Henning Oliver, Nakken Karl O
Avdeling for kompleks epilepsi, Klinikk for kirurgi og nevrofag, Oslo universitetssykehus, Norway.
Tidsskr Nor Laegeforen. 2013 Jun 11;133(11):1205-9. doi: 10.4045/tidsskr.12.1238.
Epilepsy-related psychoses lie in the border zone between neurology and psychiatry. The aim of this article is to give a brief overview of current knowledge of these psychoses, and to offer recommendations for their treatment.
The article is based on a discretionary selection of articles found through a search in PubMed, as well as the authors' own experience with this patient group.
Epilepsy-related psychoses may occur during, after or between seizures. In addition, psychoses may occur as a side-effect of antiepileptic drugs, and as so-called alternative psychosis. The latter may arise in patients who, with the aid of treatment (medication or surgery), have become completely seizure-free. Ictal psychoses and the majority of postictal psychoses are often of such short duration that treatment with antipsychotics is not appropriate. In these cases, optimizing antiepileptic treatment is the best prophylaxis. Treatment with antipsychotics may, however, be indicated for interictal psychoses and for some patients with especially long-lasting or recurrent postictal psychoses.
Different types of epilepsy-related psychosis require different types of treatment, and some are treated with antipychotics. In those circumstances, we recommend the use of medication that is less likely to lower the seizure threshold, for example risperidone.
癫痫相关性精神病处于神经学和精神病学的交叉领域。本文旨在简要概述目前对这些精神病的认识，并为其治疗提供建议。
本文基于通过在PubMed上搜索而酌情挑选的文章，以及作者对该患者群体的自身经验。
癫痫相关性精神病可在癫痫发作期间、发作后或发作间期出现。此外，精神病可能作为抗癫痫药物的副作用出现，以及作为所谓的替代性精神病出现。后者可能出现在那些借助治疗（药物或手术）已完全无癫痫发作的患者中。发作期精神病和大多数发作后精神病的持续时间通常很短，以至于使用抗精神病药物治疗并不合适。在这些情况下，优化抗癫痫治疗是最佳预防措施。然而，对于发作间期精神病以及一些发作后精神病持续时间特别长或反复发作的患者，可能需要使用抗精神病药物进行治疗。
不同类型的癫痫相关性精神病需要不同类型的治疗，有些需要使用抗精神病药物治疗。在这种情况下，我们建议使用不太可能降低癫痫发作阈值的药物，例如利培酮。
