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1.
Epilepsy Behav ; 140: 109087, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-36702055

RESUMO

OBJECTIVES: To clarify the pathophysiology of psychoses after the new administration of antiepileptic drugs (AED), we analyzed the annual incidence, timing of development, and duration of episodes. METHODS: Psychotic outcomes in the first 6-month period after an AED or non-AED administration in patients with focal epilepsy were exhaustively reviewed in eight Japanese neuropsychiatry institutions. In cases with psychotic episodes, the subtype of psychosis, timing of development, previous history of psychosis, and duration of the episode were evaluated. RESULTS: Between 1981 and 2015, 5018 new drugs (4402 AED and 616 non-AED) were administered to 2067 patients with focal epilepsy. In the first 6-month period, 105 psychotic episodes occurred (81 interictal psychosis [IIP] and 24 postictal psychosis). Furthermore, 55 cases were first episodes and 50 were recurrent episodes. The frequency of psychoses is significantly higher after AED administration (n = 102) compared with non-AED administration (n = 3). Psychosis occurred most frequently in the initial 1-month period after new-AED administration and tended to decrease with increasing time. The estimated annual incidence of all psychoses after a new AED administration was 3.5% (2.0% for first-episode psychosis and 1.8% for first-episode IIP). Duration of psychoses (mean, 38.5 weeks) was equivalent to overall IIP. Duration of IIP did not shorten with discontinuation of newly administered AED. SIGNIFICANCE: Patients with epilepsy exhibit psychosis more frequently after new AED administration than after non-AED administration. This study shows the pathophysiology of psychoses after AED administration with annual incidence, the timing of development, and the duration of PAP, which have rarely been reported.


Assuntos
Epilepsias Parciais , Epilepsia , Transtornos Psicóticos , Humanos , Anticonvulsivantes/efeitos adversos , Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Transtornos Psicóticos/epidemiologia , Convulsões/tratamento farmacológico , Epilepsias Parciais/tratamento farmacológico
2.
Epilepsy Behav ; 97: 138-143, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31252268

RESUMO

OBJECTIVE: Many studies show psychoses after some antiepileptic drug (AED) administrations (post-AED administration psychoses [PAP]). It remains uncertain about psychogenetic potential of each AED and effects of clinical state factors on PAP. We examined the relations between AED-related factors (types, generations, dosages, and concomitant AED) and PAP. METHODS: The clinical records of patients with focal epilepsy were retrospectively reviewed from eight adult epilepsy clinics, for every six-month period after administration of a new drug (either AED or non-AED) between 1981 and 2015. Characteristics of psychotic episodes, AED-related factors (type, daily dosage, and concomitant AED), and other state-related risk factors to psychosis (age, duration of epilepsy, history of psychosis, and seizure frequency) were examined. Psychogenetic risks of AED-related and state-related factors were analyzed with multifactorial procedures. RESULTS: Of 2067 patients with focal epilepsy, 5018 new drugs (4402 AEDs and 616 non-AEDs) were administered. Within the first six-month period, 89 patients exhibited 105 psychotic episodes (81 interictal and 24 postictal psychoses: 55 first episodes and 50 recurrences). With second-generation AED (SAED) administration, particularly topiramate and lamotrigine, frequency of psychosis was significantly increased. Daily dosage of AED was not significantly associated with psychosis. Psychosis tended to occur with a higher number of concomitant AED. Subsequent analysis with AED-related and general factors showed that SAED administrations and previous psychotic history were the most significant risks for PAP. CONCLUSION: Post-AED administration psychoses is associated with type of AED (SAED), rather than its dosage. Individual vulnerabilities are also associated with PAP.


Assuntos
Anticonvulsivantes/efeitos adversos , Epilepsias Parciais/tratamento farmacológico , Lamotrigina/efeitos adversos , Psicoses Induzidas por Substâncias/etiologia , Topiramato/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Relação Dose-Resposta a Droga , Esquema de Medicação , Epilepsias Parciais/complicações , Feminino , Seguimentos , Humanos , Lamotrigina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Psicoses Induzidas por Substâncias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Topiramato/uso terapêutico
3.
Epilepsy Behav ; 79: 234-238, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29249448

