Naoto Adachi1, Peter Fenwick2, Nozomi Akanuma3, Koichiro Hara4, Ryouhei Ishii5, Mitsutoshi Okazaki6, Masumi Ito7, Masanori Sekimoto8, Masaaki Kato8, Teiichi Onuma8. 1. Adachi Mental Clinic, Sapporo, Japan; National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan. Electronic address: adacchan@tky2.3web.ne.jp. 2. Institute of Psychiatry [emeritus], King's College London, London, UK. 3. National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Lambeth Assessment, Liaison and Treatment Team, South London and Maudsley NHS Foundation Trust, London, UK. 4. Asai Hospital, Togane, Japan. 5. Department of Psychiatry, University of Osaka Graduate School of Medicine, Osaka, Japan. 6. National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan. 7. National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Jozen Clinic, Sapporo, Japan. 8. National Centre Hospital for Mental, Nervous and Muscular Disorders, NCNP, Kodaira, Japan; Musashino Kokubunji Clinic, Kokubunji, Japan.
Abstract
OBJECTIVE: Many studies show psychoses after some antiepileptic drug (AED) administrations (post-AED administration psychoses [PAP]). It remains uncertain about psychogenetic potential of each AED and effects of clinical state factors on PAP. We examined the relations between AED-related factors (types, generations, dosages, and concomitant AED) and PAP. METHODS: The clinical records of patients with focal epilepsy were retrospectively reviewed from eight adult epilepsy clinics, for every six-month period after administration of a new drug (either AED or non-AED) between 1981 and 2015. Characteristics of psychotic episodes, AED-related factors (type, daily dosage, and concomitant AED), and other state-related risk factors to psychosis (age, duration of epilepsy, history of psychosis, and seizure frequency) were examined. Psychogenetic risks of AED-related and state-related factors were analyzed with multifactorial procedures. RESULTS: Of 2067 patients with focal epilepsy, 5018 new drugs (4402 AEDs and 616 non-AEDs) were administered. Within the first six-month period, 89 patients exhibited 105 psychotic episodes (81 interictal and 24 postictal psychoses: 55 first episodes and 50 recurrences). With second-generation AED (SAED) administration, particularly topiramate and lamotrigine, frequency of psychosis was significantly increased. Daily dosage of AED was not significantly associated with psychosis. Psychosis tended to occur with a higher number of concomitant AED. Subsequent analysis with AED-related and general factors showed that SAED administrations and previous psychotic history were the most significant risks for PAP. CONCLUSION: Post-AED administration psychoses is associated with type of AED (SAED), rather than its dosage. Individual vulnerabilities are also associated with PAP.
OBJECTIVE: Many studies show psychoses after some antiepileptic drug (AED) administrations (post-AED administration psychoses [PAP]). It remains uncertain about psychogenetic potential of each AED and effects of clinical state factors on PAP. We examined the relations between AED-related factors (types, generations, dosages, and concomitant AED) and PAP. METHODS: The clinical records of patients with focal epilepsy were retrospectively reviewed from eight adult epilepsy clinics, for every six-month period after administration of a new drug (either AED or non-AED) between 1981 and 2015. Characteristics of psychotic episodes, AED-related factors (type, daily dosage, and concomitant AED), and other state-related risk factors to psychosis (age, duration of epilepsy, history of psychosis, and seizure frequency) were examined. Psychogenetic risks of AED-related and state-related factors were analyzed with multifactorial procedures. RESULTS: Of 2067 patients with focal epilepsy, 5018 new drugs (4402 AEDs and 616 non-AEDs) were administered. Within the first six-month period, 89 patients exhibited 105 psychotic episodes (81 interictal and 24 postictal psychoses: 55 first episodes and 50 recurrences). With second-generation AED (SAED) administration, particularly topiramate and lamotrigine, frequency of psychosis was significantly increased. Daily dosage of AED was not significantly associated with psychosis. Psychosis tended to occur with a higher number of concomitant AED. Subsequent analysis with AED-related and general factors showed that SAED administrations and previous psychotic history were the most significant risks for PAP. CONCLUSION: Post-AED administration psychoses is associated with type of AED (SAED), rather than its dosage. Individual vulnerabilities are also associated with PAP.