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Special Articles   |    
Risk Factors for Psychosis Secondary to Temporal Lobe Epilepsy: A Systematic Review
Lynn G. Irwin, M.Sc.; Dónal G. Fortune, Clin.Psy.D., Ph.D.
The Journal of Neuropsychiatry and Clinical Neurosciences 2014;26:5-23. doi:10.1176/appi.neuropsych.12120403
View Author and Article Information

From Acquired Brain Injury Ireland, Midwest Region, Republic of Ireland, and the Dept. of Psychology, University of Limerick, Republic of Ireland.

Send correspondence to Dr. Fortune; e-mail: dfortune@abiireland.ie

Copyright © 2014 by the American Psychiatric Association

Received December 20, 2012; Revised March 04, 2013; Accepted March 08, 2013.

Abstract

The authors critically reviewed all relevant peer-reviewed quantitative research pertaining to the risk factors for psychosis secondary to temporal lobe epilepsy, carrying out an extensive literature search to identify all relevant research studies, and applying specific exclusion criteria; the search yielded 27 original research articles for critical review. These studies were individually assessed for methodological quality. Authors reached consensus on a number of important risk factors for psychosis, including early age at epilepsy onset, history of status epilepticus, hippocampal sclerosis, and left-hemisphere abnormalities. Inconsistencies in defining and diagnosing epileptic psychoses were apparent, as well as the sole use of case–control, cross-sectional, and/or retrospective study designs. There remains a need for research using consistent classification criteria and longitudinal study designs.

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FIGURE 1. Number of Studies Identified for Review and Exclusion Criteria Applied
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TABLE 1.Description of Studies Reviewed and Ranking by Score on the Modified Quality Index14
Table Footer Note

LRE: localization-related epilepsy; IIP: interictal psychosis; PIP: postictal psychosis; TLE-P: temporal lobe epilepsy and psychosis (not ictally classified); TLE-NP: temporal lobe epilepsy with no psychosis; HC: healthy control participants; HS: hippocampal sclerosis; MTS: mesial temporal sclerosis; JME: juvenile myoclonic epilepsy; MTR: magnetization transfer ratio; FA: fractional anisotropy; MD: mean diffusivity; UHS: unilateral hippocampal sclerosis; H/A: hippocampus–amygdala complex; CoA: corpora amylacea; OPCRIT: Operational Criteria Checklist for Psychotic Illness; Cho: choline; Cr+PCr: creatine+phosphocreatine; IPI: initial precipitating injury.

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TABLE 2.Summary of Potential Risk Factors for Postictal Psychosis (PIP), Interictal Psychosis (IIP), and Psychoses Not Ictally-Defined
Table Footer Note

Evidenced by research of: *** Quality Index Score of 10–15; **Quality Index Score of 5–9; *Quality Index Score of 0–4; † inverse relationship; ** †***Multiple entries indicate conflicting findings in the research, (i.e., one study found support for the risk factor, whereas another found an inverse relationship).

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