Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy1 By : Dr Seddigh HUMS.
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Transcript of Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy1 By : Dr Seddigh HUMS.
Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 1
Psychiatric Aspects of Epilepsy
By : Dr SeddighHUMS
Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 2
NatureNatureGoalGoal
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Prevalence range from 20 to 50%.
MDD 30%COGNITIVE 20%ANXITY DX 15 %AGRESSION 10 %BMD 8 %PSYCHOSIS 5%
SEXUAL DX unknown OCD rare
Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 4
A Variety of Factors can cause the Behavioral/Psychiatric
Disturbances Associated with Epilepsy
ictal seizure discharge/periictal stateCNS pathology
effects of antiepileptic drugs (AEDs)adverse psychosocial consequences
of having epilepsy (reactive)unrelated co-existence
Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 5
Ictal state – Behaviors/emotions that are direct expressions of
the epileptic seizure.Periictal State (Pre- or Postictal) –
Behaviors/emotions that are temporarily associated with seizures but are not direct manifestations of
epileptic discharges.Interictal Period –
Behaviors/emotions that are a function of non-ictal conditions.
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Psychiatric Disorders in Epilepsy
PsychosisDepressionAnxiety DisordersPersonality Disorder
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Psychosis in Epilepsy
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prevalence estimates 2.5 to5 %
1% rate among the general population.
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Ictal Psychosis(Common Features)
episodes of nonconvulsive status epilepticus can be mistaken for schizophrenia or a manic-like state. Generalized non-convulsive status
Absence status,petitmal status,spike wave status
Complex focal statusstatus psychomotoricus,epileptic twilight
state
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EEG
Bilatral synchoronized spike waveVariable F (1-4 Hz)
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Management of Ictal Psychosis
control with antiepileptic drugs confirmation by EEG recording is the most definitive
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Postictal Psychosis relationship with seizure activity series of generalized tonic clonic
complex partial seizures Features include confusion, automatisms, wandering, grandiose or religious delusions, hallucinations, and inappropriate behavior.
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Postictal Psychosis
often without the need for neuroleptic treatment. may be pharmacological intervention (neuroleptics or benzodiazepines are typically used)
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Interictal Psychosis –
like the hallucinations and delusions observed in schizophrenia,
and have suggested a link to temporal lobe pathology.
relationship between temporal lobe epilepsy and a chronic paranoid hallucinatory state.
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Predisposing Factors for the Interictal Schizophreniform
Psychosis of Epilepsy
Epilepsy characteristics:- CPS with secondary GTCS - more auras and automatisms - epilepsy presents for 11 to 15 years before psychosis - long interval of poorly controlled seizures- left temporal focus
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Predisposing Factors for the Interictal Schizophreniform
Psychosis of EpilepsyPsychosis Characteristics:- paranoia with sudden onset - psychosis alternating with seizure - preserved affective warmth - failure of personality deterioration - less social withdrawal - less systematized delusions - more hallucinations and affective symptoms - more religiosity low IQ
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DRUG INDUCED PSYCHOSIS
By Flebamate ,vigbatrine, zonisamide
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SUMMRYCONSCIOUSNESSDURATION EEGTREATMENT
ICTAL,POSTICTAL,INTERICTAL,DRUG INDUCED PSYCHOSIS
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Depression in Epilepsy
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Hippocrates noted in about 400 B.C. that:
A strong association between epilepsy and depression has been recognized throughout recorded medical history
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Prevalence of Depression in Epilepsy
“Depression is the most frequent psychiatric co-morbidity in epilepsy
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Published Prevalence Rates of Depression in Epilepsy
range 20 to 55% recurrent seizures
3 to 9% controlled epilepsy
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Epilepsy patients also appear to have a much greater risk of committing suicide
than the general population
suicide 10 times (K&S CTP: 4-5 times) Than general population (10 to 12 per
100,000). higher temporal lobe epilepsy. (K&S CTP: up
to 25%)
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Both patients and clinicians
“normal adaptation process” to this chronic disease.
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Clinical Presentation of Depression in Epilepsy
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Prodromal depressionPeri-ictal (ictal or postictal) Depression - Symptoms occurring just prior to the onset of seizures or following their occurrence.Interictal Depression - Symptoms occurring that are unrelated to specific seizure episodes.
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Prodromal depression
Prodromal symptoms may extend for hours or even for 1 to 2 days prior to the onset of a seizure.
May lead to suicide
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Periictal Depression
Psychiatric symptoms 25% of auras, approximately 15% affect or mood changes.May lead to suicide
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Interictal Dysphoric DisorderDepressive-Somatoform Symptoms
Depressed moodanergia pain insomnia
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Interictal Dysphoric DisorderAffective Symptoms
irritabilitybrief euphoric statesfearanxiety
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Anxiety in Epilepsy
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Ictal Anxiety
Fear and anxiety are fairly common ictal affects in patients with temporal lobe epilepsy (Williams, 1956).
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Interictal Anxiety
Anxiety syndromes appear to occur in both TLE and generalized epilepsy.Patients reportedly experience a variety of symptoms ranging from feelings of apprehension to DSM-IV syndromes (Panic Disorder, Generalized Anxiety Disorder, Obsessive-Compulsive Disorder).
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Anxiety TLEAgitation FLE
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The Impact of AEDs on Mood
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Barbituates
risk of eliciting depressive symptomatology (Robertson, 1985).
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Phenytoin (Dilantin)
a relationship between phenytoin and depressive symptoms (Ettinger et al., 2002).
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Vigabatrin (Sabril)
a significant risk of inducing adverse psychiatric events, particularly psychosis.
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Topiramate (Topamax)
may cause symptoms of depression
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WITH THANKS FOR YOUR ATTENTION
L
Dr Seddigh