Temporal Lobe Epilepsy: Impact And Management Of Epileptic Psychosis
Epileptic psychosis is a rare but serious mental health condition that can occur before, during, or after a seizure. Epileptic psychosis is typically characterized by hallucinations, delusions, and disorganized thinking. These symptoms can have an impact on a person’s daily life and typically occur after the seizure has ended, lasting from a few hours to a few days.
Not all individuals who experience a seizure or epilepsy will experience psychotic symptoms, and the cause of psychosis of epilepsy is not well understood. Treating psychosis in epilepsy and other psychotic syndromes may involve a combination of medication and psychotherapy techniques to manage and reduce symptoms over time.
Understanding postictal psychosis (PIP)
Types of psychosis caused by temporal lobe epilepsy
1. Peri-ictal psychosis: Peri-ictal psychosis symptoms occur around the time that a seizure occurs. An individual may experience peri-octal psychosis before (pre-ictal), during (ictal), or after (post-ictal) having a seizure.
Symptoms of psychosis caused by an epileptic seizure
- Insomnia: One of the markers of epileptic psychosis can be the inability to fall and stay asleep (insomnia). In individuals with a history of epileptic psychosis, doctors and mental health providers may prescribe antipsychotics or seizure control medication at the onset of insomnia.
- Delusions: As with other forms of psychosis, individuals with epileptic seizures and postictal psychosis may experience delusions. Delusions are false beliefs that aren’t based in reality, such as believing that a person is out to get you, even with evidence to the contrary.
- Hallucinations: Individuals with epileptic psychosis may see, hear, taste, feel, or smell nonexistent stimuli. Hallucinations may seem real to the person experiencing them.
- Agitation: Some people who experience epileptic psychosis may be easily agitated or irritated.
Causes and risk factors of epileptic psychosis
Age
Studies show that people who develop epilepsy before the age of ten have an increased risk of developing psychosis.
Seizure duration
Long-lasting seizures may cause long-term damage to the brain structures, which can increase the risk of developing epileptic psychosis.
Lateral location of seizure
Seizures may happen in different locations within the brain. Seizures that are bilateral or unilateral on the left side may be linked to a higher rate of epileptic psychosis.
Epilepsy surgery
Although updated evidence may be needed, individuals who undergo surgery to treat epilepsy may experience new cases of psychosis more frequently.
Risk factors for developing epileptic psychosis may also include a history of psychiatric disorders, such as schizophrenia or bipolar disorder, as well as a history of traumatic brain injury.
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The risk of experiencing epileptic psychosis may also be higher in individuals with poorly controlled epilepsy or those with a history of frequent or severe seizures. This could be due, in part, to the increased rate of brain damage for individuals with severe or frequent seizures.
Impacts of epileptic psychosis
Individuals who experience epileptic psychosis may undergo different psychological and emotional impacts. The symptoms of psychosis can make it challenging to manage elements of daily life, such as going to work or school, as well as managing interpersonal relationships with friends and family members.
During psychosis, individuals may make decisions or partake in behavior that they ordinarily would not, which may be damaging to them physically, mentally, or emotionally.
Importance of diagnosing epileptic psychosis early
Early detection and treatment can be important in managing the symptoms of epileptic psychosis, and for individuals who are at heightened risk, it may be beneficial to work with a mental health professional. A mental health professional may work with a person’s medical providers to develop coping strategies and treatments to reduce the symptoms and impact of epileptic psychosis.
Diagnosis and assessment of epileptic seizures
For mental health professionals, diagnosing and assessing epileptic psychosis can be challenging. Symptoms of epileptic psychosis may overlap with other mental health conditions, such as schizophrenia and bipolar disorder. This can make it difficult to diagnose using symptoms alone. Individuals experiencing epileptic psychosis may also be reluctant to report symptoms to a healthcare provider due to embarrassment or lack of awareness.
While diagnosing epileptic psychosis may not be easy, identifying and treating the disorder early can be important to a person’s long-term health.
Currently, there are no set diagnostic criteria for epileptic psychosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). A team of medical and mental health professionals may work together to eliminate other causes of psychosis and look at a person holistically to identify whether seizures are related to a person’s psychotic episodes. A doctor may consider a patient’s medical and mental health history, conduct brain imaging, and use laboratory tests.
An electroencephalogram, or EEG, may be used as well. The EEG is a test that can measure the electrical activity in the brain. It can identify abnormal brain activity characteristic of epilepsy and may be used to determine whether there is a correlation between seizures and psychotic episodes. Once a diagnosis has been made, a doctor or mental health professional may begin treating symptoms and managing the impact of epileptic psychosis.
Coping strategies for patients with epileptic psychosis
Epilepsy and psychosis can be challenging for individuals and their caregivers to manage. The changes that come with epileptic psychosis may cause stress and anxiety for all stakeholders. However, these can often be managed by implementing various coping strategies.
Techniques for managing psychotic symptoms
- Education: Building an understanding of the disorder can help individuals and their caregivers predict potential outcomes and develop personal strategies to manage symptoms.
- Medication adherence: Prescription medications can help prevent psychosis and seizures. Following the prescribing provider’s recommendations and communicating side effects can reduce the impact of epileptic psychosis.
- Stress management: Stress can trigger seizures and worsen psychotic symptoms. Practicing mindfulness strategies, exercise, and other stress management techniques can be helpful.
- Support groups: Joining a support group for epilepsy or psychosis can provide individuals and their caregivers with a sense of community and understanding. It can also be helpful to connect with others who are going through similar experiences.
- Open communication: It can be important for people with epileptic psychosis to talk to their healthcare provider, family, and friends about their condition and how others can support them. Open communication can reduce feelings of isolation and improve overall well-being.
While individuals with epileptic psychosis and their caregivers can follow these guidelines to improve outcomes, treatment may be more involved and usually requires professional support. Connecting with a therapist can be a good place to start.
Treatment for psychotic symptoms caused by temporal lobe epilepsy
Treating epileptic psychosis typically involves a combination of medication and psychotherapy. Antipsychotic medication may be prescribed by a doctor or psychiatrist during or after a psychotic episode and may be effective at reducing symptoms like hallucinations and delusions.
Postictal psychosis treatment
For postictal and ictal seizures, antipsychotics may be combined with benzodiazepines, which can reduce and control seizures.
Cognitive behavioral therapy (CBT)
In addition to treating epileptic psychosis with medication, it may also be beneficial for people with psychosis to work with a mental health professional. A therapist may implement various techniques, such as cognitive behavioral therapy (CBT), to help individuals identify and reframe psychosis triggers and negative thought patterns. Individuals can also learn coping strategies and mindfulness techniques to reduce the impact of symptoms in the long term.
Online therapy
Although individuals experiencing psychosis may require in-person support during a psychotic episode, online therapy can be an effective way to prevent and manage psychosis before and after a psychotic event. Online therapy can be effective in treating and improving psychosis in some individuals and may be a part of a wider prevention strategy.
Traveling to a brick-and-mortar office for therapy sessions during the workday can be challenging. Online therapy sessions can occur anywhere with an internet connection, allowing people to attend sessions from any location at times that are convenient for them. An online therapy platform may also offer more flexibility in finding a therapist who fits one’s needs.
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