What is postictal psychosis? It is a question you might be asking if you are here reading these words. If someone has had epileptic episodes for a long period of time, these episodes can sometimes convert into postictal psychosis, which is a type of psychosis that is characterized by auditory and visual hallucinations, delusions, paranoia, affective change, and aggression including violent behavior that takes place after a seizure episode. We are here to discuss what it pertains to and what preventative measures relate to them.
Let’s Learn More About Postictal Psychosis
“Occasionally, after a fit, or, more frequently, after a series of fits, an attack of mental disturbance may come on which lasts for several days. It may be simply a demented state, or there may be hallucinations, with irritability and even violence(1). That’s what William Richard Gowers, a renowned British Neurologist, said in his seminal book titled Epilepsy and Other Chronic Convulsive Disorders. Although you may now have a better idea about what postictal psychosis is, let us elaborate some more on it.
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Around 70% of the affected individuals suffer from some kind of postictal complications and approximately 7% of temporal lobe epilepsy sufferers are bound to suffer from some kind of psychosis, predominantly postictal psychosis(2). Postictal psychosis is a rare yet severe psychiatric complication of epilepsy with its prevalence found in roughly 2 % of the patients medically diagnosed with epilepsy (PWE)(2). This often results in suicidal behavior or interpersonal violence, thus requiring immediate attention and treatment(2).
Researchers have set criteria for postictal psychosis symptoms(3) as seen below. For diagnosis, this criterion is widely accepted:
- Arrival of psychosis and confusion in the onset stage usually amounting to a week that ends with the apparent return of normal function
- The symptoms have been manifesting for around 3 months
- Disgruntled mental state, as characterized by:
- Disorientation, or delirium and clouded consciousness
- Hallucinations and delusions with clear consciousness
- A combination of all of the above
Factors such as these can also contribute to the onset of postictal psychosis(3):
- EEG evidencing the post ictal phase’s psychotic seizures
- Head injuries or concussion
- Previous history of interictal psychosis
- Anticonvulsant toxicity
These factors are further exacerbated by the presence of additional risk factors associated with post-ictal psychosis such as bilateral independent seizure foci and a personal or family history of psychiatric disorders different from psychosis(4).
Read More: The Science Behind Psychosis Symptoms From Drugs
What Happens When One Is Going Through Post Seizure Psychosis
Usually, postictal psychosis can be recurrent in many of the epileptic episodes(5). However, strides have been made in studies that proclaim that 25% of the patients often go on to develop a chronic interictal psychosis as a form of progression. Interictal psychosis is basically psychosis that can happen at any time unrelated to seizure activity rather than after seizure episodes like postictal psychosis, although the interictal type is indeed usually found in. It is evidenced in a study of 18 patients with postictal psychosis symptoms. 7 of these patients (39%) with postictal psychosis went on to develop interictal psychosis(3), (6).
Postictal Psychosis Treatment
Swift recognition of postictal psychosis is necessary because if it is left untreated, the consequences can be dire. Many affected individuals don’t readily believe that they are suffering from postictal psychosis, which is why it is important to schedule a questioning session to pinpoint if one really does have postictal psychosis symptoms(7).
A mixture of antiepileptic drugs(8), benzodiazepine (antidepressants)(7), and an atypical antipsychotic drug(7,8) along with different types (whichever suits the patient) psychotherapies often used to treat postictal psychosis and might help the treating variable postictal psychosis. If these don’t work then the only option is to go for surgery (a physician or a surgeon should be consulted for this), which can finally help affected individuals find relief(8).
Read More: PTSD with Psychosis: Is this Real?
Conclusion
It was good of us to shine some light on postictal psychosis and postictal psychosis treatment, so more awareness can be created for this type of symptom, which is predominantly found in people suffering from some kind of epileptic seizures. If there are other conditions similar to post ictal psychosis like schizophrenia or others such as anxiety, depression, insomnia, PTSD, or ADHD, Solid Foundation Psychiatry can help with treatment through methods like telepsychiatry or psychotherapy.