Overview of Epilepsy and Psychosis
Epilepsy is a chronic disorder of human brain causing a recurrent seizure or sudden electrical activities in human brain. This disease is spread worldwide and according to the data of World Health organization, more than 50 million people belonging to all the age groups are affected with this syndrome (Hilger et al. 2013). There are several social and mental barriers affecting people with this disorder across the globe as more than three forth of epilepsy affected people belong to low income countries. The epileptic seizure are of two types, general seizure that affects the whole brain and the focal or partial seizure, affecting a part of the while brain. These conditions can lead to post-ictal psychosis or inter-ictal psychosis (Kuba, Brázdil and Rektor 2012). The post-ictal psychosis is the changed state of consciousness that occurs after an epileptic seizure and lasts for 20 to 30 minutes. Whereas the inter-ictal disorder is associated with depression and is more common in patients having temporal lobe epilepsy than generalized epilepsy. This disorder bears much more relevancy in recent times as increased work related pressure and competition leading to auditory, visual, and thought related hallucinations, religious delusions, paranoia and aggression affecting the entire society (Kanemoto 2016). Recent researchers are keen to understand the brain related disorders affecting the thought process of people affected with epilepsy and are focusing on forced normalization using the concepts of neurosciences. This assignment will be focusing on the clinical symptoms of both these disorders. Further, after selecting a research article, will discuss the findings and methodology of the study and will discuss its positive or negative aspects.
There has been several researches to find out the link between epilepsy and psychosis and the prevalence of it. Calncy et al. (2012) conducted a systematic review complying with the PRISMA guidelines and the inclusion criteria involved people from every age group. Further, after data extraction, meta-analysis and randomized control was done depending on the substantial heterogeneity. Finally, after the data calculation it was understood that the prevalence rates of psychosis varied in a range from 0.02% to 27% in all the inclusive studies. Further after the substantial heterogeneity it was observed that the prevalence rate of psychosis in the epilepsy was 5.6% and in postictal psychosis it was 5.4%. Further in the inter-ictal psychosis, it was more than 7 percent (Kanemoto, Tadokoro and Oshima 2012).
The clinical presentation of post-ictal psychosis is asymptomatic until a sudden brain impulse affects the patient with confusion and lethargy. As the effect of this type of psychosis lasts longer than other seizures, patient’s sleep to wake up cycle, fine motor activities, impaired attention and the automatic activities of patient gets affected. The symptoms can vary from mild to severe and self-harm might also be seen in the process. According to Cleary et al. (2013), the symptoms of post-ictal anxiety are not common and generally involves disorganized nature, disinhibited behavior, over reactive nature. Moreover, psychotic symptoms generally evolved around hallucinations, delusions and thought disorders related mania. Post ictal psychosis eventually transforms eventually into inter-ictal psychosis due to transient neurochemical changes. The inter-ictal psychosis involves disorders related to depression, bipolar disorder and anxiety. According to Kandratavicius et al. (2012), depression is the most common symptom of tertiary or inter-ictal psychosis and due to the temporal lobe epilepsy development this disorder becomes deleterious. The clinical symptoms include low mood and interest, sleep and appetite loss and anhedonia. Further chronic intermittent dysthymia and anxiety can also be seen. On the other hand in the inter-ictal bipolar disorder partial epilepsy is seen.
Clinical Symptoms of Postictal Psychosis and Interictal Psychosis
As both this psychological disorders are connected to the psychological condition of the brain, special measures for the differential diagnosis is applied for clinical presentation. The reason behind this practice is the asymptomatic nature of the disease and if the differential diagnosis is removed, differentiation between psychosis and delirium cannot be spotted. Hence, for the diagnosis process, signs and symptoms of the illness, collateral information from the caregivers about the behavior of the patient and the changed environment should be included so that those patients can be provided with medications having psychoactive effects.
For the competition of the Meta-analysis, PRISMA guidelines was followed and few of the most recent research articles were selected for the systematic review about the topic (Clancy et al. 2014). Ten most recent research articles were selected for the Meta analysis study. All the research articles were collected from PubMed and google scholar and the range of publication was decided from 2012 to 2018. The terms which were used for search criteria included Postictal and interictal psychosis, temporal lobe epilepsy, Prevalence of epilepsy and schizophrenia related illness. The inclusion criteria involved complete research analysis, having population ranging from children to adults, having clear difference between the psychosis terms such as schizophrenia psychosis, postictal psychosis and interictal psychosis (Kandratavicius et al. 2012). Further papers which were not in English and not having complete research analysis, book chapters and case reports were excluded from the pool of papers. The PRISMA chart related to the inclusion and exclusion criteria is presented below:
According to Kanemoto, Tadokoro and Oshima (2012), more than 95% of the epileptic patients have three type of psychosis affecting them such as acute psychosis, chronic psychosis and postictal psychosis. The prime aim of their research was to find out the link between schizophrenia and sudden epilepsy in patients with disability. Another researcher Hilger et al. (2013) used video electroencephalogram recording of patients from 1995 to 2012 to understand the relation between the temporal lobe epilepsy and the postictal psychosis. The similarity between both these research articles was they utilized already present data for their research analysis and the first research used 4 case studies to draw interference whereas the second research articles collected 684 patients result to determine that the prevalence of psychosis with epilepsy was more than 7%. Further, Buranee et al. (2016), conducted a research in which the prevalence of post ictal and inter-ictal psychosis was reduced by implementing the epilepsy related surgery that reduces seizure in more than 90 percent of the surgery cases. Another research article Kanemoto (2016) included different diagnosis criteria and collected the evidences form the EEG recordings of the patients and the inclusion criteria was presence of psychotic symptoms for within I week of seizure without any treatment. They also determined that postictal symptoms differed from interictal symptoms and using different pharmacological intervention such as administration of benzodiazepine (supported by Butler et al. (2012)) intramuscular administration of dopamine blockers (supported by Kuba, Brázdil and Rektor (2012)) and seizure lowering drugs are effective to treat patients suffering from such disorder.
