Premorbid psychiatric risk factors for postictal psychosis.
Postictal psychosis (PIP) is a common and clinically significant sequela of inpatient epilepsy monitoring. A series of 622 patients with complex partial epilepsy undergoing video-EEG evaluations as candidates for epilepsy surgery were evaluated, by structured psychiatric interview, for individual and family psychiatric histories, depression, anxiety, and features of personality disorders. No patient had psychotic symptoms at baseline. Twenty-nine developed a PIP episode during monitoring. The a priori hypotheses were that patients with PIP would have higher baseline schizotypal and paranoid personality ratings and a greater prevalence of histories of psychiatric treatment and family history of psychotic illness. However, only a higher prevalence of mood disorder among first- and second-degree relatives distinguished the patients who developed PIP on logistic regression analyses (odds ratio=3.49, P=0.001). Possible mechanisms linking vulnerability toward mood disorders and the development of psychotic symptoms in epilepsy are discussed.
Alper
K
K
Department of Neurology, Comprehensive Epilepsy Center, New York University, Mt. Sinai School of Medicine, New York, NY 10016, USA. kra1@is9.nyu.edu
Devinsky
O
O
Westbrook
L
L
Luciano
D
D
Pacia
S
S
Perrine
K
K
Vazquez
B
B
D000328:Adult; D002540:Cerebral Cortex / Q000503:physiopathology; D004569:Electroencephalography; D017029:Epilepsy, Complex Partial / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology / Q000601:surgery; D005260:Female; D020022:Genetic Predisposition to Disease / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D019964:Mood Disorders / Q000175:diagnosis / Q000235:genetics / Q000503:physiopathology; D010260:Paranoid Personality Disorder / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D012307:Risk Factors; D012569:Schizotypal Personality Disorder / Q000175:diagnosis* / Q000235:genetics / Q000503:physiopathology; D014741:Video Recording