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

我们开发了一种新的癫痫精神病五轴诊断方案，它系统地描述了所有的临床信息。使用该方案，我们进行了一项多中心研究，从五个机构招募了128例癫痫精神病患者，其中男性63例，女性65例。平均年龄39.9±12.8岁，癫痫起病年龄13.5±9.8岁，精神病起病年龄27.9±9.5岁。在第1轴上编码的精神病的类型是不同的，依次是偏执型分裂样精神病、慢性妄想障碍、急性短暂性精神病、青春型分裂样精神病、紧张性障碍、幻觉症。大多数病例在精神病发作时脑电未见改变，仅8例恢复正常，4例加重。未证实癫痫灶有副作用。多达49例编码在5轴上的病例通过脑成像…显示了各种异常G检查较多，如弥漫性脑萎缩、单侧海马区萎缩、局灶性脑萎缩、肿瘤性病变、皮质发育不良，依次为。34例有脑损伤病史，依次为脑炎、产伤、挫伤、婴儿期癫痫持续状态、脑肿瘤术后状态、脑血管疾病。智力障碍以智能障碍为主，轻度障碍38例，中度障碍12例。这些癫痫精神病患者与53名在精神病发病时年龄、性别和年龄相匹配的功能性精神病患者进行了比较，这些患者使用McGuffin于1998年开发的操作多诊断标准(OPCRIT)。评分符合率在90%以上的有29个，超过80%的有26个，超过70%的有18个，超过60%的有4个。与功能性精神病相比，癫痫精神病患者表现出较少的施耐德一级症状、系统性妄想、幻听持续一周以上、迫害妄想、活动迟缓、思维内容差、情感扁平化，表现出更多的不理解对话和不恰当的情感。DSM-IV诊断表明，不明原因的精神障碍在癫痫精神病中普遍存在，尤其是在颞叶癫痫和发作后精神病中，癫痫精神病被认为是与功能性精神病不同的临床实体。由于癫痫精神病的广泛异质性，目前的多轴诊断被认为有助于确定其病因。较少

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