PSYCHIATRIC ASPECTS OF EPILEPSY

GENERAL OBJECTIVE
• Describe psychiatric aspects or behavioral
disturbances or disorders that take place
during epilepsy.
 SPECIFIC OBJECTIVES
• Define ictal.
• Explain the meaning of pre-ictal, ictal, post-
ictal, inter-ictal.
• Outline the behavioural or psychiatric
disorders that take place before, during, after
and in between seizures.
 INTRODUCTION
• Psychiatric co morbidity is common in people
with epilepsy.
• People with epilepsy have 2 times a chance of
developing psychiatric disorders than in the
general population.
• Between 10% and 50% of patients with epilepsy
have psychiatric symptoms.
• Many different types of psychiatric disorders are
associated with epilepsy.
• They include cognitive, affective, emotional, and
behavioural disturbances.
 DEFINITIONS
• Ictal means convulsion.
 Behavioural disturbances occur in
relation to seizures as follows:
• Before (pre-ictal),
• During (ictal),
• After (post-ictal),
• Between (inter-ictal)
 PRE-ICTAL PSYCHIATRIC
DISTRUBANCES
• Symptoms may be experienced hours to days before a
seizure. They include:
• Tension (cannot relax due to worry)
• Irritability
• Anxiety
• Depression
• aura (warning sensation before epileptic episode)may
occur just before the seizure and may consist in
derealisation and depersonalization experiences,
• Hallucinations: (auditory, visual, sensory, and olfactory
hallucinations or illusions).
 Ictal psychiatric disturbances
• During a seizure the following can occur:
• Temporary confusional states - (disorientation, memory
loss, altered conciousness)
• Affective disturbances (moods)
• Anxiety
• Automatisms – no control over body eg. movements that
tend to be disorganized and purposeless (although complex
actions may be carried out), especially in partial seizures.
• Abnormal mental state (blank, staring) may be the only sign
of non convulsive (complex partial or absence) status
epilepticus and this diagnosis can be easily overlooked.
• Psychoses (delusion, hallucination)
 POST-ICTAL PSYCHIATRIC
DISTURBANCES
• Psychiatric disturbances may occur in the hours following a seizure.
• Psychotic symptoms are seen in about 10%.
• They may be due to long duration of epilepsy that has occurred due
to brain lesions.
• They may occur as part of a delirium (confusional state with
disorientation, inattention, variable levels of consciousness, and
sometimes paranoia)
• or in clear consciousness.
• Post ictal violence is rare but may be secondary to psychotic
experiences.
• If violence does occur, it is extreme, recurrent (may be due to
automatism in which actions are carried out unknowingly) and
more likely to occur in men, after a cluster of seizures.
• There is usually amnesia of the event.
 INTER-ICTAL PSYCHIATRIC
DISTURBANCES
• Brief psychosis may occur unrelated to a seizure, even when there
is good control of epilepsy.
• Chronic ‘schizophrenia-like’ psychosis: A chronic schizophrenia like
psychotic illness is 6-12 times more common in epileptics than in
the general population. It is particularly associated with left
temporal lobe epilepsy, early severe epilepsy and in women with
epilepsy. The onset of this illness is often 10-15 years after the
diagnosis of epilepsy has been made.
• Other disorders include cognitive impairments (poor memory,
intellectual disability)
• personality difficulties in a few people,
• depression (dysthmia),
• suicide and deliberate self harm is more frequent in people with
epilepsy than in the general population, and
• higher still in people with temporal lobe epilepsy.
 CONCLUSION
• People with epilepsy experience disturbance in
their behaviour during seizures.
• This disturbances can occur before, during, or
after a fit, as well as in between seizures or fits.
• ASSIGNMENT: IN YOUR GROUPS, Describe the
role of a nurse in the care of patients during
either pre-ictal, ictal, post-ictal & inter-ictal types
of behavioural disturbances as continuation from
the class exercise. 1 PAGE ONLY.
• Hand in on MONDAY 22nd July.