1. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy1 By : Dr Seddigh HUMS

2. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy2 NatureGoal

3. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy3 Prevalence range from 20 to 50%. MDD 30% COGNITIVE 20% ANXITY DX 15 % AGRESSION 10 % BMD 8 % PSYCHOSIS 5% SEXUAL DX unknown OCD rare

4. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy4 A Variety of Factors can cause the Behavioral/Psychiatric Disturbances Associated with Epilepsy ictal seizure discharge/periictal state CNS pathology effects of antiepileptic drugs (AEDs) adverse psychosocial consequences of having epilepsy (reactive) unrelated co-existence

5. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy5 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.

6. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy6 Psychiatric Disorders in Epilepsy Psychosis Depression Anxiety Disorders Personality Disorder

7. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy7 Psychosis in Epilepsy

8. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy8 prevalence estimates 2.5 to5 % 1% rate among the general population.

9. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy9 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 status status psychomotoricus,epileptic twilight state

10. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy10 EEG Bilatral synchoronized spike wave Variable F (1-4 Hz)

11. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy11 Management of Ictal Psychosis control with antiepileptic drugs confirmation by EEG recording is the most definitive

12. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy12 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.

13. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy13 Postictal Psychosis often without the need for neuroleptic treatment. may be pharmacological intervention (neuroleptics or benzodiazepines are typically used)

14. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy14 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.

15. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy15 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

16. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy16 Predisposing Factors for the Interictal Schizophreniform Psychosis of Epilepsy Psychosis 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

17. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy17 DRUG INDUCED PSYCHOSIS By Flebamate,vigbatrine, zonisamide

18. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy18 SUMMRY CONSCIOUSNESS DURATION EEG TREATMENT ICTAL,POSTICTAL,INTERICTAL,DRUG INDUCED PSYCHOSIS

19. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy19 Depression in Epilepsy

20. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy20 Hippocrates noted in about 400 B.C. that: A strong association between epilepsy and depression has been recognized throughout recorded medical history

21. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy21 Prevalence of Depression in Epilepsy “Depression is the most frequent psychiatric co-morbidity in epilepsy

22. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy22 Published Prevalence Rates of Depression in Epilepsy range 20 to 55% recurrent seizures 3 to 9% controlled epilepsy

23. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy23 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%)

24. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy24 Both patients and clinicians “normal adaptation process” to this chronic disease.

25. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy25 Clinical Presentation of Depression in Epilepsy

26. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy26 Prodromal depression Peri-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.

27. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy27 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

28. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy28 Periictal Depression Psychiatric symptoms 25% of auras, approximately 15% affect or mood changes. May lead to suicide

29. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy29 Interictal Dysphoric Disorder Depressive-Somatoform Symptoms Depressed mood anergia pain insomnia

30. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy30 Interictal Dysphoric Disorder Affective Symptoms irritability brief euphoric states fear anxiety

31. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy31 Anxiety in Epilepsy

32. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy32 Ictal Anxiety Fear and anxiety are fairly common ictal affects in patients with temporal lobe epilepsy (Williams, 1956).

33. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy33 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).

34. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy34 Anxiety TLE Agitation FLE

35. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy35 The Impact of AEDs on Mood

36. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy36 Barbituates risk of eliciting depressive symptomatology (Robertson, 1985).

37. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy37 Phenytoin (Dilantin) a relationship between phenytoin and depressive symptoms (Ettinger et al., 2002).

38. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy38 Vigabatrin (Sabril) a significant risk of inducing adverse psychiatric events, particularly psychosis.

39. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy39 Topiramate (Topamax) may cause symptoms of depression

40. Dr Seddigh 24.9.88Psychiatric Aspects of Epilepsy40 WITH THANKS FOR YOUR ATTENTION ِ Dr Seddigh