The exclusive focus on seizures in the epileptic patient may also be in error as the epileptic brain is not normal between seizures. Similar brain phenomena may be produced by pathology in different brain regions ( 7). Third, the similarity between temporal lobe phenomena and psychotic symptoms does not necessarily imply a common origin for the two sets. The 6-month criterion for schizophrenia used in DSM-III and subsequent classifications had a major impact on the prevalence rates for this disorder, with implications for associations based on previous epidemiological data. For example, estimates of the proportion of epilepsy patients who have a temporal lobe focus vary from 30% to as much as 76% ( 6), and studies have differed in the rigor with which a temporal lobe onset was investigated. ![]() Second, both epilepsy and schizophrenia are heterogeneous disorders, and their categorization should be systematically studied before any association is described. ![]() In this review, I restrict myself to the examination of psychoses that phenomenologically resemble a schizophreniform illness. Clearly, the significance of a confusional postictal psychosis is different from that of a postictal manic psychosis or an interictal schizophreniform psychosis. It is likely that structural brain abnormalities, e.g., cortical dysgenesis or diffuse brain lesions, underlie both epilepsy and psychosis, and that the seizures modify the presentation of the psychosis, and vice versa, thus producing a clinical picture of both an affinity and an antagonism between the two disorders.įirst, the definitions of “psychosis” and “schizophrenia” used in many studies have lacked standardization. CONCLUSIONS: There are many mechanisms by which epilepsy may be associated with schizophrenia-like psychosis. Different neuropathological studies suggest the presence of cortical dysgenesis or diffuse brain damage. Some suggested risk factors are severe and intractable epilepsy, epilepsy of early onset, secondary generalization of seizures, certain anticonvulsant drugs, and temporal lobectomy. The chronic psychosis resembles schizophrenia phenomenologically. The majority of investigators support a special but not exclusive relationship with mediobasal temporal lobe epilepsy, and left temporal bias receives only limited support. Many aspects of the relationship with chronic interictal psychosis remain controversial. Brief interictal psychoses, involving alternation between epilepsy and psychosis and accompanied by forced normalization, are uncommon. The recent interest in postictal psychoses has opened an important avenue for research. Their categorization into ictal, postictal, and interictal psychoses is clinically useful, but it does not imply distinct pathophysiology for each. RESULTS: The schizophrenia-like psychoses of epilepsy are inadequately categorized by the current classifications. METHOD: The author provides an overview of the published literature on epilepsy and schizophrenia-like psychosis. Current Psychiatry Reports Springer Journals OBJECTIVE: Current knowledge of the relationship between epilepsy and schizophrenia-like psychosis is examined, and the proposed pathogenetic mechanisms are evaluated. ![]() The discussion on the pathophysiology of musical hallucinations comprises theories of deafferentation (including auditory Charles Bonnet syndrome), of sensory auditory deprivation, of parasitic memory, and of spontaneous activity in a cognitive network module. Anticonvulsant and antidepressive agents have been effective in the treatment of some musical hallucinations. Hemispheric dominance seems to play no major role in the pathogenesis of musical hallucinations, but hypacusis is present in the majority of all patients. Musical hallucinations most often occur in patients over age 60 years, although patients whose hallucinations are caused by focal brain lesions are significantly younger. There is a female preponderance of about 70%. Analyzing the published cases, five subgroups can be separated according to their etiology: hypacusis, psychiatric disorders, focal brain lesions, epilepsy, and intoxication. Musical hallucinations have been described in numerous neurologic and psychiatric patients, but their pathophysiologic background is not understood. Musical hallucinations Musical hallucinations
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