Psychosis and Epilepsy

Psychosis is a serious mental disorder characterized by hallucinations, delusions and thought disorders. Thoughts may be disorganized and the person may experience delusions or disturbances of perception (hallucinations and distortions of sensation). The person may feel a lack of emotions or inappropriate emotions. The sense of self can be disturbed. The person may display decreased drive and motivation, social withdrawal and detachment, paranoia, or extreme levels of physical activity, becoming either hyperactive or immobile.

What causes psychosis ?

Psychosis can occur as a psychiatric disorder without any associated neurological disorder (as in schizophrenia). Psychosis can also result from brain injuries such as viral encephalitis, or can be caused by certain medications such as amphetamines (stimulants). Persons with epilepsy have an increased rate of interictal psychosis (psychosis "in between" seizures, not only around the time of seizures). Overall, the chances that someone with epilepsy will develop an interictal psychosis are approximately 7%. Patients with temporal lobe epilepsy appear to be at the greatest risk.

The best-documented form of psychosis in epilepsy, post-ictal psychosis (psychosis which occurs after seizures) usually occurs after a cluster of complex partial or tonic-clonic seizures. These individuals often appear well for a few hours or days and then express disordered thoughts, delusional ideas (for example, paranoid thoughts that someone is going to hurt him or her), and even aggressive behavior. Such psychoses are usually relatively brief and can be effectively treated with antipsychotic and tranquilizing drugs.

How is psychosis treated ?

Prompt recognition and treatment of this disorder are critical. Some older antipsychotic drugs such as chlorpromazine (Thorazine) and thioridazine (Mellaril) can occasionally cause seizures and should be used at the lowest effective dosage. Newer antipsychotic drugs, however, have minimal risk of worsening seizure control. These drugs include:

  • rispiridone (Risperidal)
  • olanzapine (Zyprexa)
  • quetiapine (Seroquel)
  • aripiprazole (Abilify)
  • ziprasidone (Geodon)
  • molindone (Moban)

In conclusion, multiple psychiatric symptoms and syndromes may be experienced by people with epilepsy and are often easy to treat if recognized. It is important to talk to your doctor about your symptoms of depression, anxiety or any unusual thoughts or feelings.