title: Psychoses in epilepsy: A comparison of postictal and interictal psychoses.
abstract: We retrospectively analyzed data of patients with epilepsy (n=1434) evaluated with prolonged EEG monitoring in order to estimate the prevalence of postictal psychosis (PP) and interictal psychosis (IP), to investigate a potential association of psychosis subtype with epilepsy type, and to assess differences between PP and IP. The overall prevalence of psychosis was 5.9% (N=85); prevalence of PP (N=53) and IP (N=32) was 3.7% and 2.2%, respectively. Of patients with psychosis, 97.6% had localization-related epilepsy (LRE). Prevalence of psychosis was highest (9.3%) in patients with temporal lobe epilepsy (TLE). When comparing PP with IP groups on demographic, clinical, and psychopathological variables, patients with IP were younger at occurrence of first psychosis (P=0.048), had a shorter interval between epilepsy onset and first psychosis (P=0.002), and more frequently exhibited schizophreniform traits (conceptual disorganization: P=0.008; negative symptoms: P=0.017) than those with PP. Postictal psychosis was significantly associated with a temporal seizure onset on ictal EEG (P=0.000) and a higher incidence of violent behavior during psychosis (P=0.047). To conclude, our results support the presumption of a preponderance of LRE in patients with psychosis and that of a specific association of TLE with psychosis, in particular with PP. Given the significant differences between groups, PP and IP may represent distinct clinical entities potentially with a different neurobiological background.
authors.affiliation: Department of Neurology, Medical University of Vienna, Austria. Electronic address: eva.hilger@meduniwien.ac.at.
authors.forename: Eva
authors.initials: E
authors.lastname: Hilger
authors.affiliation: Department of Neurology, Medical University of Vienna, Austria.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Zimprich
authors.affiliation: Department of Neurology, Medical University of Vienna, Austria.
authors.forename: Ekaterina
authors.initials: E
authors.lastname: Pataraia
authors.affiliation: Department of Neurology, Medical University of Vienna, Austria.
authors.forename: Susanne
authors.initials: S
authors.lastname: Aull-Watschinger
authors.affiliation: Department of Neurology, Medical University of Vienna, Austria.
authors.forename: Rebekka
authors.initials: R
authors.lastname: Jung
authors.affiliation: Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, 2nd Neurological Department, General Hospital Hietzing with Neurological Center Rosenhuegel, Vienna, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Baumgartner
authors.affiliation: Department of Neurology, Medical University of Vienna, Austria.
authors.forename: Silvia
authors.initials: S
authors.lastname: Bonelli
mesh_terms: D000328:Adult; D017668:Age of Onset; D004569:Electroencephalography; D004827:Epilepsy / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D004833:Epilepsy, Temporal Lobe / Q000150:complications / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011618:Psychotic Disorders / Q000453:epidemiology / Q000209:etiology* / Q000523:psychology; D012189:Retrospective Studies; D012640:Seizures / Q000150:complications* / Q000453:epidemiology / Q000523:psychology; D012959:Socioeconomic Factors; D014754:Violence / Q000523:psychology; D055815:Young Adult
keywords: Epilepsy; Interictal psychosis; Neurobiology; Postictal psychosis; Prevalence