Comprehensive Textbook of Psychiatry.

In 1969, the International League Against Merlis, Dr. D. David Daly of Dallas, Dr. Epilepsy published a scheme for classifica- Dieter Janz of Berlin, Dr. J. Kiftin Penry of tion of epileptic seizures. Professor H. Bethesda, Dr. Carlo Alberto Tassinari of Gastaut, then Secretary-General of ILAE Marseille. In addition, Dr. Rudolph Dreyer and a member of the Commission on Clas- of Bethel. Dr. Antonio V. Escueta of Los sification, related the history of the work Angeles, Dr. K. F. Masuhr of Berlin, Dr. which represents a milestone in efforts at Richard H. Mattson of New Haven, Dr. classifying epileptic seizures and has led to Roger J. Porter of Bethesda. Dr. Dieter world-wide adoption (Gastaut, 1970). Schmidt of Berlin, and Dr. Gregory 0. Since the publication of the 1969 classifi- Walsh of Los Angeles attended as particication, objective and sophisticated methods pants and discussants in this workshop. for studying epileptic seizures have become In 1977, a workshop on generalized seicommonplace. These methods include zures was held in Berlin. The above Comvideo display of epileptic seizures on mag- mission members were present with the adnetic tape, the simultaneous recording of dition of Dr. Toyoji Wada of Shizuoka and the electroencephalogram using hard-wired invited participants who presented vidrecording techniques and radiotelemetry eotape data, including Dr. A. Cirignotta of with split screen display and instant replay Bologna, Dr. Peter Kellaway of Houston, capability. Dr. Cesare Lombroso of Boston, Dr. K. F. Since 1975, two further Commissions on Masuhr of Berlin, and Dr. D. Stefan of Classification and Terminology of the In- Bonn. The results of these workshops comternational League Against Epilepsy have prise the major portions of the version of convened in order to continue to update, the International Classification of Epileptic amend, and improve the classification in Seizures herewith proposed.

Proposal for Revised Clinical and ~lectro~nce~halo ~ra~hic Classification of Epileptic Seizures From the Commission on Classification and Terminology of the International League Against Epilepsy*

Hallucinations constitute one of the 5 symptom domains of psychotic disorders in DSM-5, suggesting diagnostic significance for that group of disorders. Although specific featural properties of hallucinations (negative voices, talking in the third person, and location in external space) are no longer highlighted in DSM, there is likely a residual assumption that hallucinations in schizophrenia can be identified based on these candidate features. We investigated whether certain featural properties of hallucinations are specifically indicative of schizophrenia by conducting a systematic review of studies showing direct comparisons of the featural and clinical characteristics of (auditory and visual) hallucinations among 2 or more population groups (one of which included schizophrenia). A total of 43 articles were reviewed, which included hallucinations in 4 major groups (nonclinical groups, drug- and alcohol-related conditions, medical and neurological conditions, and psychiatric disorders). The results showed that no single hallucination feature or characteristic uniquely indicated a diagnosis of schizophrenia, with the sole exception of an age of onset in late adolescence. Among the 21 features of hallucinations in schizophrenia considered here, 95% were shared with other psychiatric disorders, 85% with medical/neurological conditions, 66% with drugs and alcohol conditions, and 52% with the nonclinical groups. Additional differences rendered the nonclinical groups somewhat distinctive from clinical disorders. Overall, when considering hallucinations, it is inadvisable to give weight to the presence of any featural properties alone in making a schizophrenia diagnosis. It is more important to focus instead on the co-occurrence of other symptoms and the value of hallucinations as an indicator of vulnerability.

/pdf/hallucinations-a-systematic-review-of-points-of-similarity-tqz6cp1xps.pdf

Hallucinations: A Systematic Review of Points of Similarity and Difference Across Diagnostic Classes

Many recent epidemiological studies have found the prevalence of depression and anxiety to be higher in people with epilepsy (PWE) than in people without epilepsy. Furthermore, people with depression or anxiety have been more likely to suffer from epilepsy than those without depression or anxiety. Almost one-third of PWE suffer from depression and anxiety, which is similar to the prevalence of drug-refractory epilepsy. Various brain areas, including the frontal, temporal, and limbic regions, are associated with the biological pathogenesis of depression in PWE. It has been suggested that structural abnormalities, monoamine pathways, cerebral glucose metabolism, the hypothalamic-pituitary-adrenal axis, and interleukin-1b are associated with the pathogenesis of depression in PWE. The amygdala and the hippocampus are important anatomical structures related to anxiety, and γ-aminobutyric acid and serotonin are associated with its pathogenesis. Depression and anxiety may lead to suicidal ideation or attempts and feelings of stigmatization. These experiences are also likely to increase the adverse effects associated with antiepileptic drugs and have been related to poor responses to pharmacological and surgical treatments. Ultimately, the quality of life is likely to be worse in PWE with depression and anxiety than in PWE without these disorders, which makes the early detection and appropriate management of depression and anxiety in PWE indispensable. Simple screening instruments may be helpful for in this regard, particularly in busy epilepsy clinics. Although both medical and psychobehavioral therapies may ameliorate these conditions, randomized controlled trials are needed to confirm that.

/pdf/depression-and-anxiety-in-people-with-epilepsy-2uycht7u0x.pdf

Depression and anxiety in people with epilepsy.

