Authors :
Presenting Author: VARSHA NANDWANA, MD – Virginia Tech Carilion School of Medicine
Ching-Fang Sun, MD – Resident, Psychiatry, Virginia Tech carilion School of Medicine; Geetika Bajpai, MD – Resident, Neurology, Virginia Tech Carilion School of Medicine; Anita Kablinger, MD – Professor and Program Director, Psychiatry, Virginia Tech Carilion School of Medicine; Aashit Shah, MD, FAAN, FANA – Chairperson, Neurology, Virginia Tech Carilion School of Medicine
Rationale: Postictal psychosis (PIP) is a transient psychiatric phenomenon characterized by the onset of psychotic symptoms following a seizure. While the immediate manifestations of PIP have been widely documented, there is limited understanding of its long-term implications, particularly its relationship with primary psychotic disorders. This retrospective cohort study aimed to investigate whether patients experiencing PIP are at an elevated risk of being diagnosed with primary psychotic disorders.
Methods: We conducted a retrospective cohort study by analyzing deidentified patient information between 2003-2023 on the TriNetX database. We defined the study population as individuals aged 4 to 65 years. The study cohort is defined as individuals with PIP. The control cohort is defined as individuals without PIP. We defined PIP as a diagnosis of brief psychotic disorder due to a known physiological condition (International Classification of Diseases, ICD-10-CM: F06.0, F06.2) or brief psychotic disorder within seven days of the epileptic disorder diagnosis (ICD-10-CM: F23). We excluded patients with psychotic disorder diagnosis (ICD-10-CM: F20-F29) prior to PIP and those who had delirium (ICD-10-CM: F05) following PIP. The study cohort was propensity-score matched with the control cohort at a 1:1 ratio by age, sex, race, ethnicity, common psychiatric conditions, and chronic physical conditions (Table 1). Outcome was defined as any type of psychotic disorder in the five year follow-up period. We applied Kaplan–Meier analysis to obtain hazard ratios and log-rank test to assess the differences in survival probabilities.
Results: A total of 899 individuals were identified and matched for analysis. Patients in the study cohort were at a higher risk of subsequent psychotic disorders (Hazard ratio [HR]= 8.59, 95% Confidence Interval (CI) 4.11-17.92, p=0.02), within the five-year time frame of PIP diagnosis. Kaplan-Meier analyses (Fig. 1) indicate the difference in the overall survival probability at five years for the study cohort with 89.2% (i.e., at five years 89.2% of the study cohort did not develop psychotic disorder), compared to 98.3% in the control group (log-rank test, χ2= 47.5; p< 0.001).