Psychiatric Aspects of epilepsy - Prof.Tarek Asaad

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Information about Psychiatric Aspects of epilepsy - Prof.Tarek Asaad
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Published on January 19, 2019

Author: tarekasaad.com

Source: authorstream.com

Psychiatric Aspects of “Epilepsy”: Psychiatric Aspects of “Epilepsy” Dr.Tarek Asaad Agenda & Objectives: Agenda & Objectives Epilepsy : definition, classification,… Psychiatric symptoms in relation to epilepsy: i-pre-ictal / ii-ictal / iii-post-ictal / iv-inter-ictal. Psychiatric DD in relation to epilepsy. Epilepsy & possible pathogenesis of psychiatric disorders. Psycho-pharmacology of epilepsy in relation to psychiatry : a-Use of anti-epileptics in psychiatry. b-Psychiatric side effects of anti-epileptics. c-Use of psychotropics in epilepsy. Epilepsy: Epilepsy Prevalence : 1%. Definition : Transient paroxysmal pathophysiologic disturbance of cerebral function, caused by spontaneous excessive discharge of neurons. Classification : I-Partial : a-with elementary symptoms & no impaired consciousness ( motor / sensory / autonomic / compound). b-with complex symptoms & impaired consciousness ( psychomotor or TLE ). c-with secondary generalization. II-Generalized ( petit-mal, grand-mal, myoclonic, tonic, atonic,clonic, akinetic, infantile spasms..). III-Unilateral seizures. IV-Unclassified seizures. Complex Partial Seizures: Complex Partial Seizures Synonyms : Psychomotor epilepsy, TLE, limbic epilepsy…(not accurate?). Prevalence : most common form of epilepsy in adults (3/1000)? Psychiatric comorbidity : 30%, commonly depression. Subtypes : -with impaired consciousness only. -with cognitive symptoms. -with affective symptoms. -with psychosensory symptoms. -with psychomotor symptoms ( automatism ). -compound forms. Psychiatric Manifestations of Epilepsy: Psychiatric Manifestations of Epilepsy Pre-ictal Symptoms ( Aura) : cognitive ( déjà vu, jamais vu, dreamy state..) , affective ( fear, panic, depression, elation..). Ictal Symptoms :brief, disorganized, uninhibited behavior..(rarely, organized directed violent behavior) / amnesia / use of sphenoidal or ant.temporal electrodes or sleep EEG..? / LT EEG recording? / Medico-legal aspects? Post-ictal Symptoms : confusion, abnormal behavior... Psychiatric Manifestations of Epilepsy: Psychiatric Manifestations of Epilepsy Inter-ictal Symptoms (epileptic equivalent) : 1-Epileptic personality : religiosity, viscosity,change of sexual behavior ( most frequent abnormality). 2- Psychosis : 10% of TLE, female, Lt. lesions, hallucinations & paranoid delusions, usually preceded by personality, unlike S : preserved affect & circumstantiality, rather than association problems. 3- Violence : especially temporal & frontal ? 4- Mood : less than psychosis, episodic, non-dominant temporal foci, may explain increased suicide in epilepsy? Psychiatric DD in relation to epilepsy: Psychiatric DD in relation to epilepsy Conversion x epileptic seizures ? Sleep related epilepsy x sleep terror, walking and RMBD ? Epilepsy x Narcolepsy ? Panic attacks x epilepsy ? Transient psychosis x epilepsy ? NE x epilepsy ? Conversion x epileptic seizures: Conversion x epileptic seizures Pseudo-seizure Seizure Uncommon Common 1-nocturnal fits None Usually 2-stereotyped aura Rare Common 3-Cyanotic skin changes Rare Common 4-self-injury Rare Common 5-incontinence No Yes 6-post-ictal confusion Non-stereotyped Tonic, clonic… 7-body movements Yes No 8-effect of suggestion NAD Spike, slowing… 9-EEG No change in prolactin Increased prolactin ? 10-Lab Psychopharmacological Perspectives: Psychopharmacological Perspectives Indications of Anti-epileptics in psychiatry? Psychiatric side effects of Anti-epileptics? Psychotropics & epilepsy : -Anti-pressants ? -Anti-psychotics ? -Stimulants ? -Sedatives ? Slide10: THANK YOU

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