SEIZURE DISORDERS PRESENTING WITH PSYCHIATRIC SYMPTOMATOLOGY - 08/09/11
Résumé |
The behavioral phenomena caused by seizures are some of the most tangible behavioral phenomena of the central nervous system (CNS). Disruptions of consciousness, motor activity, hallucinations, abrupt mood, and anxiety changes can all be seizure manifestations caused by cortical neuronal discharges. Consequently, it is not surprising that seizure disorders and their subsequent behavioral symptoms are often confused with psychiatric disorders and vice versa. Both psychiatric and seizure disorders are caused by dysfunctions of the CNS. Depending on the area of the cortex stimulated during a seizure, varied behavioral changes can be seen, and these phenomena in themselves are not diagnostic. In fact, until the development of the EEG by Berger in 1929,2 many seizure disorders were classified as emotional disorders. It was only when we could correlate the observed behavior with an objective measure of brain function, such as an electroencephalogram (EEG), that people began to look at seizures as something other than emotional disturbances.
Behavior disorders and seizure disorders do seem to be related, however. There is an increased risk for psychopathology in patients with seizure disorders that range from 20% to 40% in many studies.22 The low estimates of behavior disturbance in patients with seizure disorders are usually from community samples and the highest from tertiary care facilities and specialized epilepsy centers. The incidence may also vary by the comprehensiveness of the scales used to assess the psychopathology. Recently, Victoroff25 used a standardized interview to assess the DSM-III-R diagnosis in 60 patients with intractable complex partial seizures. He found that 70% had a lifetime history of one or more DSM-III-R diagnoses. Fifty-eight percent had histories of depressive episodes, 32% had histories of agoraphobia without panic or other anxiety disorders, and 13% had histories of psychosis. There is also a heightened risk for suicide in seizure disorder patients.9 In a similar fashion, seizure disorders are three to seven times more common in groups of hospitalized psychotic patients.10 So it is quite clear that a psychiatrist may be the first to evaluate and treat a patient with an as-yet undiagnosed seizure disorder. In fact, it is not an uncommon scenario in which a psychiatrist treats a young adult for psychosis, the patient remains refractory to treatment, and the patient then has a seizure (often a major motor seizure). The appropriate diagnosis then becomes evident, often followed by a marked response of the behavioral symptoms to anticonvulsive medication.
This article examines the classification of seizures, some of the proposed causes of the psychopathology, and the specific types of psychopathology seen in patients with seizure disorders. Guidelines are proposed for the differential diagnosis of these conditions.
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| Address reprint requests to Gary J. Tucker, MD, WG Magnuson Health Science Center, 1959 NE Pacific Street, Room B–1644, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195 |
Vol 21 - N° 3
P. 625-635 - septembre 1998 Retour au numéro
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- MINOR HEAD TRAUMA
- David G. Weight
- THE DISSOCIATIVE DISORDERS : Rarely Considered and Underdiagnosed
- Philip M. Coons
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