RESUMO

OBJECTIVE: Despite a theoretical consensus that interictal psychosis (IIP) is related to various epilepsy-related factors, the impact of seizure activity on development of IIP remains inconclusive. This is the first controlled study using quantitative seizure-activity measures at the onset of IIP. METHODS: One hundred and eighty-one patients with epilepsy who exhibited first-episode IIP (IIP group) and 427 patients with epilepsy without psychotic episodes (control group) were enrolled. The control group was matched for age, epilepsy type, and duration of epilepsy. The two seizure-activity indices (seizure frequency at the time of onset of first-episode IIP and the number of seizures before the onset of IIP) were evaluated and compared between the IIP and control groups. Logistic regression analysis was used for extracting risk variables to develop first-episode IIP. RESULTS: The sum of previous seizures was greater in the IIP than in control groups. This was particularly the case in the patients with partial epilepsies (PE). Higher seizure frequency in the patients with PE was associated with the development of first-episode IIP while no association was found in the whole cohort or in the patients with generalized epilepsies (GE). Subsequent multivariate analysis revealed the sum of previous seizures and family history of psychosis as risk variables to first-episode IIP. CONCLUSIONS: The accumulation of seizure-related damages and family history of psychosis is associated with the onset of IIP episodes, particularly in the patients with PE. Seizure activity and individual vulnerability to psychosis are likely to be interacted for as the development of IIP in patients with epilepsy.


Assuntos
Epilepsia/complicações , Transtornos Psicóticos/complicações , Convulsões/complicações , Adulto , Epilepsias Parciais/complicações , Epilepsia Generalizada/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Adulto Jovem
4.
Epilepsy Behav ; 44: 185-91, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25727502

RESUMO

Psychogenic nonepileptic seizures (PNESs) in patients with epilepsy can be categorized as dissociative disorders. The prevalence of PNESs in patients with epilepsy appears to be much higher than that of dissociative experiences in nonclinical subjects. In order to clarify as to whether epilepsy-related factors were associated with pathological dissociation, we conducted a controlled study with 225 patients with epilepsy and 334 nonclinically matched individuals. All participants completed the Japanese version of the Dissociative Experiences Scale (DES). There was no significant difference in the DES score (DES-S) between the group with epilepsy and the control group. The group with epilepsy showed a significantly higher DES taxon (DES-T; a subset of DES-S and an index of pathological dissociation) than the control group. Thirty-one out of the 225 patients with epilepsy (13.8%) had PNESs. Because of its strong association with the DES-S and DES-T, PNESs can be regarded as a symptom of dissociation. With multiple regression analysis, the patients with a shorter duration of epilepsy, higher seizure frequency, or shorter period in education tend to suffer from pathological dissociation. These findings demonstrate that patients with epilepsy are more prone to experiencing pathological dissociation when having certain clinical factors.


Assuntos
Transtornos Dissociativos/psicologia , Epilepsias Parciais/psicologia , Convulsões/psicologia , Adulto , Estudos de Casos e Controles , Transtornos Dissociativos/epidemiologia , Epilepsias Parciais/epidemiologia , Epilepsia/epidemiologia , Epilepsia/psicologia , Feminino , Humanos , Japão/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Prevalência , Convulsões/epidemiologia , Transtornos Somatoformes/epidemiologia , Transtornos Somatoformes/psicologia , Adulto Jovem
5.
Epilepsia ; 54 Suppl 1: 19-33, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23458463

RESUMO

In patients with epilepsy, coexisting psychoses, either interictal (IIP) or postictal (PIP), are associated with serious disturbance in psychosocial function and well-being, and often require the care of a specialist. Unfortunately, evidence-based treatment systems for psychosis in patients with epilepsy have not yet been established. This article aims to propose concise and practical treatment procedures for IIP and PIP based on currently available data and international consensus statements, and primarily targeting nonpsychiatrist epileptologists who are often the first to be involved in the management of these complex patients. Accurate and early diagnosis of IIP and PIP and their staging in terms of acuity and severity form the essential first step in management. It is important to suspect the presence of psychosis whenever patients manifest unusual behavior. Knowledge of psychopathology and both individual and epilepsy-related vulnerabilities relevant to IIP and PIP facilitate early diagnosis. Treatment for IIP involves (1) obtaining consent to psychiatric treatment from the patient, whenever possible, (2) optimization of antiepileptic drugs, and (3) initiation of antipsychotic pharmacotherapy in line with symptom severity and severity of behavioral and functional disturbance. Basic psychosocial interventions will help reinforce adherence to treatment and should be made available. Due consideration must be given to patients' ability to provide informed consent to treatment in the short term, with the issue being revisited regularly over time. Given the often prolonged and recurrent nature of IIP, treatment frequently needs to be long-term. Treatment of PIP consists of two aspects, that is, acute protective measures and preventive procedures in repetitive episodes. Protective measures prioritize the management of risk in the early stages, and may involve sedation with or without the use of antipsychotic drugs, and the judicious application of local mental health legislation if appropriate. As for preventative procedures, optimizing seizure control by adjusting antiepileptic drugs or by surgical treatment is necessary.


