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Psychiatric Disorders related to Epilepsy

في الثلاثاء يناير 29, 2013 12:45 am
Introduction :-

The term (epilepsy) refers to a neurological disorder , that results from the presence of an epileptic focus in the brain , with irregular epileptic electrical discharges , the spread of which to different parts of the brain results in the clinical manifestations of the disorder including convulsions (1) .
There are many different forms of epilepsy including : -
1- Grand Mal epilepsy .
2- Petit Mal epilepsy .
3- Temporal lobe epilepsy .
A number of clinical studies showed that the incidence of mental disorders is generally higher in epileptics compared to other members of the population . (25%) , Of the epileptics suffer from a neurotic disorder , (50%) are diagnosed
ــــــــــــــــــ
* PROF. DIAA E .Elgaili, M.D. Professor of Psychiatry , Head of the Dept . of Mental Health , Faculty of Medicine University OF Gezira .

as being cases of a personality disorder , while (8%) suffer from a psychotic disorder (1) .
It is clear that epileptics suffer from a variety of mental disorders . An epileptic is likely to face the social stigma of the disorder , which may be reflected negatively on the psychological health of the patient . Epilepsy results in a great change in the patient’s life , with many restrictions to normal daily functioning .
Mental disorder in an epileptic is likely to be associated with brain atrophy , which is likely to the cause , or the result of epilepsy (1) .
Psychiatric disorders related to epilepsy :-

1. Depression :-

Depression is fairly common among epileptics .Depressive symptoms are likely to preceed the epileptic fits , to occur during the fits , or to occur in the inter- ictal period .
A comparative study showed that the physical symptoms of depression occur in (60%) of depressed epileptics compared to(30%) depressed non- epileptic patients . The incidence of suicide and attempted suicide is five times more common in depressed epileptics compared to depressed non- epileptics .
Depressed patients with a diagnosis of temporal lobe epilepsy have even a higher incidence of suicide (25 times more than depressed non- epileptics ) .
When treating a depressive episode with an anti-depressant , attention should be paied to the choice of the appropriate anti -depressant drug , since some anti -depressants lower the fits threshold and have a negative impact on the control of epileptics
Psychotherapeutic approaches , especially cognitive Psychotherapy , play an important role in the treatment of depression in epileptics , since it allows the patient to have a better state of adaptation with his environment .
2-Anxiety disorder :-
Anxiety symptoms are commen in epileptics , and may be related to fearful anticipation of fits in an epileptic , as well as being related to the social stresses (the social stigma , the limitations put on epileptics , ect . ) facing the epileptic patient .
Some epileptics suffer from an anxiety disorder that requires drug and psychological therapy .
3-Psychotic Disorders :-
The relation between epilepsy and psychotic disorders is complex and was subject of many studies . In the past , it was thought that the presence of epilepsy prevents the occurrence of psychotic disorders . However , it is now clear that this is not true , and that there is a relation between epilepsy and psychotic disorders , especially schizophrenia - like psychotic disorder (2)

psychotic disorders in epilepsy include : -
1. Schizophrenia- like psychotic disorder .
2. An acute manic -like psychotic disorder .
3. An acute organic psychotic disorder (delirium) .
Psychiatric Symptoms accompaning temporal lobe epilepcy :-
1. Behavioral symptoms:-
Usually simple behavioral symptoms including automatic activities that occur during the fits . Automatic activities may be motor , or in the form of more simple , type of behavioral .
When the behavioral symptoms accompany a disturbance in the level of consciousness , then childish or anti social behavioral may appear .
2. Affective symptoms:
include being mainly fearful and apprehensive , but it can occasimally be in the form of an elated mood (3) .
3. Other symptoms include :-
a) Disturbed level of consciousness .
b) Persecutory and grandiose delusions .
c) Visual hallucinations .
d) Obessional thoughts (3) .



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