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Psychosis in temporal lobe epilepsy: atypical presentation
Priya Gandhi1, Boluwaji Ogunyemi, Andrea MacDonald
1Psychiatry Department, Memorial University of Newfoundland, St Johns', Canada.
BMJ Case Reports
|June 6, 2012
Summary
A patient with bipolar disorder experienced behavioral changes, paranoia, and hallucinations. Diagnosis shifted to temporal lobe epilepsy, and treatment with carbamazepine led to significant improvement.
Area of Science:
- Neuroscience
- Psychiatry
Background:
- A 55-year-old female with a history of bipolar mood disorder presented with altered behavior, paranoia, and olfactory hallucinations.
- The patient had a history of non-compliance with lithium treatment for 10 weeks prior to admission.
Observation:
- Initial investigations included CT scan and electroencephalogram (EEG).
- CT scan results were normal, but EEG showed significant abnormalities.
- Neurology consultation was obtained, leading to orders for a sleep-deprived EEG and MRI.
Findings:
- A diagnosis of temporal lobe epilepsy was made.
- Carbamazepine treatment was initiated.
- The patient demonstrated a positive response to carbamazepine, with improvement in all symptoms.
Implications:
- This case highlights the importance of considering epilepsy in patients with psychiatric symptoms, especially when standard psychiatric treatments are ineffective.
- The successful management with carbamazepine underscores the potential for misdiagnosis and the need for comprehensive neurological evaluation.
- Interdisciplinary collaboration between neurology and psychiatry is crucial for optimizing patient outcomes in complex cases.
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