CLINICAL MANAGEMENT OF RECURRENT POSTICTAL PSYCHOSIS

Although there are numerous reports of interictal psychosis in epilept ic patients, there are few studies describing the longitudinal course and treatment of postictal psychosis. The goal of this study was to de fine the clinical features, natural history, and possible intervention al methods in a group of patients with complex partial seizures and po stictal psychosis. We studied seven patients who manifested psychotic behavior following an increase in their seizure frequency. Mean follow -up was 83 months. Patients underwent neuropsychiatric testing, crania l magnetic resonance imaging, and extensive EEG evaluation. All but on e patient had severe epilepsy. An increased number of seizures was fol lowed by a brief period of lucidity and then psychosis, which lasted b etween 2 and 14 days and tended to recur (mean, one episode every 4 mo nths). EEGs done during the psychotic episodes generally demonstrated a mild diffuse background slowing without evidence of ictal epileptifo rm discharges. Evaluation between episodes revealed no persistent psyc hiatric features. The patients rarely required hospitalization or neur oleptic medications. Patients usually responded to mild sedation, clos e observation, and a supportive environment.