Trimble, Michael R.; (1994) Studies of the psychoses of epilepsy. Doctoral thesis (M.D), UCL (University College London).

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Abstract

There are two components to this Thesis. The first is a review of the literature. Associations between epilepsy and psychiatry have been known since historical times, but most interest in the psychopathology associated with epilepsy emerged in the French, German and English literatures of the nineteenth century. This is the first substantial literature review which has been carried out in this area, and the author has gone to original sources where that has been possible. Following the literature review a number of conclusions about relationships between epilepsy and psychoses are made. One of these is that patients with temporal lobe epilepsy have an increased liability to develop psychoses. Four studies are presented. In the first, an attempt was made to classify the types of psychoses that patients with epilepsy present and their relationship to psychosis in the absence of epilepsy. It is concluded that patients with temporal lobe epilepsy are more likely to present with nuclear schizophrenia, and that this form is most likely to be present with a left sided lesion. This is followed by three imaging studies. Two of these relate to structural imaging, namely a CT study and an MRI study, and examine the hypothesis that an organic structural brain disorder underlies the development of these psychoses. Essentially, few significant differences are found which support the hypothesis. The third study is a Positron Emission Tomography study, examining changes of brain function in patients with epileptic psychosis. Here, significant associations are noted between altered cerebral metabolic rate of oxygen use and the presence of psychosis. The final part of the thesis is a discussion of these findings in relationship to the literature review of the first section. It is concluded that the schizophrenia-like psychoses of epilepsy form a good biological model to further our understanding of schizophrenia.

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