psychiatric_features_of_epilepssssy.pptx

neuropsychiatric aspects of epilepsy

1. Psychiatric Features of Epilepsy

2. Definition Epileptic seizures are sudden, involuntary behavioral events associated with excessive or hypersynchronous electrical discharges in the brain Epilepsy is a chronic neurological disorder characterized by recurrent seizures. Affects nearly 50 million people worldwide. Psychiatric comorbidities are highly prevalent in epilepsy.

3. Prevalence The prevalence of epilepsy is approximately 7 per 1000 in the developed world Most studies report a slight preponderance of males relative to females, Of the different types of epilepsy, the great majority appearing in the first 20 years of life are generalized epileptic syndromes, while after this age the proportion of localization-related epilepsies rapidly increases

4. Psychiatric Comorbidity in Epilepsy Psychiatric features occur in 20–50% of epilepsy patients. Includes mood disorders, psychosis, personality changes. Recognition is crucial for treatment and prognosis.

5. Temporal Lobe Epilepsy (TLE) TLE is strongly associated with psychiatric disturbances. Complex partial seizures often originate here. Particularly linked to interictal and peri-ictal symptoms.

6. Framework of Psychiatric Features Peri-ictal: symptoms before, during, or after seizures. Interictal: psychiatric states independent of seizure activity. Special syndromes: e.g., Gastaut-Geschwind syndrome.

7. Peri-ictal Features: Overview Peri-ictal = psychiatric symptoms linked to seizure cycle. Includes prodromal, ictal, and postictal phases. Different phenomenology across stages.

8. Prodromal Symptoms: Overview Occur hours to days before seizures. May include irritability, mood changes, anxiety. Warning signs of impending seizure.

9. Prodromal Symptoms: Examples Depression, irritability, headache, restlessness. Affective instability, sleep disturbances. Useful for anticipating seizure onset.

10. Ictal Psychiatric Phenomena Occur during the seizure itself. Symptoms: hallucinations, illusions, forced thinking. Altered consciousness and automatisms common.

11. Ictal Features: Hallucinations & Forced Thinking Visual/auditory hallucinations may appear. Forced thinking: intrusive, uncontrollable thoughts. May mimic psychotic experiences.

12. Automatisms & Altered Consciousness Automatisms: repetitive, purposeless movements. Consciousness often impaired during ictal state. Speech arrest or incoherence may occur.

13. Postictal Psychosis: Definition & Onset Occurs after cluster of seizures. Lucid interval of 24–72 hours before onset. Sudden emergence of psychotic features.

14. Postictal Psychosis: Symptoms & Duration Grandiose, religious or paranoid delusions. Hallucinations may accompany delusions. Usually resolves within days to two weeks.

15. Interictal Psychosis: Definition Psychosis not temporally linked to seizures. Occurs during seizure-free intervals. May last weeks to months.

16. Clinical Features: Delusions Paranoid or grandiose delusions common. Religious and mystical themes frequent. Content may reflect seizure focus.

17. Clinical Features: Hallucinations Auditory hallucinations most common. Visual and olfactory hallucinations may occur. Hallucinations often vivid and structured.

18. Affect & Personality Preservation Unlike schizophrenia, affect usually preserved. Personality often intact. Negative symptoms less prominent.

19. Course & Prognosis Interictal psychosis has variable duration. Some remit spontaneously; others chronic. Better social function compared to schizophrenia.

20. Forced Normalization / Alternative Psychosis Psychosis emerging as seizures improve. Linked to normalization of EEG activity. Paradoxical relationship between seizures and psychosis.

21. Risk Factors: Clinical Temporal lobe epilepsy strongly linked. Long duration of poorly controlled epilepsy. Frequent generalized seizures.

22. EEG Abnormalities & Interictal Psychosis Interictal spikes and slow-wave abnormalities. Bitemporal discharges linked to higher risk. EEG useful for diagnosis and monitoring.

23. Gastaut-Geschwind Syndrome: History First described in patients with temporal lobe epilepsy. Named after Norman Geschwind and Henri Gastaut. Represents a cluster of personality traits.

24. Syndrome: Overview of Traits Cluster of interictal behavioral features. Includes hypergraphia, hyperreligiosity, altered sexuality. Represents limbic system involvement.