Assuntos
Antipsicóticos/uso terapêutico , Epilepsia/psicologia , Transtornos Psicóticos , Epilepsia/complicações , Humanos , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Psicoterapia , Transtornos Psicóticos/complicações , Transtornos Psicóticos/diagnóstico , Transtornos Psicóticos/tratamento farmacológico
6.
Epilepsy Behav ; 27(2): 342-5, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23537620

RESUMO

Treatment protocols for interictal psychosis (IIP) of patients with epilepsy have not yet been established. We aimed to clarify the effects of antipsychotic drugs (APDs) on duration of IIP episodes. We studied 393 IIP episodes in 200 patients with epilepsy in accordance with our empirical treatment protocol. The duration of all the episodes and APD treatments were reviewed. Antipsychotic drugs were used in 338 episodes and not used in 55 episodes (non-APD group). The APDs used in the treatment of IIP episodes were divided into the following three groups: first-generation APDs (FAPD, n=252), second-generation APDs (SAPD, n=44), and the combination of first- and second-generation APDs (CAPD, n=42). The non-APD group showed a significantly shorter episode duration than did the APD group (F=6.05, p=0.014). Among the 3 APD groups (FAPD, SAPD, and CAPD), there was a significant difference in duration of IIP episode (F=8.65, p=0.000). Whereas the duration of episodes was significantly longer in the CAPD group than in the other two groups, it was not significantly different between the FAPD and SAPD groups. Our findings further to clarify the nature of IIP and add further perspectives on treatment protocols for IIP.


Assuntos
Antipsicóticos/uso terapêutico , Epilepsia/psicologia , Transtornos Psicóticos/tratamento farmacológico , Adolescente , Adulto , Idade de Início , Idoso , Análise de Variância , Epilepsia/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Transtornos Psicóticos/complicações , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
7.
Epilepsia ; 53(6): 1088-94, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22429239

RESUMO

PURPOSE: There have been few reports showing the distribution of the duration of interictal psychosis (IIP) episodes and their association with clinical characteristics. To clarify the nature of IIP, we studied the duration of IIP episodes and their related factors. METHODS: One hundred fifty-five patients with epilepsy exhibited 320 IIP episodes during our follow-up period (mean 16.9 years). The duration of all the episodes and the longest episode in each patient during the follow-up periods were studied. Characteristics of the patients (e.g., epilepsy type, age of onset, and family history of psychosis) and episode-specific factors (e.g., age of the episode, seizure frequency, administrations of antiepileptic drugs [AEDs] and antipsychotic drugs [APDs]) were analyzed in association with the duration of the episodes. KEY FINDINGS: Mean duration of the 320 IIP episodes was 82.7 weeks and that of the longest IIP episodes was 150.1 weeks. During the follow-up period, 17 patients (11.0%) showed all episodes remitting within a month and 54 (34.8%) showed all episodes lasting for 6 months or longer. The IIP episodes that occurred at a younger age were often prolonged. Patients with a family history of psychosis or with early onset of psychosis tended to have more prolonged IIP episodes. Among the episodes treated with APDs, early administration of APDs was significantly associated with shorter IIP duration. SIGNIFICANCE: The distribution of the duration of IIP episodes indicated the broad spectrum and heterogeneity of the IIP phenomena. The individual vulnerability to psychosis may be associated with prolonged episodes. Administration of APDs soon after onset of the episodes appeared to be effective in controlling them. These findings support empirical treatment principles for IIP to administer APDs at an early stage of its development.


