：

CHEN Yanyan ¹ , WU Qiong ¹ , YANG Jinyu ¹ ,  SANG Hong ¹ ,  LIN Weihong ²

1. The Epilepsy Comorbid Clinic of the Sixth Hospital of Changchun, Changchun 130052, China;
2. Department of Neurology,The First Hospital of Jilin University, Changchun 130021, China;

Corresponding author：

SANG Hong, Email: sanghong2008@sina.com; LIN Weihong, Email: linweihong321@126.com

Keywords：

Epilepsy; Schizophrenia; Psychosis; Schizophrenia-like psychosis

DOI：

10.7507/2096-0247.20200064

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Object Aimed to describe the clinical characteristics of the patients with interictal schizophrenia-like psychoses of epilepsy (SLPE), so as to improve the identification, diagnosis and treatment.Methods We collected the cases from January 2017 to December 2019 that diagnosed as "epileptic psychosis/organic mental disorders/brain damage and functional disorders and somatic diseases caused by other mental disorders/organic delusions (schizophrenia-like) disorders" in the medical record system of the Sixth Hospital of Changchun. The discharge records were re-diagnosed by two experienced epilepsy specialists and psychiatrists respectively. Retrospective statistical analysis was performed on the cases identified as SLPE.Results A total of 45 patients were diagnosed as SLPE (male: female=1:1.4). The onset age of epilepsy and mental symptoms was (16.4±12.5) years and (35.3±13.4) years respectively. The duration of mental symptoms after first seizure was (18.9±13.4) years. 7 patients (15.6%) were not treated with AEDs, and 26 patients (57.8%) were treated with first generation AEDs. 8 patients (17.8%) had no seizures within 1 year before the onset of mental symptoms, and 28 patients (62.2%) had frequent seizures, even status epilepticus or clustered seizures. 2 patients (4.4%) had generalized tonic-clonic seizure, only 4 patients (8.9%) showed focal impaired awareness seizure, and 39 patients (86.7%) had focal to bilateral tonic-clonic seizure.The PANSS positive symptom score, PANSS negative symptom score and BPRS score were (15.1±4.4), (17.7±4.6) and (44.7±8.4) respectively.Conclusion There were some features of epilepsy in SLPE, such as early onset age, frequent seizure (some patients were seizure-free), focal epilepsy, and poor AEDs treatment compliance. The onset age of mental symptoms in SLPE was later than Schizophrenia and long duration after first seizure. The PANSS scale showed that the mental symptoms of patients with SLPE were similar to those of patients with schizophrenia, and both positive and negative symptoms existed.

Citation： CHEN Yanyan, WU Qiong, YANG Jinyu, SANG Hong, LIN Weihong. The clinical characteristics of interictal schizophrenia-like psychosis in epilepsy. Journal of Epilepsy, 2020, 6(5): 402-406. doi: 10.7507/2096-0247.20200064 Copy

1.	Jeżowska-Jurczyk K, Kotas R, Jurczyk P, <italic>et al</italic>. Mental disorders in patients with epilepsy. Zaburzenia psychiczne u chorych na padaczkę. Psychiatr Pol, 2020, 54(1): 51-68.
2.	Agrawal N, Mula M. Treatment of psychoses in patients with epilepsy: an update. Ther Adv Psychopharmacol, 2019, 9: 2045125319862968.
3.	Kandratavicius L, Hallak JE, Leite JP. What are the similarities and differences between schizophrenia and schizophrenia-like psychosis of epilepsy? A neuropathological approach to the understanding of schizophrenia spectrum and epilepsy. Epilepsy Behav, 2014, 38: 143-147.
4.	Clancy MJ, Clarke MC, Connor DJ, <italic>et al</italic>. The prevalence of psychosis in epilepsy: A systematic review and meta-analysis. BMC Psychiatry, 2014, 14(1): 75.
5.	Ma J, Leung LS. Dual effects of limbic seizures on psychosis-relevant behaviors shown by nucleus accumbens kindling in rats. Brain Stimul, 2016, 9(5): 762-769.
6.	Maguire M, Singh J, Marson A. Epilepsy and psychosis: a practical approach. Pract Neurol, 2018, 18(1): 106-114.
7.	Qin P, Xu H, Laursen TM, <italic>et al</italic>. Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study. BMJ, 2005, 331(7507): 23.
8.	Tadokoro Y, Oshima T, Kanemoto K. Interictal psychoses in comparison with schizophrenia--a prospective study. Epilepsia, 2007, 48(12): 2345-2351.
9.	Marder SR, Cannon TD. Schizophrenia. N Engl J Med, 2019, 381(18): 1753-1761.
10.	Kanemoto K, Tadokoro Y, Oshima T. Psychotic illness in patients with epilepsy. Ther Adv Neurol Disord, 2012, 5(6): 321-334.
11.	Slater E, Beard AW, Glithero E. The schizophrenia- like psychoses of epilepsy. Br J Psychiatry, 1963, 109(2): 95-150.
12.	Flugel D, Cercignani M, Symms MR, <italic>et al</italic>. A magnetization transfer imaging study in patients with temporal lobe epilepsy and interictal psychosis. Biol Psychiatry, 2006, 59(3): 560-567.
13.	Matsuura M, Adachi N, Oana Y, <italic>et al</italic>. A polydiagnostic and dimensional comparison of epileptic psychoses and schizophrenia spectrum disorders. Schizophr Res, 2004, 69(2): 189-201.
14.	Adachi N, Kanemoto K, de Toffol B, <italic>et al</italic>. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia, 2013, 54(Suppl 1): 19-33.
15.	Landolt H. Some clinical EEG correlations in epileptic psychosis (twilight states). EEG Clin Neurophysiol, 1953, 5: 121.
16.	Tellenbach H. Epilepsie als Anfallesleiden und als Psychose. Über alternative Psychosen paranoider Prägung bei ‘forcierter Normalisierung’ (Landolt) des Elektroenzephalogramms. Epileptischer. Nervenarzt, 1965, 36(2): 190-202.
17.	Krishnamoorthy ES, Trimble MR. Forced normalization: clinical and therapeutic relevance. Epilepsia, 1999, 40(Suppl): 57-64.
18.	Kawakami Y, Itoh Y. Forced normalization: antagonism between epilepsy and psychosis. Pediatric Neurology, 2017, 70(1): 16-19.
19.	Calle-López Y, Ladino LD, Benjumea-Cuartas V, <italic>et al</italic>. Forced normalization: A systematic review. Epilepsia, 2019, 60(8): 1610-1618.

