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Predictive variables of interictal psychosis in epilepsy

From the Adachi Mental Clinic (Dr. Adachi), Sapporo; Department of Neuropsychiatry (Dr. Matsuura), Nihon University School of Medicine; Department of Neuropsychiatry (Dr. Okubo), School of Medicine, Tokyo Medical and Dental University; Department of Neuropsychiatry (Dr. Oana), School of Medicine, Tokyo Medical University; Department of Neuropsychiatry (Dr. Takei), School of Medicine, Hamamatsu Medical University,; National Center Hospital for Mental, Nervous, and Muscular Disorders (Drs. Kato and Onuma), Kodaira; and Komagino Hospital (Dr. Hara), Hachioji, Japan.

Address correspondence and reprint requests to Dr. N. Adachi, Adachi Mental Clinic, Kitano 7-5-12, Kiyota, Sapporo 004-0867, Japan; e-mail: adacchan{at}tky2.3web.ne.jp

OBJECTIVE: To evaluate which variables predict interictal psychosis in epilepsy.

METHODS: The authors reviewed the biological backgrounds, clinical characteristics, and EEG findings in 246 patients with epilepsy and interictal psychosis and in 658 control patients with epilepsy and no psychotic history. With a logistic regression approach, the significance of each variable for the development of interictal psychosis was evaluated.

RESULTS: There are significant differences in family history of psychosis, age at onset of epilepsy, type of epilepsy, lateralization of epileptiform discharges, and level of intelligence between patients with interictal psychosis and those without it. Subsequent logistic regression analysis with all variables demonstrated that family history of psychosis, age at onset of epilepsy, type of seizures, and level of intelligence significantly correlated with psychosis.

CONCLUSIONS: A family history of psychosis, earlier age at onset of epilepsy, complex partial seizures or generalized tonic clonic seizures, and borderline intellectual functioning were the most important predictors for development of interictal psychosis.

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