Aripiprazole treatment and one year follow up of an interictal psychosis patient

Aripiprazole treatment and one year follow up of an interictal psychosis patient Objective: The presence of chronic neurological functional deficits in epilepsy increases susceptibility to psychiatric diseases. Especially, complex partial seizures are associated with psychiatric symptoms commonly and as many as %10-30 of patients may have psychosis. The classification has been made according to the time interval of the psychotic symptoms; ictal psychosis psychotic symptoms occur only during a seizure; postictal psychosis occurs after a short period, and seizures arising from persistent psychotic symptoms of schizophrenia-like condition are referred as interictal psychosis. Methods: A 42 year old patient with epilepsy since age 7, who had psychotic symptoms, was differentiated from schizophrenia and diagnosed with interictal psychosis based on the clinical features (ICD-10 schizophrenia like psychosis). He was treated with aripiprazole and his treatment response and 1 year follow up were discussed. An epileptic focus was determined in the right hemisphere on EEG and in left parietal lobe on PET and also left mesial temporal sclerosis (MTS) was detected on MRI. Aripiprazole 10mg/day, which is known to reduce the seizure threshold and also lower and improve the negative symptoms, was started. Treatment response was assessed by SANS, SAPS, and social- occupational functioning assessment questionnaires. First evaluations were conducted in the second week and there were dramatic changes in the scale scores. She also had significant clinical improvement especially in negative symptoms and social functioning. She was called to assess response to treatment second time after 4 weeks. Conclusion: Our case has the following features: We have offered a 1-year follow-up period and reviewed the similarities and the differential diagnosis from schizophrenia and the clinical symptoms observed in follow up of patients with interictal psychosis. Finally, our case also has a unique feature due to treatment of schizophrenia-like psychosis of epilepsy with aripiprazole. The antipsychotic treatments are known to reduce the threshold for epileptic seizures. However psychosis associated with epilepsy needs two-way thinking. Therefore we thought the so-called third-generation antipsychotic aripiprazole might be a good option to use. The clinical similarities and differences between idiopathic schizophrenia and schizophrenia-like psychosis of epilepsy are important to know for differential diagnosis and treatment planning.