Understanding And Managing Epileptic Psychosis
Epileptic psychosis is a complex condition that occurs in some individuals with epilepsy. Psychotic symptoms such as hallucinations, delusions, or disorganized thoughts may create additional challenges in managing this complex neurological disorder. Treating co-occurring epilepsy and psychosis tends to involve a multifaceted approach, often including a combination of medical care, medications, lifestyle changes, and mental health techniques. Here, we’ll examine the causes and symptoms of epileptic psychosis and explore treatment and management options.
What is epileptic psychosis?
Epilepsy is a brain disorder that causes recurring seizures. Epileptic psychosis is when psychotic episodes occur in an individual with epilepsy. Episodes of epileptic psychosis are thought to be linked to the abnormal electrical activity in the brain associated with seizures.
Epileptic psychosis is most common in individuals with temporal lobe epilepsy rather than idiopathic generalized epilepsy or other generalized epilepsies. Epileptic psychosis adds a psychological dimension to the condition of epilepsy that can significantly affect an individual’s mental health and overall well-being.
Epileptic psychosis is distinct from psychiatric disorders or psychotic syndromes due to its direct link to the timing and neurological mechanisms of epilepsy. Unlike a primary psychotic disorder such as schizophrenia, the onset of epileptic psychosis may often be tied to seizure patterns, medication changes, or other neurological causes.
Causes and risk factors for psychosis in people with epilepsy
Although not everyone who experiences epilepsy or partial epilepsy will experience psychiatric symptoms of psychosis, studies suggest that individuals with epilepsy may be at higher risk of developing psychotic episodes compared to the general population. The causes and risk factors may vary from person to person but may include neurological factors, lifestyle choices, and medication interactions.
Possible causes of psychosis in people who have seizures
Some of the possible causes of psychosis in people who have seizures may include:
- Neurological factors. The specific brain regions involved in a seizure, such as the temporal lobe, are typically involved in psychotic symptoms, including olfactory, auditory, or visual hallucinations. In this way, abnormal brain activity, which may be linked to seizures, can cause symptoms of psychosis.
- Impacts of medications. Anti-epileptic medications for seizure control may cause psychosis in some people due to interactions in the brain.
- Psychosocial stressors. Chronic stress, anxiety, and social isolation may increase the risk of developing psychosis in individuals with epilepsy.
Psychosis risk factors for people with epilepsy
There are several risk factors that may increase the risk of psychotic episodes in people living with epilepsy. Some key examples include lifestyle factors, such as sleep deprivation or substance use. Both a lack of sleep and using mind-altering substances can impact brain chemistry, which may cause more seizures and can influence the development of psychotic symptoms as a result. Additionally, research suggests that sudden hormonal changes may cause a shift in frequency and intensity of seizures in those with epilepsy, which could be linked to psychosis.
Ictal psychosis, interictal psychosis, and postictal psychosis
Individuals living with epileptic psychosis may experience any of three different types of psychosis depending on when the psychotic symptoms occur. These types are ictal psychosis, interictal psychosis, and postictal psychosis.
Ictal psychosis
Ictal psychosis is a psychotic episode that happens at the same time as a seizure. Symptoms may include confusion, hallucinations, or behavioral changes. This type is often linked to prolonged or focal seizures, particularly those affecting the temporal lobe.
Interictal psychosis
Interictal psychosis occurs in between seizures and may be unrelated to the timing of a previous or future seizure. This type of psychosis can be challenging to diagnose because it may resemble signs of other psychotic disorders such as schizophrenia, with symptoms including persistent delusions, paranoia, and/or auditory hallucinations. Individuals with poorly controlled epilepsy or a history of long-term seizure activity may experience interictal psychosis more frequently.
Postictal psychosis
Psychosis that develops after a seizure occurs, usually within one week of a seizure, is known as postictal psychosis. Postictal psychotic episodes may include hallucinations, delusions, and agitation. Symptoms of psychosis may resolve after a few days but can persist longer, especially if left untreated.