Spirituality and Religion in Epilepsy

An international consensus clinical practice statement issued in 2011 ranked psychogenic nonepileptic seizures (PNES) among the top three neuropsychiatric problems. An ILAE PNES Task Force was founded and initially charged with summarizing the current state of the art in terms of diagnosis and treatment, resulting in two publications. The first described different levels of diagnostic certainty. The second summarized current knowledge of management approaches. The present paper summarizes an international workshop of the ILAE PNES Task Force that focused on the current understanding and management of PNES around the world. We initially provide a knowledge update about the etiology, epidemiology, and prognosis of PNES-in adults and in special patient groups, such as children, older adults, and those with intellectual disability. We then explore clinical management pathways and obstacles to optimal care for this disorder around the world by focusing on a number of countries with different cultural backgrounds and at very different stages of social and economic development (United Kingdom, U.S.A., Zambia, Georgia, China, and Japan). Although evidence-based methods for the diagnosis and treatment of PNES have now been described, and much is known about the biopsychosocial underpinnings of this disorder, this paper describes gaps in care (not only in less developed countries) that result in patients with PNES not having adequate access to healthcare provisions. A range of challenges requiring solutions tailored to different healthcare systems emerges. Continued attention to PNES by the ILAE and other national and international neurologic, psychiatric, and health organizations, along with ongoing international collaboration, should ensure that patients with PNES do not lose out as healthcare services evolve around the world.

https://onlinelibrary.wiley.com/doi/pdf/10.1002/epi4.12060

PNES around the world: where we are now and how we can close the diagnosis and treatment gaps. An ILAE PNES Task Force report

Summary

Purpose: To prospectively investigate the incidence of interictal psychoses of epilepsy patients, and make a comparison between those with interictal psychoses and patients with schizophrenia in respect to their responses to antipsychotic drugs, as well as psychotic states.



Methods: We undertook a two-part prospective investigation. In Part I, the psychotic episodes of 619 epilepsy patients were investigated, while 182 patients with psychotic syndromes were followed in Part II, of whom 59 were diagnosed with schizophrenia and 13 with epilepsy with interictal psychoses. The Positive and Negative Syndrome Scale was used for efficacy assessment.



Results: The average annual incidence of interictal psychosis was 0.42% during the 56-month study period. A significant difference was found between patients with schizophrenia and epilepsy patients with interictal psychoses in respect to results on the negative subscale of the PANSS at the initial examination (mean scores of 18.1 and 13.2, respectively, p = 0.004). The response rates one year later for these groups were 27.1% and 53.8%, respectively, which showed a trend of better response to the antipsychotic medication by the epilepsy group (p = 0.098). Initial and maximum doses of antipsychotic drugs used for epilepsy patients with interictal psychoses were significantly lower than those used for patients with schizophrenia (p = 0.008 and p = 0.006, respectively).



Conclusions: Schizophrenia and epileptic psychosis showed different symptom profiles. On average, epilepsy patients with interictal psychoses achieved higher remission rates with lower doses of antipsychotic drugs as compared to patients with schizophrenia in the present 1-year follow-up study.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1528-1167.2007.01230.x

Interictal psychoses in comparison with schizophrenia--a prospective study.

Violence and postictal psychosis: a comparison of postictal psychosis, interictal psychosis, and postictal confusion.

Screening for major depressive episodes in Japanese patients with epilepsy: validation and translation of the Japanese version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E).

Summary: Purpose: To clarify duration of postictal psychosis (PIP) episodes and identify factors that influence its duration. Methods: Fifty-eight patients with epilepsy exhibited 151 PIP episodes during a mean follow-up period of 12.8 years. Distribution of the duration of these episodes was determined, and factors potentially affecting were analyzed. Factors analyzed included PIP-related variables (i.e., antecedent seizures and the lucid interval) and patient characteristics (i.e., type of epilepsy, lateralization of EEG abnormalities, and intellectual functioning). Results: The mean duration of the 58 first PIP episodes was 10.5 days, and that of all 151 PIP episodes (including multiple episodes) was 9.2 days. Approximately 95% of the PIP episodes resolved within 1 month. Most PIP-related variables, except for antipsychotic drugs administered, were not associated with duration of the episodes. Several patient characteristics, i.e., history of interictal psychosis, family history of psychosis, and intellectual functioning, were associated with duration of the PIP episodes. Conclusions: This study showed that most PIP episodes last less than 1 month. PIP episodes appear to be prolonged when individuals have an underlying vulnerability to psychosis. Clinical phenomena that can trigger PIP may not determine the course of the PIP episode. Ke yW ords: Epilepsy—Postictal psychosis— Duration—Time course—Clinical characteristics.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1528-1167.2007.01058.x

Yukari Tadokoro

Papers

PNES around the world: where we are now and how we can close the diagnosis and treatment gaps. An ILAE PNES Task Force report

Interictal psychoses in comparison with schizophrenia--a prospective study.

Violence and postictal psychosis: a comparison of postictal psychosis, interictal psychosis, and postictal confusion.

Screening for major depressive episodes in Japanese patients with epilepsy: validation and translation of the Japanese version of Neurological Disorders Depression Inventory for Epilepsy (NDDI-E).

Duration of Postictal Psychotic Episodes