Interictal psychosis of epilepsy: What is the role of the neurologist? - PubMed

Interictal psychosis of epilepsy: What is the role of the neurologist?

Luis Pintor et al. Epilepsy Behav Rep. 2024.

Abstract

Psychotic disorders are more frequent in people with epilepsy than the general population. They constitute one of the most serious psychiatric comorbidities which require an immediate psychopharmacologic intervention. Yet, access to psychiatrists is often limited or not available and the neurologists taking care of these patients are called-upon to start treatment with antipsychotic medication. The purpose of this manuscript is to provide clinicians with pragmatic psychopharmacologic strategies to treat interictal psychotic disorders in patients with epilepsy. We review the case of a 45 years-old man with a 35-year history of treatment-resistant focal epilepsy of bitemporal origin who developed a de-novo psychotic episode that began with insomnia, mood lability and agitation and evolved into paranoid delusions, auditory hallucinations and a thought disorder. The patient was diagnosed with an interictal psychotic episode and was treated with aripiprazole which resulted in significant improvement after reaching a 20 mg /day dose and allowed for the patient to be discharged home. In summary, interictal psychotic episodes of epilepsy are relatively frequent in patients with epilepsy and require of an early psychopharmacologic treatment to facilitate their remission or stabilization until mental health professionals can take over their long-term care. Compared to primary psychotic disorders, interictal psychotic episodes respond better and at lower doses of antipsychotic drugs.

Keywords: Atypical antipsychotic drugs; Iatrogenic psychotic episodes; Rsperidone aripiprazole; Schizophrenia-like psychosis of epilepsy.

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Similar articles

• [Interictal psychosis of epilepsy].

  de Toffol B, Adachi N, Kanemoto K, El-Hage W, Hingray C. de Toffol B, et al. Encephale. 2020 Dec;46(6):482-492. doi: 10.1016/j.encep.2020.04.014. Epub 2020 Jun 25. Encephale. 2020. PMID: 32594995 French.

• Psychotic Disorders in Epilepsy: Do They Differ from Primary Psychosis?

  Kanemoto K. Kanemoto K. Curr Top Behav Neurosci. 2022;55:183-208. doi: 10.1007/7854_2021_234. Curr Top Behav Neurosci. 2022. PMID: 34426945

• Psychosis of epilepsy: a multifaceted neuropsychiatric disorder.

  Kanner AM, Rivas-Grajales AM. Kanner AM, et al. CNS Spectr. 2016 Jun;21(3):247-57. doi: 10.1017/S1092852916000250. CNS Spectr. 2016. PMID: 27322691 Review.

• Cognitive Behavioural Therapy for Psychosis: A Health Technology Assessment.

  Health Quality Ontario. Health Quality Ontario. Ont Health Technol Assess Ser. 2018 Oct 24;18(5):1-141. eCollection 2018. Ont Health Technol Assess Ser. 2018. PMID: 30443277 Free PMC article. Review.

• Letter to the Editor: Rethinking The Cost Of Antipsychotic Treatment: The Average Cost Of The Drugs Used In Turkey In 2020.

  Yıldız M, Osman E. Yıldız M, et al. Turk Psikiyatri Derg. 2022 Summer;33(2):146-148. doi: 10.5080/u26315. Turk Psikiyatri Derg. 2022. PMID: 35730516 English, Turkish.

References

LinkOut - more resources

• Full Text Sources

  • Elsevier Science
  • PubMed Central