Prevalence of Psychosis in People with Epilepsy: A Multicenter Retrospective Cohort Study

Strategic Insights -

A new research study has shed light on the prevalence, clinical characteristics, and risk factors for psychosis in people with epilepsy. Conducted in West China, the study aimed to assess the prevalence and clinical characteristics of psychosis in a cohort of people with epilepsy. The research, published in the journal Epilepsia, found that 13% of the 882 individuals with epilepsy were diagnosed with psychosis, including 7% with interictal psychosis, 3% with ictal psychosis, and 2% with postictal psychosis.

Key Takeaways:

  • The study found that 13% of people with epilepsy were diagnosed with psychosis, which is twice the prevalence reported in previous studies.
  • Individuals with pre-epilepsy psychosis exhibited a lower proportion of refractory epilepsy, less frequent seizures, reduced seizure severity, and higher frequency and severity of hallucinations and delusions compared to those with psychosis of epilepsy.
  • The three most common psychotic symptoms in people with epilepsy of psychosis were bizarre behavior, avolition, and anhedonia.
  • Risk factors for interictal psychosis included earlier age at seizure onset, family history of schizophrenia, current frequent seizures, temporal lobe epilepsy, hippocampal sclerosis, perampanel use, and taking at least two antiseizure medications.
  • Severe head trauma, current frequent seizures, and temporal lobe epilepsy were risk factors for postictal psychosis.
  • Current frequent seizures alone were a risk factor for ictal psychosis.
  • The study suggests that prompt recognition and early management of psychosis are warranted in people with epilepsy.

Statistics:

  • 13% of 882 individuals with epilepsy were diagnosed with psychosis.
  • 7% (62 individuals) of the 882 individuals were diagnosed with interictal psychosis (IIP).
  • 3% (29 individuals) of the 882 individuals were diagnosed with ictal psychosis (IP).
  • 2% (21 individuals) of the 882 individuals were diagnosed with postictal psychosis (PIP).
  • 27 individuals (3%) of the 882 were diagnosed with epilepsy following the onset of psychosis.
  • The study found that individuals with pre-epilepsy psychosis exhibited a lower proportion of refractory epilepsy (65% vs. 85% in those with psychosis of epilepsy).
  • The frequency of seizures was significantly lower in individuals with pre-epilepsy psychosis (5.8 times per month vs. 14.2 times per month in those with psychosis of epilepsy).

Sources:

  • Department of Neurology Reports Findings in Seizures (Prevalence, clinical characteristics, and risk factors for psychosis in people with epilepsy: A multicenter retrospective cohort study). Psychology & Psychiatry Journal. May 10, 2025; p 137.
  • Prevalence, clinical characteristics, and risk factors for psychosis in people with epilepsy: A multicenter retrospective cohort study. Epilepsia, 2025.
  • Wiley, 111 River St, Hoboken 07030-5774, NJ, USA. (Wiley-Blackwell - www.wiley.com/; Epilepsia - onlinelibrary.wiley.com/journal/10.1111/(ISSN)1528-1167)