Epileptic Psychosis: A Closer Look At Its Impact And Management

Epileptic psychosis, also known as postictal psychosis, is a rare but serious mental health condition that can occur after a seizure in people with epilepsy. It is normally characterized by hallucinations, delusions, and other psychotic symptoms. 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 epileptic psychosis symptoms

Individuals with temporal lobe epilepsy may experience a type of epileptic psychosis called postictal psychosis (PIP), which typically occurs within one to three days of an epileptic seizure. 

Psychiatric symptoms of this psychotic disorder may include the following: 

• Insomnia: One of the markers of epileptic psychosis can be the inability to fall and stay asleep (insomnia). In individuals with a history of PIP, 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. These can be defined as 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 PIP may see, hear, taste, feel, or smell nonexistent stimuli. These hallucinations can be unnerving and usually seem real to the person experiencing them. 
• Agitation: Some who experience epileptic psychosis may be easily agitated or irritated.

In addition to PIP, individuals who experience seizures may experience psychosis without having a seizure. This is usually called “interictal psychosis,” and it may have no relation to the timing of seizures. 

Individuals with epileptic psychosis may also experience alternative psychosis, which usually occurs in individuals who have been living with epilepsy that has been effectively managed with anti-seizure medications.

Causes and risk factors 

The underlying cause and largest risk factor for epileptic psychosis may be the presence of seizures or epilepsy in general. The abnormal electrical activity during a seizure may disrupt normal brain function, leading to psychosis in some individuals. Other risk factors may include the following: 

• Age: Studies have shown that the age at which a person first begins to have seizures may play a role in whether they develop epileptic psychosis. Individuals who experience seizures earlier in life may have a higher risk of developing psychosis. This may be due to the impact of seizures on the developing brain. 
• 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 postictal psychosis may also include a history of psychiatric disorders, such as schizophrenia or bipolar disorder, as well as a history of traumatic brain injury. 

The risk 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. 

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

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 and caregivers

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. 

• 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 approaches

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. For postictal and ictal seizures, antipsychotics may be combined with benzodiazepines, which can reduce and control seizures. 

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. 

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.

Takeaway

Epileptic psychosis is a relatively rare yet highly impactful mental health condition that usually involves episodes of psychosis related to seizures. Managing both seizures and psychotic symptoms can be crucial for reducing instances of epileptic psychosis. A team of mental health professionals and doctors may work together to provide treatment, which may involve medication and psychotherapy. Online therapy options can be effective at managing symptoms of psychosis and improving long-term outcomes.