Psychosis of Epilepsy: A 10-Year Iranian Clinical Survey

Mahan Shafie; Jaber Darijani; Zahra Mirsepassi; Alireza Razavi; Mahsa Mayeli; Mohammad Arbabi; Vajiheh Aghamollaii

doi:10.18502/ijps.v18i4.13634

Mahan Shafie School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Jaber Darijani Department of Psychiatry, Roozbeh Psychiatric Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Zahra Mirsepassi Department of Psychiatry, Roozbeh Psychiatric Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Alireza Razavi Student Research Committee, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran.
Mahsa Mayeli Department of Diagnostic Radiology & Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Mohammad Arbabi Department of Psychiatry, Psychosomatic Medicine Research Centre, Tehran University of Medical Sciences, Tehran, Iran
Vajiheh Aghamollaii Department of Neurology, Roozbeh Psychiatric Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/ijps.v18i4.13634

Keywords: Epilepsy; Generalized Epilepsy; Health Survey; Partial Epilepsy; Psychotic Disorders

Abstract

Objective: Psychoses of epilepsy usually have an acute onset, accompanied by brief symptom duration and a risk of recurrence. Managing these conditions can be challenging due to the potential for seizures associated with certain antipsychotic medications, as well as exacerbating psychosis resulting from some antiepileptic medications. Our objective in this study was to assess the occurrence of psychosis among patients with epilepsy, as well as identify the factors linked to the presence and severity of psychosis in this population.

Method: In this study, we included a total of 514 subjects diagnosed with epilepsy referring to our neuropsychiatry clinic affiliated with Tehran University of Medical Sciences from April 2011 to December 2021, among whom 57 patients showed psychotic presentations. We compared baseline and clinical characteristics between patients with psychosis of epilepsy and non-psychosis patients who also had epilepsy.

Results: Marital status was the sole demographic factor that displayed a statistically significant difference between the psychosis and non-psychosis groups (P = 0.019). There was no significant difference observed between the two groups regarding family history of epilepsy and age at the onset of the epilepsy. Patients with psychosis experienced significantly more frequent seizures and generalized type (P < 0.001). Participants were matched for demographics and other clinical factors between the refractory and controlled psychosis groups, except for the psychosis frequency (P = 0.007). The type of epilepsy was significantly associated with psychosis when adjusted for the covariates (P < 0.001).

Conclusion: Patients with psychosis of epilepsy experienced more episodes of epilepsy than non-psychotics. We identified generalized epilepsy as an independent risk factor for the development of psychosis. Additional cohorts are warranted to explore the factors associated with epilepsy-related psychosis across diverse populations.