Assuntos
Antipsicóticos/uso terapêutico , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Transtornos Psicóticos/complicações , Transtornos Psicóticos/tratamento farmacológico , Adolescente , Adulto , Idade de Início , Anticonvulsivantes/uso terapêutico , Criança , Eletroencefalografia , Feminino , Humanos , Lactente , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
8.
Epilepsia ; 52(7): 1239-44, 2011 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-21453354

RESUMO

PURPOSE: Patients with recurrent epileptic seizures after the development of psychosis (Psychosis-Epilepsy) have been regarded as belonging to a different clinical entity from those with epilepsy antedating the development of psychosis (Epilepsy-Psychosis). However, clinical characteristics of patients with Psychosis-Epilepsy have not been well described, except for early German studies. We aimed to estimate the reliability of distinction between Psychosis-Epilepsy and Epilepsy-Psychosis by comparing their clinical characteristics. METHODS: Among 312 patients with epilepsy and psychosis enrolled in this multicenter study, 23 patients had Psychosis-Epilepsy and 289 patients had Epilepsy-Psychosis (i.e., interictal psychosis). Demographic (i.e., sex, age at time of evaluation, and intellectual functioning), psychiatric (i.e., age at onset of psychosis, subtype of psychosis, duration of psychotic episode, and a family history of psychosis), and epileptic (i.e., age at onset of epilepsy, subtype of epilepsy, seizure type, and a family history of epilepsy) characteristics of both groups were compared. KEY FINDINGS: Clinical characteristics, either in their psychoses or epilepsies, except for age-related variables, were equivalent between patients with Psychosis-Epilepsy and those with Epilepsy-Psychosis. Time intervals between onset of psychosis and that of epilepsy in the two groups showed a normal distribution curve. SIGNIFICANCE: The presence of many common features and the linear distribution of the time intervals did not fully support that Psychosis-Epilepsy and Epilepsy-Psychosis were two distinctly different entities. Among certain patients who have genetic vulnerabilities to both psychoses and seizures, psychosis may develop either antedating or postdating the development of epilepsy. These findings may suggest a necessary reconceptualization of psychoses in epilepsy.


Assuntos
Epilepsia/complicações , Transtornos Psicóticos/complicações , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Fatores de Risco , Convulsões/complicações , Convulsões/psicologia , Fatores de Tempo , Adulto Jovem
9.
Br J Psychiatry ; 196(3): 212-6, 2010 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-20194544

RESUMO

BACKGROUND: Age at the first psychotic episode and an interval between the onset of epilepsy and that of psychosis reflect developmental processes of interictal psychosis. However, factors relating to these indices remain unknown. AIMS: To identify clinical variables that are associated with the timing of the development of interictal psychosis. METHOD: In 285 adults with epilepsy with interictal psychosis, effects of epileptic (epilepsy type), organic (intellectual functioning) and genetic (family history of psychosis) variables on timing of the development of psychosis were examined. RESULTS: The mean interval between the onset of epilepsy and that of psychosis was 14.4 years. Some psychosis occurred within a few years of the first seizure. Generalised epilepsy, normal intellectual function and a positive family history of psychosis were associated with early onset of psychosis. CONCLUSIONS: Early development of interictal psychosis in people with epilepsy may reflect other individual vulnerabilities to psychosis rather than epilepsy-related damage.


Assuntos
Epilepsia/complicações , Transtornos Psicóticos/etiologia , Adulto , Fatores Etários , Idade de Início , Idoso , Análise de Variância , Epilepsia/genética , Epilepsia/psicologia , Feminino , Predisposição Genética para Doença , Humanos , Deficiência Intelectual/complicações , Masculino , Pessoa de Meia-Idade , Transtornos Psicóticos/genética , Transtornos Psicóticos/psicologia , Fatores de Risco , Índice de Gravidade de Doença , Fatores de Tempo , Adulto Jovem
10.
Epilepsy Behav ; 18(3): 218-22, 2010 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-20494621

RESUMO

Persons with epilepsy experience déjà vu phenomena with or without seizure recognition. Déjà vu experiences are also common mental phenomena in nonclinical individuals. The purpose of this study was to clarify two forms of déjà vu experiences in persons with epilepsy. Déjà vu experiences of 312 patients with epilepsy and 402 nonclinical individuals were evaluated using the Inventory of Déjà vu Experiences Assessment. In the patients with epilepsy, characteristics of déjà vu experiences with seizure recognition (SR form) were compared with those experiences with no seizure recognition (NSR form). The incidence (63.1%) of déjà vu experiences in patients with epilepsy was significantly lower than that (76.1%) of nonclinical individuals (chi(2)=14.2, P=0.000). Among the patients with epilepsy, 55.6% had the NSR form and 24.0% had the SR form. Those with the NSR form manifested fewer psychopathological characteristics than did those with the SR form. Patients tended to view the SR form more negatively (i.e., frightened, uncomfortable, or disturbed) than the NSR form. The NSR form was significantly associated with idiopathic generalized epilepsies, less frequent antiepileptic drug administration, and no mesial temporal sclerosis. Although there was a significant association between the frequency of the SR form and patients' habitual seizures, the frequency of the NSR form was not associated with the frequency of the patients' habitual seizures. Persons with epilepsy experience two forms of déjà vu which are differently associated with their seizure recognition.


