Prevalence, clinical characteristics, and risk factors for psychosis in people with epilepsy: A multicenter retrospective cohort study.

Objective: We aimed to assess the prevalence, clinical characteristics, and risk factors for psychosis in a cohort of people with epilepsy in West China.

Methods: We used retrospective information from databases of three tertiary epilepsy centers, which included follow-up records from 2006 onward. Those with complete baseline data and at least one follow-up record were included. A psychiatrist confirmed the diagnosis of psychosis. Psychiatric features were evaluated using the Brief Psychiatric Rating Scale, Scale for the Assessment of Positive Symptoms, and Scale for the Assessment of Negative Symptoms. Demographic data and clinical characteristics were used to develop risk models for interictal psychosis (IIP), ictal psychosis (IP), and postictal psychosis (PIP).

Results: Eight hundred eighty-two people were identified. Of them, 112 (13%) were diagnosed with psychosis of epilepsy (POE), including 62 with IIP (7%), 29 with IP (3%), and 21 with PIP (2%). Twenty-seven of the 882 (3%) were diagnosed with epilepsy following the onset of psychosis. Individuals with pre-epilepsy psychosis, compared to those with POE, exhibited a lower proportion of refractory epilepsy, less frequent seizures, reduced seizure severity, and higher frequency and severity of hallucinations and delusions. In people with POE, bizarre behavior, avolition, and anhedonia were the three most common psychotic symptoms. Modeling identified several risk factors; earlier age at seizure onset, family history of schizophrenia, current frequent seizures, temporal lobe epilepsy (TLE), hippocampal sclerosis, perampanel use, and taking at least two antiseizure medications were associated with an increased risk of IIP. Severe head trauma, current frequent seizures, and TLE were risk factors for PIP, whereas current frequent seizures alone were a risk factor for IP.

Significance: Psychosis is often comorbid with epilepsy. Our study suggests that the prevalence of POE may be two times higher than previously reported. Prompt recognition and early management of psychosis are warranted.