1. Jeżowska-Jurczyk K, Kotas R, Jurczyk P, <italic>et al</italic>. Mental disorders in patients with epilepsy. Zaburzenia psychiczne u chorych na padaczkę. Psychiatr Pol, 2020, 54(1): 51-68.
2. Agrawal N, Mula M. Treatment of psychoses in patients with epilepsy: an update. Ther Adv Psychopharmacol, 2019, 9: 2045125319862968.
3. Kandratavicius L, Hallak JE, Leite JP. What are the similarities and differences between schizophrenia and schizophrenia-like psychosis of epilepsy? A neuropathological approach to the understanding of schizophrenia spectrum and epilepsy. Epilepsy Behav, 2014, 38: 143-147.
4. Clancy MJ, Clarke MC, Connor DJ, <italic>et al</italic>. The prevalence of psychosis in epilepsy: A systematic review and meta-analysis. BMC Psychiatry, 2014, 14(1): 75.
5. Ma J, Leung LS. Dual effects of limbic seizures on psychosis-relevant behaviors shown by nucleus accumbens kindling in rats. Brain Stimul, 2016, 9(5): 762-769.
6. Maguire M, Singh J, Marson A. Epilepsy and psychosis: a practical approach. Pract Neurol, 2018, 18(1): 106-114.
7. Qin P, Xu H, Laursen TM, <italic>et al</italic>. Risk for schizophrenia and schizophrenia-like psychosis among patients with epilepsy: population based cohort study. BMJ, 2005, 331(7507): 23.
8. Tadokoro Y, Oshima T, Kanemoto K. Interictal psychoses in comparison with schizophrenia--a prospective study. Epilepsia, 2007, 48(12): 2345-2351.
9. Marder SR, Cannon TD. Schizophrenia. N Engl J Med, 2019, 381(18): 1753-1761.
10. Kanemoto K, Tadokoro Y, Oshima T. Psychotic illness in patients with epilepsy. Ther Adv Neurol Disord, 2012, 5(6): 321-334.
11. Slater E, Beard AW, Glithero E. The schizophrenia- like psychoses of epilepsy. Br J Psychiatry, 1963, 109(2): 95-150.
12. Flugel D, Cercignani M, Symms MR, <italic>et al</italic>. A magnetization transfer imaging study in patients with temporal lobe epilepsy and interictal psychosis. Biol Psychiatry, 2006, 59(3): 560-567.
13. Matsuura M, Adachi N, Oana Y, <italic>et al</italic>. A polydiagnostic and dimensional comparison of epileptic psychoses and schizophrenia spectrum disorders. Schizophr Res, 2004, 69(2): 189-201.
14. Adachi N, Kanemoto K, de Toffol B, <italic>et al</italic>. Basic treatment principles for psychotic disorders in patients with epilepsy. Epilepsia, 2013, 54(Suppl 1): 19-33.
15. Landolt H. Some clinical EEG correlations in epileptic psychosis (twilight states). EEG Clin Neurophysiol, 1953, 5: 121.
16. Tellenbach H. Epilepsie als Anfallesleiden und als Psychose. Über alternative Psychosen paranoider Prägung bei ‘forcierter Normalisierung’ (Landolt) des Elektroenzephalogramms. Epileptischer. Nervenarzt, 1965, 36(2): 190-202.
17. Krishnamoorthy ES, Trimble MR. Forced normalization: clinical and therapeutic relevance. Epilepsia, 1999, 40(Suppl): 57-64.
18. Kawakami Y, Itoh Y. Forced normalization: antagonism between epilepsy and psychosis. Pediatric Neurology, 2017, 70(1): 16-19.
19. Calle-López Y, Ladino LD, Benjumea-Cuartas V, <italic>et al</italic>. Forced normalization: A systematic review. Epilepsia, 2019, 60(8): 1610-1618.

Journal of Epilepsy

The clinical characteristics of interictal schizophrenia-like psychosis in epilepsy

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