Only 5% of epileptics exhibit any symptoms of epileptic psychosis. This condition is characteristic of the aggravated form of the disease and can occur several years after the onset of the underlying ailment.
The first studies in this area were conducted by Jean-Etienne D. Escirol, a French psychiatrist and reformer in this medical field.
General characteristic of the disease
Epilepsy is a mental and neurological chronic pathology. The disease manifests itself in periodic attacks that occur against the background of loss of consciousness, motor function.
Epileptic psychosis is one of the clinical manifestations of the disease. The likelihood of psychosis increases with the duration of the disease - the longer it is present, the greater the likelihood of an attack. Psychosis is mainly acute in nature, which is a consequence of ongoing changes in the personality.
Epileptic seizures and psychosis themselves are characterized in that the seizure lasts a short time, and psychosis can last for hours, weeks, even months and has a characteristic phenomenology.
A description of epileptic psychosis would not be complete without identifying risk factors. These include:
- prolonged course of pathology;
- intense and frequent seizures;
- the location of the focus of the disease - if it is located in the temporal lobe, then the onset of psychosis is high;
- hereditary burden;
- body resistance to anticonvulsants.
Reasons for development according to international classification
According to ICD-10, epileptic psychosis is divided into the following types:
- Idiopathic. For this form, changes in the structure of the cerebral cortex are not characteristic.
- Episyndrome. This condition is a consequence of another pathology.
- Cryptogenic type. Symptoms appear due to unexplained reasons.
In the category of unspecified pathologies - F 06.912 - there is an epileptic psychosis of the NOS, which has no additional indications.
Other classification
Doctors distinguish several types of psychosis depending on the time of the onset of the attack in relation to epileptic seizures.
- Ictal. Psychosis occurs during an attack. The human condition is characterized by severe irritability, speech becomes intermittent and loud. There is aggressiveness.
- Postictal. Psychosis begins about a day after the attack. It is characterized by mania.
- Interiutal. It manifests itself in the form of paranoia and affective disorders. Psychosis occurs between epilepsy attacks.
- Alternating. This type is very similar to the interictal form, since psychosis occurs after a weakening attack.
- Medication. As a rule, it proceeds in a chronic form and is characterized by schizophrenia-like attacks. At its core, it is a side effect of antiepileptic drugs.
Organic and inorganic types of psychosis are also distinguished, that is, completely dependent on the causes of the occurrence of epilepsy itself.
Forms of ailment
Two types of pathology are distinguished, depending on the nature of the course:
Acute epileptic psychosis is characterized by confusion. This form of pathology is transient and most often occurs in patients.
The chronic type can occur in a hallucinatory-paranoid form, catotonic, paraphrenic. This type is characteristic of the later stages of the disease and can last for years.
Characteristic features of the manifestation of the disease
Symptoms of epileptic psychosis vary depending on the type of disease and the nature of the pathology. So, for the acute form with confusion and coincidence in time with an attack of epilepsy, both a complete absence of a sense of fear and a panic state are characteristic.
As soon as the attack is completed, the person becomes aggressive and emotionally stressed. At this time, motor disorders may be present, a dream-like state with auditory and visual hallucinations may occur. Many patients feel themselves to be savers of the whole planet, able to solve all world problems and save humanity from cataclysms. For a short period of time, people experience a frequent change in their emotional state, from rage to ecstasy.
If the attack passes without confusion, the patient is wary, suspects everyone of a conspiracy and threatening actions.
The affective form is characterized by an anxiety state.
In the chronic course of the disease, the patient has frequent hallucinations and a delusional state.
The catatonic form may be accompanied by childish behavior, with grimaces and “out of place” answers, the patient may mutter something.
Symptoms in children and adolescents
Regardless of whether epileptic psychosis is an NOS in children or another clearly defined type, as a rule, its symptoms are not much different from that in adults. However, mental disorders, especially in adolescence, are very bright and require special attention. In this age group, psychosis is often accompanied by numbness of the body, migraine attacks, ringing in the ears.
According to statistics, approximately 1% of patients who have epilepsy since childhood have psychosis attacks during puberty - in adolescence. This condition is very similar in its symptoms to schizophrenia.
It is very important for adolescents that, along with drug treatment, psychological support should be included in the therapy. After all, seizures, and especially psychoses, make a child think about his inferiority, as a result, a certain psychological stereotype is formed, which leads to infantility and stagnation in nervous processes and other problems.
Diagnostics
To date, there is no specific method for diagnosing psychosis. Most often, the doctor tries to establish whether the patient has epilepsy or not, and if such a diagnosis has already been made, then the causes of psychosis.
Diagnostic measures are carried out by a neurologist and / or psychiatrist. It all starts with a conversation with the patient and / or his relatives. It turns out whether the patient has an addiction to alcohol, whether there was a head injury, or if the patient is using drugs. The doctor collects detailed information about the symptoms that accompanied the epileptic psychosis, whether there were hallucinations, delusions, and so on.
Next, the doctor conducts an examination, checks whether there are signs of degenerative processes or focal lesions. If necessary, instrumental diagnostics are performed: MRI, EEG, CT of the brain.
Psychodiagnostics is already carried out by a psychologist who determines whether the patient has personality changes, cognitive impairments.
Therapeutic measures
The treatment of psychosis and epilepsy itself can be carried out only in combination. The choice of medications is a rather difficult task, since many drugs are potentially dangerous and can only increase mental activity.
Depending on the characteristic symptoms and type of disease, the following may be prescribed:
- benzodiazepines;
- antidepressants;
- antipsychotics.
Quite often, Haloperidol is used to stop psychosis. This is an effective remedy for the elimination of schizophrenic manifestations occurring in both mild and severe forms. The drug helps to relieve the patient from a delusional and manic state. A distinctive feature of the drug is that even in the initial stage of psychosis, it can be prescribed in a small amount.
Risperidone is a drug that allows you to quickly restore the central nervous system and relieve the patient of depression. It helps to eliminate the symptoms of hallucinations and other characteristic mental disorders. Allows you to adjust the state of dysphoria - one of the most common conditions in psychosis.
After eliminating the symptoms and stopping, psychotherapy sessions are prescribed. During it, the doctor corrects behavior and aligns behavioral patterns, corrects emotional disorders. Recently, the cognitive-behavioral technique, group trainings are widely used.
If previously the patient has already taken antiepileptic drugs, then the course of treatment should be adjusted so as to prevent further exacerbations.
Complications
The lack of an adequate treatment for epileptic psychosis will lead to the fact that the patient risks becoming a completely maladaptive personality both in the domestic and social sense. If we talk about children, they will not be able to study either at school, or at home, or in higher and secondary special institutions.
Relatives of a sick person will also have problems, because they will have to pay more and more attention to a sick member of the family, constantly look after him.
In the presence of frequent psychoses, the personality and character of the epileptic will inevitably change. He will avoid contact with others, will become more impulsive, vindictive and gloomy. It is precisely such changes that relatives who have close people with epilepsy speak of.
Forecast and preventive measures
A positive prognosis for improvement is completely dependent on the success of therapeutic measures associated with epilepsy. If the treatment is effective, then the number of psychoses is reduced.
To prevent their onset, the patient must protect themselves from physiological and emotional stress. It is mandatory to stop smoking and drinking alcohol. It is not recommended to even use tonic drinks.
Sunlight, being at altitude, overheating or hypothermia are negative factors that must be eliminated from the patient's life in order to prevent epileptic psychosis. In addition, the regime of the day should be observed, that is, an even distribution of the period of work and rest. Be sure to attend walks in the fresh air.
In the diet, dairy and vegetable products are required.