dr seddigh 24.9.88psychiatric aspects of epilepsy1 by : dr seddigh hums

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Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 1 Psychiatric Aspects of Epilepsy By : Dr Seddigh HUMS

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Page 1: 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

Page 2: Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy1 By : Dr Seddigh HUMS

Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 2

NatureNatureGoalGoal

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Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 3

Prevalence range from 20 to 50%.

MDD 30%COGNITIVE 20%ANXITY DX 15 %AGRESSION 10 %BMD 8 %PSYCHOSIS 5%

SEXUAL DX unknown OCD rare

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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

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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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Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 10

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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Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 17

DRUG INDUCED PSYCHOSIS

By Flebamate ,vigbatrine, zonisamide

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Dr Seddigh 24.9.88 Psychiatric Aspects of Epilepsy 18

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