Epilepsy

Patients with epilepsy develop psychosis or schizophrenia at rates exceeding those expected if the two disorders were independent (Mendez et al. 1993; Trimble 1991). Conversely, patients with schizophrenia are more prone to seizures than the general population. The excess in vulnerability may result from the neuropathological changes of schizophrenia itself or the secondary effects of the illness, which include exposure to seizure threshold-lowering medication. One possible common factor is neurodevelopmental abnormalities involving the mesial temporal lobe (Hyde and Weinberger 1997). The chronic interictal psychosis of temporal lobe epilepsy (TLE; i.e., complex partial seizure disorder) at times resembles schizophrenia phenomenologically (Slater et al. 1963). Better preservation of affect, memory impairment, visual hallucinosis, mystical experiences, and mood swings are believed to be more common in TLE with interictal psychosis than in schizophrenia. Also, mean age at onset of TLE is about 30 years (Onuma et al. 1991; Slater et al. 1963). Risk factors include severe and intractable epilepsy, epilepsy of early onset, secondary generalization of seizures, certain anticonvulsant drugs, and temporal lobectomy (Sachdev 1998).

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