Assuntos
Déjà Vu , Epilepsia/complicações , Transtornos da Memória/classificação , Transtornos da Memória/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Anticonvulsivantes/uso terapêutico , Eletroencefalografia , Epilepsia/classificação , Epilepsia/tratamento farmacológico , Feminino , Lateralidade Funcional , Humanos , Masculino , Transtornos da Memória/tratamento farmacológico , Pessoa de Meia-Idade , Testes Neuropsicológicos , Reconhecimento Psicológico , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Adulto Jovem
11.
BMJ Neurol Open ; 2(2): e000036, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33681791

RESUMO

BACKGROUND: Psychosis often develops after the administration of antiepileptic drugs (AEDs) in patients with epilepsy. However, the individual vulnerability and clinical condition of such patients have been rarely scrutinised. We investigated the effect of individually consistent (trait-dependent) and inconsistent (state-dependent) characteristics. METHODS: The individual characteristics, clinical states and psychotic outcome of patients from eight adult epilepsy clinics were retrospectively reviewed over 6-month periods after a new drug (AED or non-AED) administration between 1981 and 2015. RESULTS: A total of 5018 new drugs (4402 AEDs and 616 non-AEDs) were used in 2015 patients with focal epilepsy. Subsequently, 105 psychotic episodes (81 interictal and 24 postictal) occurred in 89 patients. Twelve patients exhibited multiple episodes after different AED administrations. Trait-dependent characteristics (early onset of epilepsy, known presumed causes of epilepsy, lower intellectual function and a family history of psychosis) were significantly associated with the patients who exhibited psychosis. Absence of family history of epilepsy was also associated with psychosis but not significantly. Subsequent logistic regression analysis with a model incorporating family history of psychosis and epilepsy, and intellectual function was the most appropriate (p=0.000). State-dependent characteristics, including previous psychotic history and epilepsy-related variables (longer duration of epilepsy, AED administration, higher seizure frequency and concomitant use of AEDs) were significantly associated with psychotic episodes. Subsequent analysis found that a model including AED administration and previous psychotic history was the most appropriate (p=0.000). CONCLUSION: Psychosis occurring after new AED administration was related to the individual vulnerability to psychosis and intractability of epilepsy.

12.
Psychiatry Clin Neurosci ; 63(2): 225-9, 2009 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-19335392

RESUMO

AIMS: To study clinical features of adult patients with idiopathic generalized epilepsy with special attention to suicidal behavior. METHODS: We reviewed the medical records of 145 consecutive adult patients with electro-clinically confirmed idiopathic generalized epilepsy and identified those with a history of at least one attempted suicide. Clinical variables in relation to their epilepsy and psychiatric conditions were analyzed. RESULTS: Seven patients (4.8%) had a history of suicide attempts with drug overdose, and one of these patients committed suicide after multiple attempts. All attempts were made interictally without direct relation to their epileptic seizures. All had at least one co-morbid mental disorder (two with dual diagnosis). Although their psychiatric diagnoses varied, they all appeared to have increased emotional instability and poor impulse control. Only one patient's attempt was directly associated with her co-morbid depression. CONCLUSIONS: Physicians managing people with epilepsies should be aware of psychiatric disturbances and suicidal behavior in idiopathic generalized epilepsy.


Assuntos
Epilepsia Generalizada/epidemiologia , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos de Coortes , Comorbidade , Overdose de Drogas , Emoções , Epilepsia Generalizada/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/complicações , Transtornos Mentais/epidemiologia , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Tentativa de Suicídio/psicologia , Adulto Jovem
13.
Epilepsy Res ; 78(2-3): 201-6, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18207368

