Like most of the diseases, seizures is the one which can also lead to many other disorders such as; postictal psychosis. It is commonly described as “an episode of psychosis which happens after the occurrence of a cluster of seizures”. And psychosis is a major mental disorder in which a person loses the contact with the reality.
It is very common in seizure patients which can lead to a chronic condition or profound morbidity depending upon the condition of the patient. It can happen within one week after the seizure attack but usually it’s short-lived and can cause remission from few days to weeks. Recurrent episodes or even a single episode can trigger the chronic condition of psychosis.
Prevalence of this disease is difficult to measure but commonly video-encephalographic technique is used to estimate the number of postictal psychosis cases in seizure patients. This disease can be treated with the timely diagnosis of the early symptoms which are important to encounter in every illness.
It has been observed that the postictal psychosis condition caused due to the seizures is easy to control and it response better to the therapy.
Postictal Psychosis Symptoms
The main cause behind this disease is still unknown and more clinical data is required to fully understand the condition and lower the number of morbidity. It can be diagnosed by a number of signs and symptoms which are described below;
- Insomnia is usually considered as a first sign in this condition.
- Auditory or visual hallucinations.
- Abnormal thoughts either in the case of content (ideas of reference or delusions which includes; paranoid, grandiose, somatic, religious etc.) or in the case of form of thoughts including; thought blockage, loose associations or tangentiality.
- Manic symptoms may co-occur with these signs but due to the less duration of these symptoms manic cannot be officially diagnosed in those patients which left the professionals with the final decision of postictal psychosis.
- Severe mood swings.
- Aggressive behavior.
Postictal Psychosis Diagnosis
Postictal psychosis is critically important to be recognized at the early stages in order to minimize the cases of morbidity. But the reporting of the very first signs such as insomnia and delusions are not considered important either by the patients or their families and lead to worsening of the condition which have greater chances of morbidity. The perfect point for the recognition of the disease is considered when patient go through abnormal thoughts, convulsions, and aggressive behavior after the epilepsy attack.
Usually in this condition, video-encephalographic is commonly used to diagnose the cases of postictal psychosis.
Postictal Psychosis Risk factors
There is a lot of defined as well as contradictory risk factors for this condition which are enlisted below;
- Bilateral or widespread CNS injury.
- Head injury.
- Bilateral interictal epileptiform activity.
- Borderline intelligence.
- EEG slowing.
- Unilateral hippocampal sclerosis.
- Tonic–clonic seizures are more significant to cause Postictal psychosis as compare to complex partial
- Postictal Psychosis seizures
- In partial epilepsy, especially TLE is considered as a major risk factor.
- Family history with mood disorders, psychosis, specific psychiatric disorders, and epilepsy can also lead to this condition in many people.
Postictal Psychosis Treatment
The main problem that has been observed during the management of postictal psychosis is the occurrence of most of the episodes out of the hospital. As it is tough condition to diagnose and early symptoms are often overlooked by the patient or the family members. So on the priority basis it is advised that the seizure patients should never be left alone and even smaller signs of no importance should be considered and reported to the concerned professionals.
This condition can be managed by two common approaches as acute protective measures or reducing the repetitive episodes. However, the best treatment approach for postictal psychosis is unknown yet.
At the early stages and even during the episodes, professionals recommend the Benzodiazepines alone or in combination with other antipsychotics drugs. As these lower the threshold of seizures but in most of the cases the basic priority is the sedation depending upon the severity of the case.
Three pharmaceutical combinations have been suggested by the professionals depending upon the severity of the condition as with the exacerbation of the symptoms treatment is suggested to move towards 2nd and 3rd options which are enlisted below;
- Oral administration of benzodiazepine (e.g., lorazepam).
- Combined oral administration of benzodiazepine anddopamine-blocker (e.g., risperidone, olanzapine, quetiapine, and chlorpromazine).
- Intramuscular administration of dopamine-blocker (e.g., haloperidol plus promethazine).
Patients with the severe conditions should be kept under strict scrutiny and no medications should be administered without consultation with the concerned professional.