PSYCHOSIS IN RELATION TO EPILEPSY - A CLINICAL MODEL OF NEURO - PSYCHIATRY

Psychosis occurring in epileptics has always been an area of research interest, particularly, because of possible link of mental illness, organic lesions, convulsive process and behavioural abnormlity, all occuring together in the same subject. Vast amount of investigation on this subject has been done with a view to understand something more fundamental in ‘Brain-Behaviour Connection’. Occurance of interictal phase of psychosis long after cessation of seizure has driven investigators to conclude the two being unrelated, which has brought important issues of brain pathology and behavioural abnormality into focus of research from dimensions of genetics, neuroendocrine and environmental influences. The aspects of behavioural neurology, behavioural genetics, genetics of epilepsy and ‘shared common genetic diathesis for development of psychosis, possibly converge in the neuropsychiatric model of psychosis in relation to epilepsy’. E.E.G.- spiking and regional slow waves in inter - ictal phase are emerging as correlates determining behaviour. Status of prolactin - dopamine relationship and its correlation to neuro - cognition may be another pointer in guiding some of these complex issues. It is expected that current focus of research should be able to develop on the profile of ‘psychotic brain’ also. One of the major clinical issue is identifying epileptic subjects prone to develop psychosis with precision of nature and type, not only because such developments jeopardises and compromises the state of art treatment done for epilepsy, but also because of devastating deterioration in quality of life of patients and relatives, besides having pharmacoeconmic devaluations. Studies have revealed that more detailed work up in the beginning may possibly identify high risk groups based upon clinical phenomenlogy, E.E.G. topography, endocrine status, regional brain damage, etc. The presention attempts to focus some of the relevant clinical issues with reference to a particular comparative study of psychosis in epilepsy and functional psychosis (schizophrenia) to understand co-existence of divergent clinical conditions.