RESUMO

To clarify the nature of psychosis development in epilepsy patients, we studied differences in age of onset of psychosis between epilepsy patients with psychosis (epilepsy-psychosis) and schizophrenia patients. Subjects were 282 patients with epilepsy-psychosis (36 postictal, 224 interictal, and 22 bimodal psychoses) and 612 schizophrenia patients. Age of onset was compared between the schizophrenia group and the whole epilepsy-psychosis group as well as its subgroups. Effects of sex and family history of psychosis on age of onset were also evaluated. Epilepsy patients developed psychosis later (mean age 30.1) than schizophrenia patients (mean age 26.6). Among epilepsy-psychosis subgroups, postictal psychosis and interictal psychosis showed a later onset than schizophrenia. In interictal psychosis, while chronic schizophrenia-like psychosis occurred at similar age compared to schizophrenia, brief episodic psychosis occurred at later age. Epilepsy-psychosis patients showed no sex difference in age of onset, whereas female schizophrenia patients showed a later onset than male schizophrenia patients. Both the epilepsy and schizophrenia patients with family history of psychosis tended to develop psychosis at an earlier age, although this did not reach statistically significant level. The findings of the study suggest that the nature of epilepsy-psychosis is not fully equivalent to that of schizophrenia.


Assuntos
Epilepsia/epidemiologia , Esquizofrenia/epidemiologia , Adolescente , Adulto , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Interpretação Estatística de Dados , Epilepsia/genética , Epilepsia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Esquizofrenia/genética , Psicologia do Esquizofrênico , Fatores Sexuais
14.
Epilepsy Behav ; 13(1): 248-51, 2008 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-18353731

RESUMO

We reviewed the medical records of 157 adult (18 years) patients with firmly diagnosed idiopathic generalized epilepsy (IGE) to investigate the extent and the type of psychiatric comorbidity and its relationship to various IGE syndromes and other epilepsy-related neurobiological factors. Forty-one patients (26.1%, 14 men and 27 women, median age: 34.0 years, range: 18-68, mean: 36.5) had comorbid mental disorders according to the 10th revision of the International Classification of Diseases (ICD-10) criteria, with four patients having a dual diagnosis. Mood disorders were the most common comorbid mental disorder (46.7%), followed by anxiety-panic disorder (26.7%). Comorbid psychiatric disorders occurred in all syndromes and in association with all seizure types, and, as in focal epilepsies, seizure control was significantly better in patients without psychiatric comorbidity (40.5% vs 19.5%, chi(2)(1)=5.873, P=0.015).


Assuntos
Epilepsia Generalizada/epidemiologia , Transtornos Mentais/epidemiologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Classificação Internacional de Doenças , Masculino , Pessoa de Meia-Idade
15.
J Nerv Ment Dis ; 196(5): 417-9, 2008 May.
Artigo em Inglês | MEDLINE | ID: mdl-18477885

RESUMO

We investigated the relation between déjà vu and dissociative experiences in nonclinical subjects. In 227 adult volunteers, déjà vu and dissociative experiences were evaluated by means of the inventory of déjà vu experiences assessment and dissociative experiences scale (DES). Déjà vu experiences occurred in 162 (71.4%) individuals. In univariate correlation analysis, the frequency of déjà vu experiences, as well as 5 other inventory of déjà vu experiences assessment symptoms and age at the time of evaluation, correlated significantly with the DES score. After exclusion of intercorrelative effects using multiple regression analysis, déjà vu experiences did not remain in the model. The DES score was best correlated with a model that included age, jamais vu, depersonalization, and precognitive dreams. Two indices for pathological dissociation (DES-taxon and DES > or = 30) were not associated with déjà vu experiences. Our findings suggest that déjà vu experiences are unlikely to be core pathological dissociative experiences.


Assuntos
Déjà Vu/psicologia , Transtornos Dissociativos/diagnóstico , Adulto , Despersonalização/diagnóstico , Despersonalização/psicologia , Transtornos Dissociativos/psicologia , Sonhos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Estatística como Assunto
16.
Brain Res Mol Brain Res ; 124(1): 88-95, 2004 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-15093689

RESUMO

Phencyclidine (PCP) produces schizophrenia-like symptoms in normal humans. This suggests that the dysfunction of glutamatergic neurotransmission may play an important role in the pathology of schizophrenia. However, PCP also exerts its effect on the mesolimbic dopamine (DA) system and modulates DA function in the brain, the abnormality of which is proposed to be a main pathology of schizophrenia. Recently, glial cell-line derived neurotrophic factor (GDNF) has been shown to play a protective role for DA neurons against neurotoxic injuries and maintaining DA function in the brain. We hypothesized that subchronic PCP may alter the function of GDNF in the ventral midbrain, where DA cell bodies are localized. Male Wistar rats were injected intraperitoneally with PCP daily for 10 days at 5 or 10 mg/kg, and their brains were removed 24 h after the last injection. The expressions of GDNF and its receptor (GFRalpha-1 and c-ret) mRNAs in the substantia nigra compacta (SNC) and ventral tegmental area (VTA) were determined by non-radioactive in situ hybridization, and those of GDNF and c-ret mRNA were found to be increased after the PCP subchronic administration. No significant changes, however, were observed in the expressions of GFRalpha-1 and basic fibroblast growth factor. These results suggest that subchronic PCP may modulate the function of the GDNF system, which exerts a trophic action on DA neurons in the ventral midbrain.


