Sachdev P
Neuropsychiatric Institute, Prince Henry Hospital and School of Psychiatry, University of New South Wales, Sydney, Australia.
Am J Psychiatry. 1998 Mar;155(3):325-36. doi: 10.1176/ajp.155.3.325.
Current knowledge of the relationship between epilepsy and schizophrenia-like psychosis is examined, and the proposed pathogenetic mechanisms are evaluated.
The author provides an overview of the published literature on epilepsy and schizophrenia-like psychosis.
The schizophrenia-like psychoses of epilepsy are inadequately categorized by the current classifications. Their categorization into ictal, postictal, and interictal psychoses is clinically useful, but it does not imply distinct pathophysiology for each. The recent interest in postictal psychoses has opened an important avenue for research. Brief interictal psychoses, involving alternation between epilepsy and psychosis and accompanied by forced normalization, are uncommon. Many aspects of the relationship with chronic interictal psychosis remain controversial. The majority of investigators support a special but not exclusive relationship with mediobasal temporal lobe epilepsy, and left temporal bias receives only limited support. The chronic psychosis resembles schizophrenia phenomenologically. Some suggested risk factors are severe and intractable epilepsy, epilepsy of early onset, secondary generalization of seizures, certain anticonvulsant drugs, and temporal lobectomy. Different neuropathological studies suggest the presence of cortical dysgenesis or diffuse brain damage.
There are many mechanisms by which epilepsy may be associated with schizophrenia-like psychosis. It is likely that structural brain abnormalities, e.g., cortical dysgenesis or diffuse brain lesions, underlie both epilepsy and psychosis, and that the seizures modify the presentation of the psychosis, and vice versa, thus producing a clinical picture of both an affinity and an antagonism between the two disorders.
探讨癫痫与精神分裂症样精神病之间关系的现有知识，并评估所提出的发病机制。
作者概述了已发表的关于癫痫与精神分裂症样精神病的文献。
目前的分类方法对癫痫所致的精神分裂症样精神病分类不充分。将其分为发作期、发作后期和发作间期精神病在临床上有用，但并不意味着每种类型都有独特的病理生理学机制。最近对发作后期精神病的关注为研究开辟了一条重要途径。短暂的发作间期精神病，表现为癫痫与精神病交替发作并伴有强制正常化，较为罕见。与慢性发作间期精神病关系的许多方面仍存在争议。大多数研究者支持其与中颞叶基底部癫痫存在特殊但并非唯一的关系，而左侧颞叶偏向仅得到有限支持。慢性精神病在现象学上类似于精神分裂症。一些提示的危险因素包括严重且难治性癫痫、早发性癫痫、癫痫继发全面性发作、某些抗惊厥药物以及颞叶切除术。不同的神经病理学研究提示存在皮质发育异常或弥漫性脑损伤。
癫痫可能通过多种机制与精神分裂症样精神病相关。脑结构异常，如皮质发育异常或弥漫性脑病变，可能是癫痫和精神病的共同基础，癫痫发作可改变精神病的表现，反之亦然，从而产生两种疾病既相似又相互拮抗的临床图景。
