Epileptic psychosis and insanity: case study and review.

This brief clinical report focuses on a case in which we were ordered by the Wayne County Circuit Court to complete a forensic evaluation of a 26year-old man facing criminal charges of Felonious Assault and Criminal Sexual Conduct. The patient believed that he had committed the offenses but that his behavior was substantially influenced by a recently diagnosed seizure disorder. After a complete clinical exam, the forensic examiners (Patrick Bacon, MD and Elissa Benedek, MD) reported to the court the defendant was psychotic at the time of the alleged offense and this psychosis was associated with his epileptic disorder but did not represent an epileptic automatism. In the past century, many epileptics charged with a crime have defended themselves by arguing that their alleged criminal behavior was the result of an epileptic automatism. Investigators have delineated research criteria to evaluate the question of whether the behavior of these individuals could have been the result of an automatism.l.2,:l To our knowledge, no epileptic has argued he or she was legally insane at the time ofthe alleged offense and his or her insanity was due to a psychotic episode that occurred as a· concomitant of his or her epileptic disorder. Psychotic episodes that occur in association with various epileptic disorders have been reported by several investigators. 4,5 The characteristics of these psychotic episodes are significantly different from the characteristics of epileptic automatisms. We review the patient we evaluated and discuss the characteristics of automatisms and epileptic psychoses that allow each to be recognized as a distinct clinical entity.