Epilepsy and psychosis

Abstract

This chapter reviews the important place that epilepsy has had in developing concepts of psychosis in general and for understanding some of the basic biological issues of schizophrenia and bipolar disorder. It starts out by offering a historical introduction noting important observations stemming from the nineteenth century. It reviews the complexity of classification in this area, highlighting in particular problems with Diagnostic and Statistical Manual, 5th edition (DSM-5). Epidemiology is followed by brief discussions of the relationship between seizures and psychosis, commenting on some paradoxes revealing why postictal psychoses are underdiagnosed, and the pitfalls of missing forced normalization, a concept that relates to the worsening of behavior with the cessation of seizures in people with intractable epilepsy. Finally, the chapter provides some guides to management of patients with epilepsy who have comorbid psychiatric disorders.