Prevalence of Epilepsy-Related Psychosis
All these 10 research articles were able to define each aspect of postictal and interictal psychosis however, there are several loopholes or lacks in their article that determined that there are many more research possibilities for modern researchers to understand the relation of postictal and interictal psychosis with epilepsy. The methodology of Hilger et al (2013) was the negative factor of the study as the researchers collected data from 1995 to 2012, and depending on them conclude the prevalence. However, this method is irrelevance as the medication of those patients was unknown to the researchers (Adachi et al. 2012). Furthermore, in another study by Cleary et al. (2013), determination of prevalence was done solely on the basis of physical and differential diagnosis and hence, the relevancy of the result is questionable. Hence, from the meta-analysis study conducted with ten research articles determined that epilepsy or the sudden impulses of brain is associated with the delirium, depression and mood swings which is the signs and symptoms of psychosis (Clancy et al. 2014).
Conclusion
The significance of this study is important for future aspects as there are more than 50 million people currently suffering from this disorder. Therefore, complete and detailed idea of the link between epilepsy and the after effects such as the postictal and interictal psychosis will help the researchers to understand the mechanism through which, this transition can be blocked. The systematic review conducted for this assignment included complete research articles that determined their findings through direct research or depending on past results or case studies. Hence, as the prevalence criteria needed detailed analysis of patient information, these research articles were able to fulfill the criteria and provided accurate result regarding the prevalence rate of postictal and interictal psychosis in epilepsy. This assignment conducted the meta-analysis using PRISMA guidelines and further determined the positive and negative aspect of those research articles while conducting the process. The clinical presentation and symptoms of both the type of psychosis was discussed and prevalence of the psychosis among the world population was mentioned in the process.
References
Adachi, N., Akanuma, N., Ito, M., Okazaki, M., Kato, M. and Onuma, T., 2012. Interictal psychotic episodes in epilepsy: duration and associated clinical factors. Epilepsia, 53(6), pp.1088-1094.
Buranee, K., Teeradej, S., Chusak, L. and Michael, M., 2016. Epilepsy-related psychoses and psychotic symptoms are significantly reduced by resective epilepsy surgery and are not associated with surgery outcome or epilepsy characteristics: A cohort study. Psychiatry research, 245, pp.333-339.
Butler, T., Weisholtz, D., Isenberg, N., Harding, E., Epstein, J., Stern, E. and Silbersweig, D., 2012. Neuroimaging of frontal–limbic dysfunction in schizophrenia and epilepsy-related psychosis: Toward a convergent neurobiology. Epilepsy & Behavior, 23(2), pp.113-122.
Clancy, M.J., Clarke, M.C., Connor, D.J., Cannon, M. and Cotter, D.R., 2014. The prevalence of psychosis in epilepsy; a systematic review and meta-analysis. BMC psychiatry, 14(1), p.75.
Cleary, R.A., Thompson, P.J., Thom, M. and Foong, J., 2013. Postictal psychosis in temporal lobe epilepsy: risk factors and postsurgical outcome?. Epilepsy research, 106(1-2), pp.264-272.
Hilger, E., Zimprich, F., Jung, R., Pataraia, E., Baumgartner, C. and Bonelli, S., 2013. Postictal psychosis in temporal lobe epilepsy: a case–control study. European journal of neurology, 20(6), pp.955-961.
Kandratavicius, L., Lopes-Aguiar, C., Bueno-Júnior, L.S., Romcy-Pereira, R.N., Hallak, J.E.C. and Leite, J.P., 2012. Psychiatric comorbidities in temporal lobe epilepsy: possible relationships between psychotic disorders and involvement of limbic circuits. Revista Brasileira de Psiquiatria, 34(4), pp.454-466.
Kanemoto, K., 2016. Postictal psychoses: Clinical and neurobiological findings. L’Encephale, 42(5), pp.443-447.
Kanemoto, K., Tadokoro, Y. and Oshima, T., 2012. Psychotic illness in patients with epilepsy. Therapeutic advances in neurological disorders, 5(6), pp.321-334.
Kuba, R., Brázdil, M. and Rektor, I., 2012. Postictal psychosis and its electrophysiological correlates in invasive EEG: a case report study and literature review. Epilepsy & Behavior, 23(4), pp.426-430.
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