Psychotic disorders induced by antiepileptic drugs in people with epilepsy
Psychotic disorders induced by antiepileptic drugs in people with epilepsy
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DOI：
10.1093/brain/aww196
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发表时间：
2016-10-01
期刊：
影响因子：
14.5
通讯作者：
Kwan, Patrick
中科院分区：
文献类型：
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作者：
Chen, Ziyi;Lusicic, Ana;Kwan, Patrick
抗癫痫药物可诱发精神病，但AED诱发的精神病性障碍（AIPD）尚无公认的诊断标准。基于对医疗记录的筛查，Chen等人报告称，七分之一的癫痫患者患有精神病，患有AIPD。女性、颞叶受累和当前左乙拉西坦的使用与AIPD相关。抗癫痫药物可诱发精神病，但AED诱发的精神病性障碍（AIPD）尚无公认的诊断标准。基于对医疗记录的筛查，Chen等人报告称，七分之一的癫痫患者患有精神病，患有AIPD。女性、颞叶受累和目前左乙拉西坦的使用与AIPD相关。抗癫痫药物治疗可诱发部分患者精神病。然而，在癫痫学或精神病学的分类系统中，抗癫痫药物引起的精神障碍没有公认的定义或诊断标准。在这项研究中，我们调查了抗癫痫药物引起的精神障碍的癫痫患者的临床谱。回顾了1993年1月至2015年6月在皇家墨尔本医院被神经精神病学家诊断为精神障碍的所有癫痫患者的病历。数据提取有关癫痫及其治疗，精神病性症状和结果。癫痫的诊断是根据国际抗癫痫联盟的分类系统确定的，而精神障碍的诊断是根据精神障碍诊断和统计手册第5版和癫痫神经精神障碍的建议确定的。将抗癫痫药物诱导的精神障碍患者与同期评估的与抗癫痫药物无关的精神障碍患者（非抗癫痫药物诱导的精神障碍组）进行比较。进行单因素比较，选择P < 0.1的变量进行多因素logistic回归分析。对2630例癫痫患者的住院和门诊病历进行了筛查，其中98例（3.7%）被确定为精神障碍。其中，14例（14.3%）被诊断为抗癫痫药物引起的精神障碍。除1例丙戊酸盐停药后出现精神病的患者外，抗癫痫药物引起的精神障碍组中76.9%为女性，抗癫痫药物引起的精神障碍组颞叶受累百分比更高（69.2%比38.1%，P < 0.05）。抗癫痫药所致精神障碍组中左乙拉西坦的使用率较高（84.6%比20.2%，P < 0.01），而对照组中卡马西平的使用率较高（15.4%比44.0%，P < 0.05）。多因素Logistic回归分析证实了四个因素与抗癫痫药物引起的精神障碍相关：女性、颞叶受累和左乙拉西坦的使用，以及与卡马西平的负相关。行为和思维紊乱在抗癫痫药所致精神障碍组中更常见（分别为100%和72.6%，76.9%和38.1%; P < 0.05）。抗癫痫药所致精神障碍组持续使用抗精神病药物的比例较低（15.4%比66.7%，P < 0.01）。抗癫痫药所致精神障碍患者中无慢性病程，而非抗癫痫药所致精神障碍患者中慢性病程占40.5%（P < 0.05）。我们的研究结果表明，七分之一的癫痫患者发展为精神病，有抗癫痫药物引起的精神障碍。在这些患者中，与其他类型的精神病相比，女性、颞叶受累和当前使用左乙拉西坦与抗癫痫药物诱导的精神病性障碍显著相关，而卡马西平则呈负相关。行为和思维紊乱是抗癫痫药物引起的精神障碍的主要表现。抗癫痫药物引起的精神障碍患者与非抗癫痫药物引起的精神障碍患者在预后方面存在差异。
Antiepileptic drugs can induce psychosis, but there are no agreed diagnostic criteria for AED-induced psychotic disorder (AIPD). Based on the screening of medical records, Chen et al. report that one in seven patients with epilepsy who develop psychosis have AIPD. Female sex, temporal lobe involvement and current levetiracetam usage are associated with AIPD.Antiepileptic drugs can induce psychosis, but there are no agreed diagnostic criteria for AED-induced psychotic disorder (AIPD). Based on the screening of medical records, Chen et al. report that one in seven patients with epilepsy who develop psychosis have AIPD. Female sex, temporal lobe involvement and current levetiracetam usage are associated with AIPD.Antiepileptic drug treatment can induce psychosis in some patients. However, there are no agreed definitions or diagnostic criteria for antiepileptic drug-induced psychotic disorder in the classification systems of either epileptology or psychiatry. In this study we investigated the clinical spectrum of antiepileptic drug-induced psychotic disorder in patients with epilepsy. The medical records of all patients with epilepsy who were diagnosed by a neuropsychiatrist as having a psychotic disorder at the Royal Melbourne Hospital from January 1993 to June 2015 were reviewed. Data were extracted regarding epilepsy and its treatment, psychotic symptoms profile and outcome. The diagnosis of epilepsy was established in accordance to the classification system of the International League Against Epilepsy while that of psychotic disorder was made according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and the proposal on neuropsychiatric disorders in epilepsy. Patients with antiepileptic drug-induced psychotic disorder were compared to those with psychotic disorders unrelated to antiepileptic drugs assessed over the same period (non-antiepileptic drug induced psychotic disorder group). Univariate comparisons were performed and variables with a value of P < 0.1 were selected for the multivariate logistic regression analysis. The records of 2630 in-patients and outpatients with epilepsy were screened, from which 98 (3.7%) with psychotic disorders were identified. Among these, 14 (14.3%) were diagnosed to have antiepileptic drug-induced psychotic disorder. Excluding one patient who developed psychosis after valproate withdrawal, 76.9% in the antiepileptic drug induced psychotic disorder group were female and the percentage of temporal lobe involvement was higher in the antiepileptic drug induced psychotic disorder group (69.2% versus 38.1%, P < 0.05). Current use of levetiracetam was higher in antiepileptic drug-induced psychotic disorder group (84.6% versus 20.2%, P < 0.01) while use of carbamazepine was higher in the comparator group (15.4% versus 44.0%, P < 0.05). Multivariate logistic regression confirmed four factors associated with antiepileptic drug-induced psychotic disorder: female gender, temporal lobe involvement and use of levetiracetam, and a negative association with carbamazepine. Disorganized behaviours and thinking were more common in the antiepileptic drug-induced psychotic disorder group (100% versus 72.6% and 76.9% versus 38.1%, respectively; P < 0.05). The percentage of continuous treatment with antipsychotic drugs was lower in the antiepileptic drug-induced psychotic disorder group (15.4% versus 66.7%, P < 0.01). No patients experienced a chronic course in antiepileptic drug-induced psychotic disorder group whereas 40.5% did in non-antiepileptic drug induced psychotic disorder (P < 0.05). Our findings indicated that one in seven patients with epilepsy who developed psychosis had antiepileptic drug-induced psychotic disorder. In these patients, female gender, temporal lobe involvement and current use of levetiracetam were significantly associated with antiepileptic drug induced psychotic disorder compared to other types of psychosis, while carbamazepine had a negative association. Disorganized behaviours and thinking were predominant in antiepileptic drug-induced psychotic disorder. Patients with antiepileptic drug-induced psychotic disorder differed from non-antiepileptic drug-induced psychotic disorders in having better outcome.