Journal Article Annotations
2018, 1st Quarter
Annotations by AUTHOR1 and AUTHOR2
Type of study: Cohort study
The finding: Greater total number of prior seizures (possibly skewed towards complex partial seizures) and presence of a family history of psychosis are significant predisposing factors for interictal psychosis. Also, mesial temporal sclerosis was a significant predisposing factor, although partial vs generalized seizure type was not.
Strength and weaknesses: A major and underemphasized aspect of this study was surprising access to seizure frequency/number data in a large number of patients (e.g. through seizure diaries), collected from the point of epilepsy diagnosis as far back as the 1980s. The introduction suggests that this study might contribute to settling the debate between whether increased or decreased seizure frequency (via accumulated damage vs, for example, forced normalization). Due to some confusing and internally inconsistent language, though, this is not completely clear since seizure frequency immediately preceding interictal psychosis onset seems not to have been studied. This may be excusable since this time window of epilepsy-psychosis is thought to be more relevant to post-ictal than interictal psychosis, but the lack of clarity remains.
Relevance: Barring the presence of a very psychiatrically-savvy neurologist, inter- and post-ictal psychopathology might only be detected by a CL psychiatrist. Any information that helps raise and hone awareness to these syndromes is important, and a high quality study like this one is optimal.
Type of study: Systematic review
The finding: The number of substances and the range of leukoencephalopathies appears to be wider than most might think.
Strength and weaknesses: This is a comprehensive review from a lead author who happens to be one of the world’s leading experts in white matter disease. It’s strength may also be a weakness, however, since it is not targeted at any one particular toxic leukoencephalopathy; the causes and consequences are both diverse.
Relevance: With heroin, morphine, and fentanyl appearing prominently on the list of offenders, and hospitalizations of misusers of these drugs on the rise, consultation-liaison psychiatrists are more often called upon to see patients with not just overdoses, but also “mysteriously” prolonged “intoxication.” This article will be a go-to piece for some time for self-education and for getting trainees started on presentations on this topic. It’s a PDF to have readily at hand.