Abstract
Background: Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis. Case Presentation: We present 3 cases of young adult men admitted to psychiatric ward as functional psychosis. They presented with irritability, physical aggression and mild cognitive impairment with intense emotional symptoms, and persecutory ideas and delusions. Two were wrongly diagnose as mania while the third was mimicking schizophrenia in its presentation. They received antipsychotic treatment and misdiagnosed as functional psychosis. They did not respond well to such treatment, until, series electroencephalograms were taken which revealed evidence of ictal psychosis. All, thence, responded well to addition of antiepileptic treatment. This, not only, proves to be effective, but also determined future management and prognosis. Conclusion: These cases shine light onto the role of the frontal cortex in the genesis of quasi-manic episodes and highlight the importance of EEG investigations in first episode of acute psychosis.
Highlights
Ictal psychosis without remarkable cognitive impairment is uncommon occurrence, presents diagnostic challenges to clinicians, often misdiagnosed as functional psychosis
Case Presentation: We present 3 cases of young adult men admitted to psychiatric ward as functional psychosis
They presented with irritability, physical aggression and mild cognitive impairment with intense emotional symptoms, and persecutory ideas and delusions
Summary
Many case report series and retrospective studies have been published addressing post-ictal psychosis and post-ictal mania, whether the epileptogenic foci origin are in the temporal or frontal lobe. Based on the results reviewed here, a reasonable speculation for the increased risk of violence associated with clinically significant focal frontal lobe injury might be 10% over the base rate for a given population Confirmation of this estimate must await prospective studies [6] [7] [8]. Reports have found higher rates of antisocial behaviour, including stealing, physical assault and sexual comments or advances [11] [12] [13] in patients with front otemporal dementia, even when compared with cognitively impaired patients with Alzheimer’s disease Overall, these neuropsychological studies tend to support a significant association between prefrontal executive dysfunction measured by neuropsychological testing and increased antisocial and aggressive behaviour. The objective of this article to improve diagnosis of ictal psychosis and give clinical examples of how elusive this can be in clinical settings
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