Jacob C. Holzer

Psychiatric presentations of epilepsy.

&NA; The abnormal neuronal excitability underlying seizure disorders may alter behavior. Behavioral alterations associated with epilepsy can occur during the ictal period, especially in patients who suffer partial seizures of temporal or frontal lobe origin, or during the interictal period in the setting of chronic temporolimbic seizure discharges. We use case descriptions to illustrate behavioral presentations of epilepsy that resemble primary psychiatric illnesses, including schizophrenic psychoses, mood disorders, panic disorder, and dissociative disorders. The varied secondary psychiatric syndromes produced by epilepsy are elucidated by a consideration of normal functions of temporal and frontolimbic structures. The clinical pictures provide clues to the causes of primary psychiatric disorders.

End-of-life care and mental illness: a model for community psychiatry and beyond

End-of-life care is often influenced by the stereotyping of patients by age, diagnosis, or cultural identity. Two common stereotypes arise from the presumed incompetence of many patients to contribute to end-of-life decisions, and the fear that the discussions themselves will be de-stabilizing. We present a model for end-of-life discussions that combines competence assessment with healthcare preferences in a psychiatric population that faces identical stereotypes. The model, which draws on clinical research in competence and suicide risk assessment, has important implications for all patients in the community who are marginalized or stereotyped during discussions of end-of-life treatment.