25. Trait: Hypergraphia Excessive writing or compulsive journaling. Content often philosophical, religious, or detailed. Reflects overinclusive thought process.

26. Trait: Hyperreligiosity Intense preoccupation with religious themes. Excessive ritualistic behavior. Seen more often in temporal lobe epilepsy.

27. Trait: Altered Sexuality Hyposexuality more common than hypersexuality. May show unusual or deviant sexual interests. Altered libido linked to temporal lobe dysfunction.

28. Trait: Circumstantial Speech Overinclusive and tangential communication. Takes long to arrive at the main point. Speech filled with unnecessary details.

29. Trait: Intensified Mental Life Deepened interest in abstract or moral issues. Philosophical and cosmic preoccupations. Intense emotional and mental experiences.

30. Clinical Significance Not all patients with TLE show this cluster. Important for differential diagnosis. Helps understand behavioral impact of epilepsy.

31. Personality Disorders in Epilepsy Increased prevalence of personality disorders. Common types: borderline, dependent, paranoid. Related to chronic illness and seizure effects.

32. Borderline & Dependent Traits Emotional instability and dependency. Fear of abandonment. Chronic interpersonal difficulties.

33. Irritability & Aggression Frequent irritability in epilepsy patients. Aggressive outbursts during peri-ictal period. Linked to temporal lobe and frontal lobe involvement.

34. Social Withdrawal & Low Self-Esteem Stigma and unpredictability of seizures cause withdrawal. Self-image negatively affected. Results in reduced social participation.

35. Behavioral Dysfunction: Examples Inappropriate affect or emotional blunting. Difficulty in occupational and family roles. Behavioral changes often misunderstood as primary psychiatric illness.

36. Differentiation from Primary Psychiatric Disorders Temporal association with seizures. Negative symptoms less severe than schizophrenia. Premorbid personality often intact.

37. Theory of Mind Deficits Difficulty in understanding others' perspectives. Impairment in interpreting social cues. Affects interpersonal relationships.

38. Empathy Impairment Reduced emotional resonance with others. Difficulty in recognizing emotions. Linked to amygdala and temporal lobe dysfunction.

39. Semantic Social Concept Deficits Difficulty understanding abstract social rules. Problems with moral reasoning and conventions. Observed in neuropsychological testing.

40. Need for Cognitive Rehabilitation Neuropsychological support improves outcomes. Training in social cognition and memory aids helpful. Multidisciplinary management is essential.

41. Risk Factors: Neuroanatomical Left or bilateral temporal lobe focus. Mediobasal temporal lesions linked to psychosis. Structural abnormalities evident on neuroimaging.

42. Duration & Seizure Control Long-standing, poorly controlled epilepsy. High seizure frequency increases risk. Clusters of seizures may precipitate psychosis.

43. Seizure Types Associated with Psychosis Generalized tonic-clonic seizures. Complex partial (focal dyscognitive) seizures. Kindling phenomena may contribute.

44. EEG & Neuropathological Correlates Interictal epileptiform discharges increase risk. EEG abnormalities correlate with psychiatric features. Brain lesions and tumors may predispose.

45. Seizure Control Strategies Optimize anti-epileptic drug regimen. Consider epilepsy surgery when indicated. Lifestyle modification to reduce triggers.

46. Antipsychotics in Epilepsy Use lowest effective dose to reduce side effects. Clozapine, olanzapine, risperidone used cautiously. Avoid drugs lowering seizure threshold if possible.

47. Psychological & Social Interventions Supportive psychotherapy and psychoeducation. Family counseling reduces stigma. Community support programs for reintegration.

48. Cognitive & Long-term Care Cognitive rehabilitation programs essential. Monitor for drug interactions and adverse effects. Holistic multidisciplinary approach recommended.

49. Case Example 1 Middle-aged patient with TLE for 15 years. Developed interictal psychosis with paranoid delusions. Improved with antipsychotics and seizure control.

50. Case Example 2 Young adult with temporal lobe focus. Exhibited Gastaut-Geschwind features: hypergraphia, hyperreligiosity. Social functioning moderately impaired.

51. Key Takeaways Epilepsy strongly associated with psychiatric comorbidities. Temporal lobe involvement central to many features. Psychiatric symptoms vary peri-ictally and interictally. Management requires medical, psychological, and social interventions.