Akanuma Nozomi, Adachi Naoto, Fenwick Peter, Ito Masumi, Okazaki Mitsutoshi, Hara Koichiro, Ishii Ryouhei, Sekimoto Masanori, Kato Masaaki, Onuma Teiichi
South London and Maudsley NHS Foundation Trust, London, UK.
Adachi Mental Clinic, Sapporo, Japan.
BMJ Neurol Open. 2020 Aug 27;2(2):e000036. doi: 10.1136/bmjno-2019-000036. eCollection 2020.
Psychosis often develops after the administration of antiepileptic drugs (AEDs) in patients with epilepsy. However, the individual vulnerability and clinical condition of such patients have been rarely scrutinised. We investigated the effect of individually consistent (trait-dependent) and inconsistent (state-dependent) characteristics.
The individual characteristics, clinical states and psychotic outcome of patients from eight adult epilepsy clinics were retrospectively reviewed over 6-month periods after a new drug (AED or non-AED) administration between 1981 and 2015.
A total of 5018 new drugs (4402 AEDs and 616 non-AEDs) were used in 2015 patients with focal epilepsy. Subsequently, 105 psychotic episodes (81 interictal and 24 postictal) occurred in 89 patients. Twelve patients exhibited multiple episodes after different AED administrations. Trait-dependent characteristics (early onset of epilepsy, known presumed causes of epilepsy, lower intellectual function and a family history of psychosis) were significantly associated with the patients who exhibited psychosis. Absence of family history of epilepsy was also associated with psychosis but not significantly. Subsequent logistic regression analysis with a model incorporating family history of psychosis and epilepsy, and intellectual function was the most appropriate (p=0.000). State-dependent characteristics, including previous psychotic history and epilepsy-related variables (longer duration of epilepsy, AED administration, higher seizure frequency and concomitant use of AEDs) were significantly associated with psychotic episodes. Subsequent analysis found that a model including AED administration and previous psychotic history was the most appropriate (p=0.000).
Psychosis occurring after new AED administration was related to the individual vulnerability to psychosis and intractability of epilepsy.
癫痫患者在服用抗癫痫药物（AEDs）后常出现精神病症状。然而，此类患者的个体易感性和临床状况很少受到仔细研究。我们调查了个体一致性（特质依赖性）和不一致性（状态依赖性）特征的影响。
回顾性分析了1981年至2015年间来自8家成人癫痫诊所的患者在服用新药（AED或非AED）后6个月内的个体特征、临床状态和精神病结局。
2015例局灶性癫痫患者共使用了5018种新药（4402种AEDs和616种非AEDs）。随后，89例患者出现了105次精神病发作（81次发作间期发作和24次发作后发作）。12例患者在服用不同的AED后出现多次发作。特质依赖性特征（癫痫早发、已知的癫痫假定病因、较低的智力功能和精神病家族史）与出现精神病的患者显著相关。无癫痫家族史也与精神病有关，但无显著相关性。随后纳入精神病家族史、癫痫家族史和智力功能的模型进行逻辑回归分析最为合适（p = 0.000）。状态依赖性特征，包括既往精神病病史和癫痫相关变量（癫痫病程较长、服用AED、癫痫发作频率较高和同时使用AEDs）与精神病发作显著相关。随后的分析发现，包括服用AED和既往精神病病史的模型最为合适（p = 0.000）。
服用新AED后出现的精神病与个体对精神病的易感性和癫痫的难治性有关。
