The psychiatric disturbances associated with seizure disorders are characterized by a wide variety of symptoms. The underlying psychiatric condition is a dysphoric disorder characterized by depression, anxiety, panic, and psychosis in the more severe cases. Consistent with good medical practice, it is recommended that any new patient be fully evaluated by a thorough medical examination. E. Fuller Torrey (1995) makes a strong point on this issue. He indicates that psychosis can occur in a variety of conditions, including bipolar disorders, temporal lobe epilepsy, brain tumors, syphilis, multiple scherosis, viral encephalitis, Huntington Disease, AIDS, Wilson’s disease, pernicious anemia, endocrine disorders, and various street drugs (e. g. LSD, PCP). He indicates that any underlying organic condition should be identified and treated by the appropriate methods as a first step.
A proper diagnosis can usually be made if the observed psychiatric disturbances occur along with a well-defined case of epilepsy. A seizure disorder is often obvious based upon the presentation of symptoms. A seizure disorder is obvious in those cases where there are convulsions and a loss of consciousness as occurs in grand mal seizures. Loss of consciousness also occurs with complex partial seizures, commonly referred to as temporal lobe epilepsy. In this case, the seizure activity originates in a single portion of the brain and spreads into both hemispheres. Other forms of epilepsy may be less obvious. Simple partial seizures are characterized by the onset of clinical activity that remains localized to a single area. Consciousness is not affected. Consciousness is also not affected in petit mal epilepsy, where there is a brief but abrupt loss of attention. The physician can distinguish between the organized patterns associated with a seizure disorder versus the complex and abnormal patterns seen with persons dealing with schizophrenia.
Psychiatric problems are most commonly associated with temporal lobe epilepsy. Symptoms are often similar to schizophrenia, but the origin of the psychiatric disturbances is markedly different and must be treated appropriately. Psychiatric disturbances can also occur in other forms of epilepsy.
An electroencephalogram (EEG) can be a useful tool for characterizing anomalies in brain activity and the type of a seizure disorder that may be occurring. A positive sign of a seizure disorder on the EEG is an indication of an underlying organic condition that must be addressed in the treatment program. Dr. Blumer advised in correspondence that “where the EEG is mute, it is necessary to identify the disorder by the suggestion of a central nervous system (CNS) impairment, family history for epilepsy or migraine, and by the psychiatric symptoms which are atypical for any of the traditional psychiatric disorders”. A seizure-related psychiatric disorder can be suspected where there has been a childhood history of absence seizures and in cases where there has been a dual diagnosis of schizophrenia and epilepsy or bipolar disorder and epilepsy.
Our son deals with a diagnosed petit mal condition. Various EEGs have noted that the temporal lobe is also involved.
Blumer (2000) indicates that the illness needs to be treated as a severe form of depression with psychotic features. The psychosis develops as a result of the depression and will be diminished by effective treatment of the depression. He indicates that symptoms are similar to schizophrenia. However, there are some marked differences. He reports that the baseline is very different. The affected persons are not schizoid. They have a lot of affect and still shake hands with you. They can have delusions and hallucinations, as seen in schizophrenics. However, the basic personality is different and there are marked affective changes. The psychotic state develops out of a dysphoric disorder.
The psychiatrist typically makes a diagnosis based upon the symptoms that are presented. Medications are normally prescribed and observations are made on the responses that are achieved. Good response to the medications helps to confirm the original diagnosis. Conversely, poor response may indicate an incorrect initial diagnosis. Over time, the psychiatrist is able to confirm a diagnosis based upon the symptoms presented and the responses to medications. Our son has historically responded well to the medications recommended for seizure-related psychosis. On the other hand, he has responded poorly to medications that are designed for the treatment of schizophrenia.
Proper diagnosis of the illness is critical. A proper diagnosis will lead to a treatment with anticonvulsants and antidepressants. On the other hand, a misdiagnosis of schizophrenia will lead to the extensive use of antipsychotic medications which is highly detrimental to the patient.