Tsunekatsu Hara

A Multicenter Study on the Prevalence of Psychiatric Disorders among New Referrals for Epilepsy in Japan

Summary:  Purpose: To investigate the prevalence rate and risk factors of psychiatric disorders among new referrals for epilepsy, a multicenter study was conducted by using the International League Against Epilepsy (ILAE) criteria for epilepsy and the ICD‐10 criteria for psychiatric disorders.

Epileptic, organic and genetic vulnerabilities for timing of the development of interictal psychosis

BACKGROUND Age at the first psychotic episode and an interval between the onset of epilepsy and that of psychosis reflect developmental processes of interictal psychosis. However, factors relating to these indices remain unknown. AIMS To identify clinical variables that are associated with the timing of the development of interictal psychosis. METHOD In 285 adults with epilepsy with interictal psychosis, effects of epileptic (epilepsy type), organic (intellectual functioning) and genetic (family history of psychosis) variables on timing of the development of psychosis were examined. RESULTS The mean interval between the onset of epilepsy and that of psychosis was 14.4 years. Some psychosis occurred within a few years of the first seizure. Generalised epilepsy, normal intellectual function and a positive family history of psychosis were associated with early onset of psychosis. CONCLUSIONS Early development of interictal psychosis in people with epilepsy may reflect other individual vulnerabilities to psychosis rather than epilepsy-related damage.

Difference in age of onset of psychosis between epilepsy and schizophrenia

To clarify the nature of psychosis development in epilepsy patients, we studied differences in age of onset of psychosis between epilepsy patients with psychosis (epilepsy-psychosis) and schizophrenia patients. Subjects were 282 patients with epilepsy-psychosis (36 postictal, 224 interictal, and 22 bimodal psychoses) and 612 schizophrenia patients. Age of onset was compared between the schizophrenia group and the whole epilepsy-psychosis group as well as its subgroups. Effects of sex and family history of psychosis on age of onset were also evaluated. Epilepsy patients developed psychosis later (mean age 30.1) than schizophrenia patients (mean age 26.6). Among epilepsy-psychosis subgroups, postictal psychosis and interictal psychosis showed a later onset than schizophrenia. In interictal psychosis, while chronic schizophrenia-like psychosis occurred at similar age compared to schizophrenia, brief episodic psychosis occurred at later age. Epilepsy-psychosis patients showed no sex difference in age of onset, whereas female schizophrenia patients showed a later onset than male schizophrenia patients. Both the epilepsy and schizophrenia patients with family history of psychosis tended to develop psychosis at an earlier age, although this did not reach statistically significant level. The findings of the study suggest that the nature of epilepsy-psychosis is not fully equivalent to that of schizophrenia.

Analogy between psychosis antedating epilepsy and epilepsy antedating psychosis

Purpose:  Patients with recurrent epileptic seizures after the development of psychosis (Psychosis‐Epilepsy) have been regarded as belonging to a different clinical entity from those with epilepsy antedating the development of psychosis (Epilepsy‐Psychosis). However, clinical characteristics of patients with Psychosis‐Epilepsy have not been well described, except for early German studies. We aimed to estimate the reliability of distinction between Psychosis‐Epilepsy and Epilepsy‐Psychosis by comparing their clinical characteristics.

Postictal Elevation of Prolactin Levels After Psychic Auras‐Evidence for Seizure Discharges Involving Mesolimbic Structures

Purpose: The postictal elevation of prolactin (PRL) levels results from the spread of ictal discharges involving mesolimbic structures (amygdala and hippocampus), via the ventral amygdalofugal pathway to the hypothalamus. To determine whether the mesolimbic structures are involved, we measured postictal PRL levels after simple partial seizures (SPSs) with psychic symptoms (psychic auras), and compared them with those after complex partial seizures (CPSs), 80% of which have been reported to show significant postictal elevations of PRL.

Concurrent development of BECCT in a pair of monozygotic twins

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Psychiatric Clinic for Epileptic Outpatients

It may be said that a great part of the outpatients in every psychiatry department of university hospitals in Japan are epileptics. It is regrettable that they are not always treated adequately during psychiatric consultation. “Seizure Clinic” for special treatment of epilepsy was opened in the Department of Neuropsychiatry of Keio University Hospital in 1962, and currently the authors are in charge of the special section for epileptic outpatients at the Clinic. The cases treated at the Clinic are outpatients diagnosed as epileptic through psychiatric assessment by doctors of the outpatients’ clinic of the Department of Neuropsychiatry. Also treated are those who request consultation with specialists in epilepsy. We may say, therefore, that the cases of the Seizure Clinic may be regarded as representative epileptic patients with serious problems or who need special psychiatric care. We have attempted in this paper to give some consideration to the psychiatrists’ role in the treatment of epilepsy, based on statistical data of the Seizure Clinic. Subjects of the study are 213 patients (106 males and 107 females) with epilepsy who have been treated at the Seizure Clinic by the authors during the period from October 1 , 1977 to September 30, 1978.