Symptoms of epileptic psychosis
Epileptic psychosis may involve symptoms that vary depending on the psychosis type and its severity. That said, some possible symptoms of epileptic psychosis include the following:
- Auditory or visual hallucinations: hearing voices that are often accusatory or commanding in nature
- Social withdrawal: avoidance of relationships or interactions with others
- Cognitive impairments: difficulty with memory, focus, or decision-making
- Blunted affect: reduced emotional expression such as a flat or monotone voice
- Fear and anxiety: heightened distress or panic, which may occur without clear causes
- Irritability or aggression: uncharacteristic hostility or frustration towards others, including friends and family members
- Hyperactivity or restlessness: difficulty staying calm or still
- Depressive symptoms: sadness, hopelessness, or lack of interest in usual activities
- Altered awareness: partial responsiveness and an inability to communicate clearly
- Paranoia: intense fear of harm or mistrust of others
- Delusional beliefs: unrealistic ideas, such as having special powers or being watched
- Disorientation: difficulty understanding surroundings or recognizing familiar people
- Emotional instability: rapid mood changes or heightened anxiety
Treatment options
Managing epileptic psychosis often involves connecting with an expert who can treat psychotic disorders as well as a doctor who specializes in treating epilepsy. For many living with epilepsy and psychosis, medications may play a key role in treatment, and ensuring seizures are well-managed through appropriate medical care may significantly reduce the risk of psychotic episodes.
Antipsychotic medications can be prescribed to manage acute episodes of psychosis, particularly in cases of postictal or interictal psychosis. However, doctors will need to carefully examine a patient's medication regimen to avoid potential interactions that could exacerbate symptoms. In some cases, a doctor may recommend epilepsy surgery for reducing psychosis. Remember to not start, stop, or change any medication without consulting with your doctor.
In addition to medical treatment options and medications, psychotherapy may help a person manage symptoms of epileptic psychosis. Psychotherapy techniques such as cognitive behavioral therapy may help clients manage the emotional impacts of their condition. Therapy may also teach coping strategies for managing anxiety and emotional distress. Other forms of supportive therapy can also provide a safe space for individuals to express their experiences and emotions and may help them build resilience and reduce feelings of isolation.
Managing seizures and psychosis in daily life
In addition to seeking appropriate medical care, managing co-occurring seizures and psychosis usually involves a combination of techniques to help minimize seizures and reduce the risk of associated psychosis. Examples of these strategies include making lifestyle changes and implementing mindfulness or relaxation practices into daily life.
Lifestyle changes that may help individuals manage epileptic psychosis
Certain lifestyle changes may help support overall brain health, reduce seizure activity, and minimize psychotic symptoms. Examples of such changes may include:
- Engaging in stress management. Chronic stress can be a significant contributing factor or cause of both seizures and psychotic episodes in people with epilepsy. Techniques such as mindfulness and deep breathing exercises may help reduce stress levels.
- Cultivating regular sleep patterns. Sleep deprivation can exacerbate seizures and psychosis. Maintaining a consistent sleep schedule is thought to be essential for brain stability.
- Avoiding common seizure causes. Identifying and avoiding known causes of seizures, such as flashing lights, certain medications, or alcohol, may help reduce episodes.
- Eating nutritious foods and exercising. Eating nutrient-rich foods as often as possible and getting regular physical activity may help promote overall brain health and emotional stability.
Mindfulness practices
Stress can play a major role in the frequency of seizures. Mindfulness practices may help a person with epileptic psychosis reduce and/or manage chronic stress, which may help reduce seizures.
Examples of mindfulness practices include deep breathing techniques, yoga, and meditation. In addition to managing stress, mindfulness and relaxation practices may also help a person achieve regular sleeping patterns, which may help reduce the occurrence of both seizures and psychosis.
Connecting with a mental health professional
For individuals with epileptic psychosis, one part of treatment may involve connecting with a mental health professional like a therapist who can provide therapeutic support and interventions for psychosis. This type of support should typically be sought in addition to a doctor's care for managing epilepsy. A therapist can consider a person’s mental health holistically and develop a treatment plan to reduce the impact of psychosis while also managing the mental health impacts of epilepsy.
While in-person care may be required in some cases, online therapy can sometimes be a useful and convenient addition to a person’s treatment plan for epilepsy and/or psychosis. It can be challenging for some to attend regular therapy sessions in person at a brick-and-mortar office, but online therapy allows an individual to attend therapy sessions from anywhere with an internet connection and personal device. This means that individuals can get the mental health care that they need from a place where they are comfortable. Online therapy may also provide added flexibility when finding a therapist because clients aren’t limited to the mental health professionals who work in their immediate area.
