Overview.
Epileptic Mental Disorder People have found through long-term observation that epileptic patients are prone to many types of mental problems, affective disorders, psychosocial adjustment disorders, personality changes and so on. Epileptic mental disorders vary in symptomatology and can be broadly categorized into seizure and non-seizure. Episodic mental disorders are characterized by sensation, perception, memory, thinking, psychomotor episodes, mood changes, and so on. Non-episodic mental disorders are characterized by psychotic-like disorders, affective disorders, personality changes or dementia. Surveys have shown that about 25% of people with epilepsy have problems such as mania, depression, personality disorders, and low libido. Patients with poorly controlled seizures are more likely to develop psychiatric disorders.
Etiology
The etiology and pathogenesis of epileptic psychiatric disorders are not completely clear. Organic or structural lesions of the brain in patients with epilepsy can be the cause of epilepsy or epileptic psychiatric disorders. In addition, when epileptic seizures occur, the brain will be ischemic and hypoxic for a certain period of time, and the neuronal excitability of the brain will be increased due to abnormal discharges in certain parts of the brain, which will affect the mental behavior and lead to mental disorders. In addition, psychosocial factors also have a certain impact, the patient may have a sense of shame, or feel isolated and helpless.
Symptoms
Epileptic mental disorders can be categorized into mental disorders during seizures, mental disorders before and after seizures, and mental disorders during interictal periods.
1. Mental disorders during seizures
(1) Perceptual disorders, such as seeing flashes of light, hearing clips of music, smelling unpleasant odors, simple to complex hallucinations, distorted vision, and hallucinations of oneself, etc., which last for a short time.
(2) Memory disorders, such as completely unfamiliar feelings in familiar environments (known as “old things are new”), new environments that seem to have been experienced in the past (known as “déjà vu”), or the sudden inability to recall certain familiar names.
(3) Thought disorder Patients feel that their thoughts suddenly stop, or there is obsessive thinking, the brain thinking is not governed by their own will, a large number of surges in the brain. Some patients have delusions of victimization.
(4) Emotional disorders Emotional outbursts, episodes of panic, irritability, and manic, aggressive, destructive and other violent behavior.
(5) Automatism Some patients may have sudden onset of impaired consciousness, dull gaze, aimless chewing and licking of lips, unbuttoning, pulling the corner of the coat, or grunting, with clumsy, repetitive, and lack of purposeful movements. When the patient gradually regained consciousness, he or she often did not know what had just happened.
2. Mental disorder before and after the seizure
Some patients have symptoms of anxiety, nervousness, irritability, impulsivity, depression, indifference and other symptoms of poor state of mind a few minutes or days before the seizure, or symptoms of autonomic dysfunction such as redness of the face and hot flashes for a period of time, so that the patient anticipates the impending seizure. Post-ictal psychosis is characterized by blurred consciousness, disorientation, hallucinations, delusions and euphoria, after which the patient may gradually fall asleep or the blurred consciousness may gradually diminish.
3. Interictal psychosis
Interictal psychosis occurs between two episodes, and the patient usually has no consciousness disorder, which lasts for months or years or is difficult to be cured. The main manifestations are:
(1) Schizophrenia-like psychosis refers to the emergence of hallucinations and delusions, which are similar to the clinical symptoms of schizophrenia, such as delusions of victimization, sense of being controlled, sense of being penetrated by others, and auditory hallucinations of commenting or ordering, etc. The patient may also suffer from emotional depression, fear and anxiety. Accompanied by emotional depression, fear, anxiety and so on.
(2) Personality disorder is often accompanied by mental retardation, which is characterized by sticky thinking and emotional outbursts. The patient is self-centered, argumentative and attached to trivialities, difficult to change his thinking, lack of creativity, and pathological redundancy. The patient is self-centered, argumentative, and obsessed with trivialities. The younger the age of onset, the greater the impact on intelligence and the more obvious the personality damage. In addition, genetics, antiepileptic drugs, adverse psychosocial factors and cultural education have an impact on the formation of personality disorders.
(3) Intellectual disability A small number of epileptic patients show mental retardation. The earlier the age of onset of epilepsy, the more likely to have intellectual decline. In some patients, intelligence may recover to a certain extent after seizures are controlled.
Examination
The main purpose is to clarify the diagnosis of epilepsy. In addition to collecting a detailed history and completing physical and neurological examinations, an electroencephalogram (EEG) is very important. If necessary, brain CTMRI and SPECT can be done to detect diffuse brain atrophy by pneumoencephalography or CTMRI. The diagnosis of epileptic psychiatric disorders requires an exhaustive psychiatric examination on top of these tests.
Diagnosis.
The diagnosis of epilepsy is first clarified. Psychiatric disorders occur on the basis of a diagnosis of epilepsy and their occurrence is associated with epilepsy. Diagnosis is made by clarifying the relationship between psychiatric symptoms and seizures, and determining whether the psychiatric symptoms occur during, before, and after, or between seizures.
Treatment
The treatment of epileptic mental disorder should be differentiated according to different situations. For psychiatric disorders before and after the seizure, the treatment should adjust the type and dose of antiepileptic drugs to control the seizure. For interictal psychiatric disorders, the treatment is the same as for non-epileptic patients, but it should be noted that many antipsychotic drugs have an increased risk of convulsive seizures, and caution should be exercised in the use of antipsychotic drugs. Patients with intellectual disability and personality changes should be better educated and managed with rehabilitation measures such as psychotherapy and occupational therapy.