Psychogenic Disturbances

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2 Psychogenic Disturbances Psychogenic seizures Episodic dyscontrol Dissociative states (dissociative hysterical neuroses) - Psychogenic fugue - Multiple personality disorder - Psychogenic amnesia - Depersonalization disorder Daydreaming (vs. absence seizures) Obsessive-compulsive behavior Panic attacks Schizophrenia (hallucinations)

3 Definitions An epileptic seizure is a transient occurrence of signs and/or symptoms due to abnormal excessive or synchronous neuronal activity in the brain. Epilepsy is a chronic disorder of the brain characterized by an enduring propensity to generate epileptic seizures, and by the neurobiological, cognitive, psychological, and social consequences of this condition. The definition of epilepsy requires the occurrence of at least one epileptic seizure.

4 Health Burden of Epilepsy 5%-10% will have one seizure during their lifetime 30% of these will develop epilepsy 0.5%-1% have epilepsy at any given point in time 40 million people worldwide 1% of the Global Burden of Disease (WHO) equivalent to - breast cancer in women lung cancer in men 30% to 40% have uncontrolled seizures accounting for 80% cost

5 Personal Burden of Epilepsy The Predicament Seizures are disabling - no warning - embarrassing or frightening - injury or death Stigma e.g., possession Misconceptions - psychiatric disorder - mental retardation - can t be treated

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8 Environmental Factors That The predicament Influence Behavior Paroxysmal occurrence without warning learned helplessness Chronic illness Stigma of epilepsy Restrictions on daily life Unrelated psychiatric comorbidity

9 Neurobiology of Behavioral Disturbances in Epilepsy Effects of treatment - Direct effects - Indirect effects Effects of the lesion - Location - Character Unrecognized ictal events Effects of epilepsy (kindling) - Aggression - Depression - Schizophrenia

10 Controversy Increase stigma of epilepsy - Demonic possession - Punishment for sins - Contagious disease - Form of insanity Potential prevention of treatment or major cause of disability

11 Neurobiology of Behavioral Disturbances in Epilepsy Effects of treatment - Direct effects - Indirect effects Effects of the lesion - Location - Character Unrecognized ictal events Effects of epilepsy (kindling) - Aggression - Depression - Schizophrenia

12 Effects of Treatment Direct effects Indirect effects - Drugs alter endocrine function - Drugs alter sleep patterns - Sudden termination of seizures can cause depression

13 Neurobiology of Behavioral Disturbances in Epilepsy Effects of treatment - Direct effects - Indirect effects Effects of the lesion - Location - Character Unrecognized ictal events Effects of epilepsy (kindling) - Aggression - Depression - Schizophrenia

14 Effects of the Lesion Location - Limbic vs. nonlimbic sites - Left vs. right hemisphere Character - Alien tissue vs. mesial temporal sclerosis - Chromosomal defects

15 Problems with Lateralization of Depression False lateralization with EEG Pathological shift of function Tests are all written

16 Neurobiology of Behavioral Disturbances in Epilepsy Effects of treatment - Direct effects - Indirect effects Effects of the lesion - Location - Character Unrecognized ictal events Effects of epilepsy (kindling) - Aggression - Depression - Schizophrenia

17 Unrecognized Ictal Events Simple partial seizures of limbic structures can produce psychic symptoms in clear consciousness without scalp EEG changes Simple partial seizures that produce other experiential symptoms can alter behavior Simple partial status epilepticus can appear to be a continuous interictal behavioral disturbance

18 Neurobiology of Behavioral Disturbances in Epilepsy Effects of treatment - Direct effects - Indirect effects Effects of the lesion - Location - Character Unrecognized ictal events Effects of epilepsy (kindling) - Aggression - Depression - Schizophrenia

19 Effects of Epilepsy Depression Endogenous opioids are released during epileptic seizures Endogenous opioids may act as euphorogens ECT is a treatment for endogenous depression Patients with epilepsy may be dependent on high levels of endogenous opioids that occur only with seizures Depression may be a symptom of withdrawal from high levels of endogenous opioids when seizures do not occur

20 Schizophrenia Effects of Epilepsy May result from epileptogenic disturbance of language and, therefore, thought May reflect a genetic defect linked to epilepsy or epileptogenicity May be caused by an epilepsy -induced alteration in dopamine receptor sensitivity

21 Effects of Epilepsy Aggression Potential hyperexcitability - Loss of affective control - Explosive motor behavior Predatory attack Defensive rage

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23 Conclusions It is not in the best interest of patients with epilepsy to deny a neurobiological relationship between epileptic seizures and behavioral disturbances Basic research in patients and in animal models may reveal mechanisms of epilepsy-induced behavioral disturbances that could allow prevention or treatment of these major causes of disability