Epilepsy and psychosis

This study reports the difficulties in the treatment and follow-up of patients with epilepsy and psychotic disorder and the orientation of neurologists about lifelong chronic effect of epilepsy towards psychiatric morbidity. Six patients (2 females, 4 males) complaining of generalized epilepsy, where the disease had started in the adulthood, for more than ten years, and suffered more than ten seizures per year, developed one of psychotic disorders. They are visitors of private clinics between 1999- 2003 as well as admission to psychiatric hospitals. They were assessed by clinical diagnosis according to criteria of DSM-IV, positive and negative syndrome scale (PANSS), magnetic resonance imaging study, and electroencephalography. Neuroleptics and antiepileptics were used with close observation and good cooperation with referring neurologists and families of all patients. Good control of both epileptic seizures and psychotic symptoms obtained in five of cases by equilibrium of the effect of neuroleptics and antiepileptics. Three cases needed repetitive hospitalization in psychiatric units. All of them re-monitored by PANSS and showed score reduction and re-integrated well to their usual environment. The sixth patient (a case of previous head injury) developed a very severe paranoid schizophrenia with aggressive attitude ended with long hospitalization in asylum. It can be concluded that mixed cases of epilepsy and psychosis are a challenge for neurologists and psychiatrists. Thus, there is a great need for close cooperation between them to point out psychiatric results of epilepsy and to study the epileptogenic effect of anti-psychotic drugs. All of these efforts are the corner stone to improve the quality of life of the patient and perform reintegration to the environment.