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Age at the first psychotic episode and an interval between the onset of
epilepsy and that of psychosis reflect developmental processes of
interictal psychosis. However, factors relating to these indices remain
To identify clinical variables that are associated with the timing of the
development of interictal psychosis.
In 285 adults with epilepsy with interictal psychosis, effects of
epileptic (epilepsy type), organic (intellectual functioning) and genetic
(family history of psychosis) variables on timing of the development of
psychosis were examined.
The mean interval between the onset of epilepsy and that of psychosis was
14.4 years. Some psychosis occurred within a few years of the first
seizure. Generalised epilepsy, normal intellectual function and a
positive family history of psychosis were associated with early onset of
Early development of interictal psychosis in people with epilepsy may
reflect other individual vulnerabilities to psychosis rather than
The association between temporal lobe epilepsy and schizophrenia suggests that the critical abnormality may be pathology within the temporal lobes. People with schizophrenia-like psychosis of epilepsy (SLPE) provide a useful group in which to examine the importance of temporal and frontal lobe dysfunction in schizophrenia.
A verbal fluency activation paradigm and a 99mTc HMPAO SPET were used to study frontotemporal function in people with SLPE (n = 12), schizophrenia (n = 11) and epilepsy (n = 16).
People with SLPE differed from both other groups by showing lower blood flow in the left superior temporal gyrus during performance of a verbal fluency task compared with a word repetition task (F=5.4, P=0.01). During the verbal fluency task people with primary schizophrenia showed a greater increase in blood flow in anterior cingulate (F=4.5, P=0.02) than the other two groups. There were no between-group differences in frontal brain regions.
Our findings support an association between left temporal lobe abnormality and SLPE. The different patterns of activation observed in people with primary schizophrenia and SLPE suggests that different pathophysiological mechanisms may operate in these two groups. In SLPE the pathophysiology may be relatively confined to the dominant temporal lobe.
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