Assuntos
Regulação da Expressão Gênica/efeitos dos fármacos , Fatores de Crescimento Neural/metabolismo , Fenciclidina/farmacologia , Proteínas Proto-Oncogênicas/metabolismo , Receptores Proteína Tirosina Quinases/metabolismo , Substância Negra/efeitos dos fármacos , Área Tegmentar Ventral/efeitos dos fármacos , Análise de Variância , Animais , Relação Dose-Resposta a Droga , Antagonistas de Aminoácidos Excitatórios/farmacologia , Fator 2 de Crescimento de Fibroblastos/genética , Fator 2 de Crescimento de Fibroblastos/metabolismo , Fator Neurotrófico Derivado de Linhagem de Célula Glial , Receptores de Fator Neurotrófico Derivado de Linhagem de Célula Glial , Hibridização In Situ/métodos , Masculino , Fatores de Crescimento Neural/genética , Proteínas Proto-Oncogênicas/genética , Proteínas Proto-Oncogênicas c-ret , RNA Complementar/metabolismo , RNA Mensageiro/metabolismo , Ratos , Ratos Wistar , Receptores Proteína Tirosina Quinases/genética , Substância Negra/metabolismo , Área Tegmentar Ventral/metabolismo
17.
Seizure ; 12(6): 346-58, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12915080

RESUMO

Medial temporal lobe structures are known to play a major role in memory processing. Recent work has revealed that extratemporal structures (e.g. the frontal lobe and thalamus) may also be important in memory function. In candidates for epilepsy surgery, particularly in those with temporal lobe seizures, presurgical evaluation of memory function is essential, since seizures may originate in the neural substrate that is critical for memory. In this article, we review the tools used for presurgical evaluation and their contribution to the understanding of memory function, focusing on the Wada test, [18F]fluorodeoxy-glucose positron emission tomography ([18F]FDG-PET) and functional magnetic resonance imaging (fMRI). We also explore perspectives on future studies that may elucidate the role of the temporal and extratemporal structures in memory function and the mechanisms of cerebral plasticity.


Assuntos
Encéfalo/fisiopatologia , Epilepsia/fisiopatologia , Imageamento por Ressonância Magnética , Transtornos da Memória/diagnóstico , Testes Neuropsicológicos , Cuidados Pré-Operatórios/métodos , Tomografia Computadorizada de Emissão , Encéfalo/diagnóstico por imagem , Encéfalo/cirurgia , Epilepsia/diagnóstico por imagem , Epilepsia/cirurgia , Epilepsia do Lobo Temporal/fisiopatologia , Lobo Frontal/cirurgia , Lateralidade Funcional , Humanos , Transtornos da Memória/fisiopatologia , Plasticidade Neuronal , Prognóstico , Convulsões/fisiopatologia , Lobo Temporal/cirurgia
18.
Eur Neuropsychopharmacol ; 24(11): 1738-44, 2014 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-25453222

RESUMO

To investigate whether addition of antipsychotic drugs (APD) would increase seizure frequency in epilepsy patients who were already treated with anti-epileptic drugs (AED), we compared a one-year seizure control outcome in 150 epilepsy patients with APD treatment for psychiatric conditions and 309 epilepsy patients without APD treatment matched for ages at epilepsy onset and the baseline evaluation and types of epilepsy. The seizure frequency was recorded at the baseline (immediately before the start of APD) and after the 1st, 3rd, 6th and 12th months. The seizure outcome at each of the four follow-up points was compared with the baseline. The seizure outcome was compared between the two groups as a whole and according to the types of epilepsy (idiopathic generalized and partial epilepsies). In the APD group, the seizure outcome was also analyzed according to the types of APD (first and second generation APD and combination of first and second generation APD) and the types of psychiatric conditions (psychosis and non-psychosis). The seizure outcome was significantly better in the APD group than control group at all the four follow-up points. According to the epilepsy types, the improvement in the seizure outcome was only observed in the patients with partial epilepsy. Of the APD group, there was no significant difference in the seizure outcome according to the types of APD or the psychiatric conditions. In epilepsy patients who are already treated with AED, APD treatment seems safe in seizure control outcome for treatment of psychiatric conditions.