Research suggests that, in some cases, online therapy can be a component of an effective plan for managing psychosis. In an online environment, a therapist can evaluate, diagnose, and provide treatment to support a client’s health and overall well-being.
Takeaway
Epileptic psychosis is a complex mental health condition where epilepsy patients may experience psychotic symptoms related to their seizures. Managing the impacts of epileptic psychosis may involve connecting with a team of medical and mental health professionals to reduce the frequency and intensity of seizures to, in turn, reduce the chances of experiencing psychosis. In addition to medications, medical care, and lifestyle changes, mental health therapy techniques may aid in reducing the impacts of epileptic psychosis and improving an epileptic patient’s overall mental health and well-being.
How long does epileptic psychosis last?
Depending on the type of epileptic seizures someone is having, such as refractory temporal lobe epilepsy, epileptic psychosis can last from a few days to months. Often, antipsychotic medications are used to control these episodes of chronic interictal psychosis. For some people, episodes may be briefer, lasting only a few days. Talk to your doctor about the type of epilepsy you have and how chronic psychoses can be connected to temporal epilepsy and other forms. Don’t start, change, or stop any antipsychotic or antiepileptic medications without consulting your doctor.
The BetterHelp platform is not intended to provide any information regarding which medication or medical treatment may be appropriate for you. The content provides generalized information that is not specific to one individual. Do not take any action without consulting a qualified medical professional.
What type of epilepsy causes psychosis?
Temporal epilepsy is the most common cause of mental disorders and schizophrenia-like psychosis. Refractory seizures in this area often cause these symptoms because the temporal lobe controls thought processing and perception. An epilepsy surgery like a temporal lobe resection may sometimes be used to reduce negative symptoms, positive symptoms, and paranoid delusions in those with mesial temporal sclerosis or epilepsy.
Other types of epilepsy are sometimes related to an individual developing interictal psychosis, though these cases tend to be rarer. Symptoms of epileptic psychosis can mimic those of other affective disorders or cause psychiatric comorbidity, such as the development of a mental health condition alongside epilepsy. A family history of mental illness may make alternative psychosis or de novo psychosis more likely.
What medication is used for epilepsy and psychosis?
Antipsychotics are generally used to treat symptoms of psychosis in patients with epilepsy, whereas antiepileptic medications can be used to treat seizures. Since both categories of medication can be strong, be sure to consult your doctor before mixing medications.
What mental illness does epilepsy cause?
Epilepsy is more frequently connected with anxiety and depression, as these disorders are common in this population. Psychosis can be rarer and is not necessarily a sign of a mental illness. Often, psychotic symptoms are caused by seizures in the temporal lobe and can be treated with medication, surgery, and other medical interventions.
Can epilepsy cause manic episodes?
Epilepsy may cause manic episodes similar to those that might be seen in bipolar I disorder. However, these episodes are typically short-lived and tend to occur more frequently after a severe seizure or brain surgery. Manic behaviors might look like excessive risk-taking, grandiose delusions, and a lack of regard for one’s personal safety or the safety of others.
What are the odd behaviors of epilepsy?
People with epilepsy may have behavioral differences because of the changes in their brains and their seizures. For example, they might showcase repetitive movements, periods of staring off into space, or sudden mood changes. Behaviors can also change alongside episodes of psychosis or mania.
What are the personality traits of someone with epilepsy?
Everyone with epilepsy is a unique individual. People with this condition experience different symptoms and have unique personalities. Like anyone else, their personalities may be formed from life experiences and genetics. In some cases, people with epilepsy may experience personality changes due to a seizure, which can change the way their brains work.
What are the psychiatric symptoms of epilepsy?
For many people with epilepsy, depression, anxiety, and worry are part of the condition. These co-occurring psychiatric disorders are highly common among this population. Symptoms might include a lack of motivation, negative thoughts, frequent worrying, rumination, and a profound sense of sadness or numbness that is difficult to escape.
Can epilepsy turn into schizophrenia?
Epilepsy does not “turn into” schizophrenia. However, schizophrenia may be caused by seizures in rare cases. In general, epileptic psychosis is temporary and does not continue to be an issue after the epilepsy is treated.
What is a psychotic seizure?
Psychotic seizures occur when brief psychotic episodes are present during a seizure, such as hallucinations, delusions, and other psychotic symptoms. A person may also feel detached from reality and express a different mood. Some people also experience mania during these types of seizures. Talk to your doctor if you’re having psychotic seizures.
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