A study on brain function and morphology changes in psychoses of epilepsy

我们开发了一个新的癫痫精神病的五轴诊断方案，它系统地描述了所有的临床信息。采用该方案，我们进行了一项多中心研究，从五个机构招募了128例（63男65女）癫痫精神病患者。平均发病年龄39.9±12.8岁，癫痫发病年龄13.5±9.8岁，精神病发病年龄27.9±9.5岁。按轴1编码的精神病类型，其异质性依次为：偏执型精神分裂症样精神病、慢性妄想性障碍、急性短暂性精神病性障碍、青春期精神分裂症样精神病、紧张性障碍、幻觉症。大多数病例在精神病发作时脑电图（编码在轴3上）没有改变，只有8例脑电图正常化，只有4例脑电图加重。癫痫灶无偏侧性。在第5轴编码的49例患者中，脑成像显示了各种异常。 关于我们 g检查，如弥漫性脑萎缩，单侧海马萎缩，局灶性脑萎缩，肿瘤性病变，皮质发育不良，依次。34例有脑损害病史，依次为脑炎、产伤、脑挫伤、婴儿癫痫持续状态、脑肿瘤术后状态、脑血管疾病。智力障碍普遍存在，轻度障碍38例，中度障碍12例。这些癫痫性精神病患者与53例功能性精神病患者进行了比较，这些患者在年龄，性别和精神病发作时的年龄使用McGuffin在1998年开发的操作多诊断标准（OPCRIT）匹配。29个症状的评分者间一致性超过90%，26个症状超过80%，18个症状超过70%，4个症状超过60%。与功能性精神病相比，癫痫性精神病的Schneider一级症状、系统性妄想、幻听持续一周以上、被害妄想、活动迟缓、思维内容贫乏、情感平淡等方面较少，而不可理解的谈话和不当情感较多。DSM-IV的诊断表明，未指明的精神障碍是流行于癫痫性精神病，特别是在颞叶癫痫和发作后精神病癫痫精神病被认为是一个不同的临床实体从功能性精神病。由于癫痫性精神病的广泛异质性，目前的多轴诊断被认为是有用的，以确定其病因。少

We developed a new five-axial diagnostic scheme for epileptic psychoses, which describes all clinical information systematically. Using this scheme, we conducted a multi-center study and 128 cases (63 males and 65 females) with epileptic psychoses were recruited from five institutions. The average age was 39.9±12.8 years, that of epilepsy onset was 13.5±9.8 years, and that of psychoses onset was 27.9±9.5 years. Types of psychoses, coded at the axis 1, were heterogeneous as follows; paranoid schizophrenia-like psychosis, chronic delusional disorder, acute transient psychotic disorder, hebephrenic schizophrenia-like psychosis, catatonic disorder, hallucinosis, in order. No changes in EEG at the onset of psychosis, coded at the axis 3, were proven in most of cases, and only eight cases showed normalization and only four showed aggravation in their EEG. No side-preferences in epileptic focus were proven. As many as 49 cases, coded at the axis 5, showed various abnormalities by brain imagin … More g examinations, such as diffuse brain atrophy, unilateral hippocampal atrophy, focal brain atrophy, tumorous lesions, cortical dysplasia, in order. Thirty-four cases had a previous history of brain damages, such as encephalitis, birth trauma, contusion, infantile status epilepticus, post-operative state of brain tumor, cerebro-vascular disorders, in order. Intelligent disturbances were prevalent, 38 with mild disturbance and 12 with moderate disturbances. These patients with epileptic psychoses were compared with 53 patients with functional psychoses who were matched in age, sex, and age at the onset of psychoses using operational polydiagnostic criteria (OPCRIT) developed by McGuffin in 1998. The inter-rater accordance was over 90% in 29 symptoms, over 80% in 26 symptoms, over 70% in 18 symptoms, and over 60% in four symptoms. Compared with functional psychoses, epileptic psychoses showed less Schneider's first rank symptoms, systematic delusions, auditory hallucinations persist more than a week, persecutory delusions, slowness in activity, poor thought contents, and affective flattening, and showed more ununderstandable conversation and inappropriate affect. The DSM-IV diagnosis showed that unspecified psychotic disorder was prevalent in epileptic psychoses, especially in temporal lobe epilepsy and in post-ictal psychosis Epileptic psychoses were thought to be a different clinical entity from functional psychoses. Because of a wide heterogeneity of epileptic psychoses, the present multi-axial diagnosis is thought to be useful to identify their etiology. Less