| Research Abstract |
We developed a new five-axial diagnostic scheme for epileptic psychoses, which describes all clinical information systematically. Using this scheme, we conducted a multi-center study and 128 cases (63 males and 65 females) with epileptic psychoses were recruited from five institutions. The average age was 39.9±12.8 years, that of epilepsy onset was 13.5±9.8 years, and that of psychoses onset was 27.9±9.5 years. Types of psychoses, coded at the axis 1, were heterogeneous as follows; paranoid schizophrenia-like psychosis, chronic delusional disorder, acute transient psychotic disorder, hebephrenic schizophrenia-like psychosis, catatonic disorder, hallucinosis, in order. No changes in EEG at the onset of psychosis, coded at the axis 3, were proven in most of cases, and only eight cases showed normalization and only four showed aggravation in their EEG. No side-preferences in epileptic focus were proven. As many as 49 cases, coded at the axis 5, showed various abnormalities by brain imagin
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g examinations, such as diffuse brain atrophy, unilateral hippocampal atrophy, focal brain atrophy, tumorous lesions, cortical dysplasia, in order. Thirty-four cases had a previous history of brain damages, such as encephalitis, birth trauma, contusion, infantile status epilepticus, post-operative state of brain tumor, cerebro-vascular disorders, in order. Intelligent disturbances were prevalent, 38 with mild disturbance and 12 with moderate disturbances. These patients with epileptic psychoses were compared with 53 patients with functional psychoses who were matched in age, sex, and age at the onset of psychoses using operational polydiagnostic criteria (OPCRIT) developed by McGuffin in 1998. The inter-rater accordance was over 90% in 29 symptoms, over 80% in 26 symptoms, over 70% in 18 symptoms, and over 60% in four symptoms. Compared with functional psychoses, epileptic psychoses showed less Schneider's first rank symptoms, systematic delusions, auditory hallucinations persist more than a week, persecutory delusions, slowness in activity, poor thought contents, and affective flattening, and showed more ununderstandable conversation and inappropriate affect. The DSM-IV diagnosis showed that unspecified psychotic disorder was prevalent in epileptic psychoses, especially in temporal lobe epilepsy and in post-ictal psychosis Epileptic psychoses were thought to be a different clinical entity from functional psychoses. Because of a wide heterogeneity of epileptic psychoses, the present multi-axial diagnosis is thought to be useful to identify their etiology. Less
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