Assuntos
Antipsicóticos/efeitos adversos , Epilepsia/complicações , Epilepsia/tratamento farmacológico , Transtornos Mentais/complicações , Convulsões/induzido quimicamente , Anticonvulsivantes/uso terapêutico , Antipsicóticos/uso terapêutico , Relação Dose-Resposta a Droga , Quimioterapia Combinada/efeitos adversos , Epilepsia/diagnóstico , Feminino , Humanos , Japão , Transtornos Mentais/tratamento farmacológico , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
J Cogn Neurosci ; 21(3): 605-22, 2009 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-18564051

RESUMO

The purpose of the present study was to explore the brain regions involved in human episodic memory by correlating unilateral memory performance estimated by the intracarotid amobarbital test (IAT) and interictal cerebral metabolism measured by [(18)F]fluorodeoxyglucose positron emission tomography ([(18)F]FDG-PET). Using this method, regional alterations of cerebral metabolism associated with epilepsy pathophysiology are used to predict hemisphere-specific episodic memory function, hence, investigate the differential distribution of memory in each hemisphere. Sixty-two patients with unilateral temporal lobe epilepsy (35 left and 27 right) were studied using [(18)F]FDG-PET with complementary voxel-based statistical parametric mapping (SPM) and region-of-interest (ROI) methods of analysis. Positive regression was analyzed in SPM with a series of different thresholds (p = .001, .01 or .05) with a correction to 100 voxels. IAT memory performance in which left hemisphere was tested by right-sided injection of amobarbital correlated with [(18)F]FDG uptake in left lateral and medial temporal regions, and in the left ventrolateral frontal cortex. Right IAT memory performance correlated with [(18)F]FDG uptake in the right inferior parietal lobule, right dorsolateral frontal cortex, right precentral gyrus, and caudal portion of the right anterior cingulate cortex. ROI analysis corroborated these results. Analyses carried out separately in patients with left (n = 50) and nonleft (n = 12) dominance for language showed that in the nonleft dominant group, right IAT scores correlated with right fronto-temporal regions, whereas left total memory scores correlated with left lateral and medial temporal regions. The findings indicate that (i) episodic memory is subserved by more widespread cortical regions beyond the core mesiotemporal lobe memory structures; (ii) there are different networks functional in the two hemispheres; and (iii) areas involved in memory may be different between patients with left and nonleft dominance for language, particularly in the right hemisphere.


Assuntos
Amobarbital , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Fluordesoxiglucose F18 , Lateralidade Funcional/fisiologia , Memória/fisiologia , Adolescente , Adulto , Mapeamento Encefálico , Epilepsia/fisiopatologia , Epilepsia/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Vias Neurais/fisiopatologia , Testes Neuropsicológicos , Tomografia por Emissão de Pósitrons/métodos , Estudos Retrospectivos , Adulto Jovem
20.
Compr Psychiatry ; 48(6): 592-6, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17954146

RESUMO

To clarify why patients with schizophrenia show déjà vu experiences less frequently, we studied déjà vu experiences in 113 schizophrenic patients in relation to psychopathologies and antipsychotic medication. Déjà vu experiences were observed in 53.1% of the schizophrenic patients. Patients with increased negative symptoms (blunted affect, motor retardation, emotional withdrawal, conceptual disorganization, and mannerisms) had déjà vu experiences less frequently. The other psychopathologies were not significantly associated with presence of déjà vu experiences. The dosage of antipsychotic drugs was significantly correlated with the frequency of déjà vu experiences. This correlation was not affected by their psychopathologies at the time of examination. The decreased frequency of déjà vu experiences in patients with schizophrenia may be mainly due to the negative symptoms. The positive relation between frequency of déjà vu experiences and the dosage of neuroleptics remains uncertain.


Assuntos
Antipsicóticos/administração & dosagem , Déjà Vu/psicologia , Esquizofrenia/tratamento farmacológico , Psicologia do Esquizofrênico , Adulto , Afeto , Idoso , Ansiedade/psicologia , Estudos de Casos e Controles , Estudos de Coortes , Depressão/psicologia , Relação Dose-Resposta a Droga , Feminino , Culpa , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos das Habilidades Motoras/psicologia
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