Abstract
BackgroundPostictal psychosis (PIP), an episode of psychosis occurring after a cluster of seizures, is common and may be associated with profound morbidity, including chronic psychosis. Symptoms are often pleomorphic, involving a range of psychotic symptoms, including hallucinations and disorders of thought. PIP is treatable and may be averted if presymptomatic risk factors are considered in susceptible patients and treatment is initiated.Case presentationIn this report, we present an illustrative case of PIP. The patient, Mr. R, presented to our emergency room with delusions and disordered thought process following a cluster of seizures. He recovered after admission, sedation and treatment with antipsychotic medication.DiscussionA list of presymptomatic risk factors is established based on review of current literature. Identification of such risk factors may potentially help with prophylactic treatment; however, little empirical research exists in this area and treatment guidelines are thus far largely based on expert opinion. Further, while the neurobiology of schizophrenia is advancing at a rapid pace, largely due to advances in genetics, the pathophysiology of PIP remains largely unknown. Considering the progress in schizophrenia research in the context of the clinical features of PIP and existing studies, potential neurobiological mechanisms for PIP are herein proposed, and further genetic analyses, which may help identify those susceptible, are warranted.ConclusionWhile PIP is an important problem that may present first to general hospital psychiatrists, as in the case presented, this topic is under-represented in the medical psychiatry literature. As discussed in this article, further research is needed to develop presymptomatic screens and treatment pathways to help prevent morbidity.
Highlights
Postictal psychosis (PIP), an episode of psychosis occurring after a cluster of seizures, is common and may be associated with profound morbidity, including chronic psychosis
While PIP is an important problem that may present first to general hospital psychiatrists, as in the case presented, this topic is under-represented in the medical psychiatry literature
Despite the fact that PIP represents 25% of the psychoses of epilepsy (POE) [5,6], it is relatively underrepresented in the psychiatric medicine literature
Summary
Logsdail and Toone defined diagnostic criteria for PIP [4], thereby distinguishing PIP from the other psychoses of epilepsy, namely ictal and interictal psychosis. Multiple authors encourage vigilant monitoring of patients with risk factors for PIP after a cluster of seizures In such patients, low dose antipsychotic medication (2–4 mg of risperidone) is recommended in the early stages after the emergence of symptoms [6]. In the MRI in the current case, bilateral lesions were observed in regions of frontal cortex likely to be multimodal association cortex (see case above) These lesions are consistent with head trauma known from the history to precede the emergence of the seizure disorder. As the field of schizophrenia genetics works to make these susceptibility loci more definitive, they may be tested for a potential role in predisposing to PIP Such studies could draw the field of epilepsy further into the convergence of other neuroscientific areas related to psychosis, and in the future provide further clinical criteria for assessing risk
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