Adachi Mental Clinic, Sapporo, Japan.
Epilepsia. 2013 Mar;54 Suppl 1:19-33. doi: 10.1111/epi.12102.
In patients with epilepsy, coexisting psychoses, either interictal (IIP) or postictal (PIP), are associated with serious disturbance in psychosocial function and well-being, and often require the care of a specialist. Unfortunately, evidence-based treatment systems for psychosis in patients with epilepsy have not yet been established. This article aims to propose concise and practical treatment procedures for IIP and PIP based on currently available data and international consensus statements, and primarily targeting nonpsychiatrist epileptologists who are often the first to be involved in the management of these complex patients. Accurate and early diagnosis of IIP and PIP and their staging in terms of acuity and severity form the essential first step in management. It is important to suspect the presence of psychosis whenever patients manifest unusual behavior. Knowledge of psychopathology and both individual and epilepsy-related vulnerabilities relevant to IIP and PIP facilitate early diagnosis. Treatment for IIP involves (1) obtaining consent to psychiatric treatment from the patient, whenever possible, (2) optimization of antiepileptic drugs, and (3) initiation of antipsychotic pharmacotherapy in line with symptom severity and severity of behavioral and functional disturbance. Basic psychosocial interventions will help reinforce adherence to treatment and should be made available. Due consideration must be given to patients' ability to provide informed consent to treatment in the short term, with the issue being revisited regularly over time. Given the often prolonged and recurrent nature of IIP, treatment frequently needs to be long-term. Treatment of PIP consists of two aspects, that is, acute protective measures and preventive procedures in repetitive episodes. Protective measures prioritize the management of risk in the early stages, and may involve sedation with or without the use of antipsychotic drugs, and the judicious application of local mental health legislation if appropriate. As for preventative procedures, optimizing seizure control by adjusting antiepileptic drugs or by surgical treatment is necessary.
在癫痫患者中，并存的精神病，无论是发作间期（IIP）还是发作后（PIP），都与严重的社会心理功能和幸福感障碍有关，通常需要专科医生的护理。不幸的是，目前尚未建立针对癫痫患者精神病的循证治疗系统。本文旨在根据现有数据和国际共识声明，为 IIP 和 PIP 提出简明实用的治疗程序，主要针对非精神科癫痫专家，他们通常是首先参与这些复杂患者管理的人。准确和早期诊断 IIP 和 PIP 及其严重程度和严重程度的分期是管理的基本第一步。每当患者表现出异常行为时，怀疑存在精神病就很重要。了解精神病学知识以及与 IIP 和 PIP 相关的个体和癫痫相关的脆弱性有助于早期诊断。IIP 的治疗包括：（1）在可能的情况下，从患者那里获得对精神治疗的同意，（2）优化抗癫痫药物，（3）根据症状严重程度和行为和功能障碍的严重程度，开始抗精神病药物治疗。基本的心理社会干预将有助于加强对治疗的依从性，并应提供这些干预。必须考虑到患者在短期内提供知情同意治疗的能力，随着时间的推移定期重新考虑这个问题。鉴于 IIP 常常具有长期性和复发性，因此治疗通常需要长期进行。PIP 的治疗包括两个方面，即急性保护措施和反复发作中的预防措施。保护措施优先考虑早期阶段的风险管理，可能涉及镇静（或不使用抗精神病药物），并在适当情况下明智地应用当地心理健康立法。至于预防措施，通过调整抗癫痫药物或手术治疗来优化癫痫控制是必要的。
