Treatment of psychosis, aggression, and irritability in patients with epilepsy
Introduction
The approach to the treatment of psychosis, irritability, and aggression in patients with epilepsy (PWE) is often dependent on their temporal relations to seizure occurrence. A classification scheme based on the development of psychopathological features observed during the prodromal, ictal, peri-ictal, and interictal periods provides a framework to discuss treatment alternatives.
Section snippets
Psychosis
Psychosis of epilepsy (POE) is a term applied to a group of psychotic disorders with a distinct phenomenology in which the potential etiopathogenic mechanisms are believed to be closely related to the seizure disorder itself. As early as the 19th century, scholars identified a bidirectional relationship between psychosis and epilepsy [1], [2]. In the 1950s, several investigators reported that patients with epilepsy, in particular those with temporal lobe epilepsy (TLE), suffered from an
Use of restraints
If possible, avoid the use of restraints in postictal aggression or irritability. In centers experienced in the care of PWE, patients who are confused and who wish to leave the bed are often allowed to do so escorted by staff. Often a delirious or confused postictal epileptic patient will ambulate briefly and eventually accept guidance back to the bed. This is strongly preferable to the situation all too commonly seen in emergency and other settings with less experience with epileptic patients.
Antipsychotics
The S2-D2 or atypical neuroleptics are current first-line treatment for psychosis and are used in aggression and irritability. The term S2-D2 refers to the action of antagonism of atypical antipsychotics at the dopamine type 2 receptor, which is also an attribute of “typical” antipsychotics, and in addition, antagonism of the serotonin type 2A receptor, which is a distinguishing attribute of atypical antipsychotics. The serotonin type 2A receptor is thought to mediate the effects of “classical”
Conclusion
Psychosis, irritability, and aggression in PWE may occur due to the bidirectional relationship between psychosis and epilepsy, in which the potential etiopathogenic mechanisms are believed to be closely related to the seizure disorder itself, and also may be a behavioral manifestation of comorbid neurological pathology. The use of appropriate psychotropic agents should minimize the possible lowering of seizure threshold and interactions with AEDs. The possibility of behavioral toxicity of AEDs
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