Epilepsy and psychiatric disorders

Summary

The relationship between epilepsy and behavior disorders will be briefly outlined, and an initial distinction between periictal and interictal disorders made. This paper will concentrate on the periictal disorders. These include the ictally driven psychoses, such as complex partial seizure status and absence status. There will then be a discussion of the postictal psychoses. It will be noted how these form a constant clinical picture, which sometimes goes unrecognized. The phenomenology may be typically paranoid or schizophrenia-like, andpatients often present in a setting of clear consciousness. The fascinating phenomenon of the lucid interval will be noted. Following this there will be some discussions on the management of these disorders. The rest of the paper will discuss the phenomenon of forced normalization, first discovered by Landolt. This often remains unrecognised, but is of interest to both neurology and psychiatry. Essentially this is about patients who, following suppression of seizures, develop an acute psychotic state or some other kind of behavior disorder. With the return of the seizures the behavior disorder resolves. Various theories in relationship to this condition will be noted, and the fascinating paradox that in psychiatry we give a seizure to resolve a psychosis, whereas in epileptology suppression of seizures can lead to a psychosis will be presented.