Psychosis often develops after the administration of
antiepileptic drugs (AEDs) in patients with
epilepsy. However, the individual vulnerability and clinical condition of such patients have been rarely scrutinised. We investigated the effect of individually consistent (trait-dependent) and inconsistent (state-dependent) characteristics.
METHODS: The individual characteristics, clinical states and psychotic outcome of patients from eight adult
epilepsy clinics were retrospectively reviewed over 6-month periods after a new drug (AED or non-AED) administration between 1981 and 2015.
RESULTS: A total of 5018 new drugs (4402 AEDs and 616 non-AEDs) were used in 2015 patients with
focal epilepsy. Subsequently, 105 psychotic episodes (81 interictal and 24 postictal) occurred in 89 patients. Twelve patients exhibited multiple episodes after different AED administrations. Trait-dependent characteristics (early onset of
epilepsy, known presumed causes of
epilepsy, lower intellectual function and a family history of
psychosis) were significantly associated with the patients who exhibited
psychosis. Absence of family history of
epilepsy was also associated with
psychosis but not significantly. Subsequent logistic regression analysis with a model incorporating family history of
psychosis and
epilepsy, and intellectual function was the most appropriate (p=0.000). State-dependent characteristics, including previous psychotic history and
epilepsy-related variables (longer duration of
epilepsy, AED administration, higher seizure frequency and concomitant use of AEDs) were significantly associated with psychotic episodes. Subsequent analysis found that a model including AED administration and previous psychotic history was the most appropriate (p=0.000).
CONCLUSION: