Schizophrenia, Psychosis, and Epilepsy

By: Natalie L. Boehm, MBA, RBLP-T

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What is Schizophrenia?

According to the American Psychiatric Association, schizophrenia is a chronic brain disorder that affects less than one percent of the U.S. Population. Symptoms of schizophrenia can include delusions, hallucinations, disorganized speech, trouble with thinking and lack of motivation (Torres, 2020).


According to the National Institute of Mental Health, a diagnosis for schizophrenia occurs in late teens to early thirties, males in their late adolescence to early twenties and females in their early twenties to early thirties. Onset of symptoms can start to be noticed in mid-adolescence years. However, it is rare for anyone to be diagnosed with schizophrenia before late adolescence years.

Signs and Symptoms of Schizophrenia

Signs and symptoms of schizophrenia vary for each person, just like epilepsy. Studies have shown that as a person ages, the incidence of severe psychotic symptoms decrease whereas not taking medication, using drugs and/or alcohol, and high levels of stress can increase symptoms (Torres, 2020).

According to Mayo Clinic, symptoms may include:

Delusions: These are false beliefs that are not based in reality. For example, you think that you’re being harmed or harassed; certain gestures or comments are directed at you; you have exceptional ability or fame; another person is in love with you; or a major catastrophe is about to occur. Delusions occur in most people with schizophrenia.

Hallucinations: These usually involve seeing or hearing things that don’t exist. Yet for the person with schizophrenia, they have the full force and impact of a normal experience. Hallucinations can be in any of the senses, but hearing voices is the most common hallucination.

Disorganized thinking (speech): Disorganized thinking is inferred from disorganized speech. Effective communication can be impaired, and answers to questions may be partially or completely unrelated. Rarely, speech may include putting together meaningless words that can’t be understood, sometimes known as word salad.

Extremely disorganized or abnormal motor behavior: This may show in a number of ways, from childlike silliness to unpredictable agitation. Behavior isn’t focused on a goal, so it’s hard to do tasks. Behavior can include resistance to instructions, inappropriate or bizarre posture, a complete lack of response, or useless and excessive movement.

Negative symptoms: This refers to reduced or lack of ability to function normally. For example, the person may neglect personal hygiene or appear to lack emotion (doesn’t make eye contact, doesn’t change facial expressions, or speaks in monotone). Also, the person may lose interest in everyday activities, socially withdraw, or lack the ability to experience pleasure.

                                                                                                                                                   (Mayo Clinic, 2020)

Schizophrenia and Epilepsy

Individuals who battle epilepsy are at higher risk for developing schizophrenia. When families have a history of psychosis and epilepsy, they are at higher risk for developing schizophrenia as well as schizophrenia-like psychosis (Cascella et. al., 2009).  Some patients experience what is referred to as schizophrenia-like psychosis of epilepsy, which is having symptoms similar to schizophrenia, but not the actual diagnosis.  

In the article, Schizophrenia and Epilepsy: Is There a Shared Susceptibility?, the authors address a concern that individuals who are battling schizophrenia are more prone to head injuries and other events that can lead to a patient developing seizures. Another part of the study address concerns that the risk of schizophrenia increases with the number of hospital admissions for epilepsy, especially for patients who are first admitted over the age of twenty-five (Cascella et. al., 2009). Studies have shown that seizures and schizophrenia can share some genetic or environmental causes (Cascella et. al.,2009).

Individuals with schizophrenia and epilepsy have a high mortality rate. In the article, Interictal psychosis of epilepsy, more than one in four people with both epilepsy and schizophrenia will die between the ages of 25 to 50.  

Schizophrenia-Like Psychosis of Epilepsy

Schizophrenia-like psychosis of epilepsy occurs in around seven percent of patients battling epilepsy and is more common in patients with seizure activity in the temporal lobes rather than primary generalized seizures (Trimble, 1992).

Symptoms of Schizophrenia-Like Psychosis of Epilepsy are:



First Rank Symptoms (auditory hallucinations, thought broadcast, thought insertion, thought withdrawal, and delusional perception)

Thought disorder

                                                                                                                                (Trimble, 1992)

Postictal Psychosis

Postictal psychosis (PIP), is defined as an episode of psychosis occurring after a cluster of seizures, is common, and may be associated with profound morbidity, including chronic psychosis (Morrow et. al., 2006). Common symptoms of postictal psychosis include delusions, auditory and visual hallucinations, mood changes and aggressive behavior (Devinsky, 2008).

For many years, postictal psychosis received little attention until the late 1980’s. Two psychiatrists, S.J. Logsdail and B.K. Toone studied postictal psychosis and came up with a diagnostic criteria.

Logsdail and Toone’s diagnostic criteria for Postictal Psychosis

1. Episode of psychosis (often with confusion and delirium), developing within 1 week of a seizure or cluster of seizures.

2. Psychosis lasting at least 15 hours and less than 2 months.

3. Mental state characterized by delirium or delusions (e.g., paranoid, nonparanoid, delusional, misidentifications) or hallucinations (e.g., auditory, visual, somatosensory, olfactory) in clear consciousness.

4. No evidence of:

a) a history of treatment with antipsychotic medications or psychosis within the past 3 months,

b) antiepileptic drug toxicity,

c) An EEG demonstrating nonconvulsive status,

d) a recent history of head trauma or alcohol/drug intoxication or withdrawal (other than benzodiazepines used for epilepsy).

                                                                                                                                (Devinsky, 2008)

Interictal Psychosis

Interictal psychosis refers to psychosis that occurs in clear consciousness in persons with epilepsy with temporal onset not during or immediately following a seizure (de Toffol et. al., 2020). Interictal psychosis can be brief or chronic, with chronic cases resembling symptoms of schizophrenia. Example can be religious delusion, sudden mood swings, and catatonic states (de Toffol et. al., 2020). Interictal psychosis often starts after many years of active temporal lobe epilepsy. Patients who experience interictal psychosis requires both a neurologist and psychiatrist to treat the symptoms. Both must be selective with any anticonvulsant or antipsychotic medication due to not just controlling seizure activity, but due to the negative side effects both classes of medications have.

Treatment Options

Doctors need to be concerned when treating both epilepsy and schizophrenia. While anticonvulsants are used to treat epilepsy, antipsychotics are used to treat schizophrenia.

There are two classes of antipsychotics that can be prescribed to people with schizophrenia, first-generation and second-generation antipsychotics. First-generation antipsychotics have significant neurological side effects that can cause irreversible damage. First-generation antipsychotics include:

  • Chlorpromazine
  • Fluphenazine
  • Haloperidol
  • Perphenazine

(Mayo Clinic, 2020)

Second-generation medications pose a lower risk of serious side effects. Second-generation medications include:

  • Aripiprazole (Abilify)
  • Asenapine (Saphris)
  • Brexpiprazole (Rexulti)
  • Cariprazine (Vraylar)
  • Clozapine (Clozaril, Versacloz)
  • Iloperidone (Fanapt)
  • Lurasideone (Latuda)
  • Olanzapine (Zyprexa)
  • Paliperidone (Invega)
  • Quetiapine (Seroquel)
  • Risperidone (Risperdal)
  • Ziprasidone (Geodon)

(Mayo Clinic, 2020)

Therapy to help improve mental wellness and social skills are important for individuals battling schizophrenia and epilepsy. Common treatments include

  • Individual therapy
  • Social skills training
  • Family therapy
  • Vocational rehabilitation/supported employment

            (Mayo Clinic, 2020)


Schizophrenia is a chronic brain disorder that affects less than one percent of the U.S. Population. diagnosis for schizophrenia occurs in late teens to early thirties, males in their late adolescence to early twenties and females in their early twenties to early thirties. Onset of symptoms can start to be noticed in mid-adolescence years. Individuals who battle epilepsy are at higher risk for developing schizophrenia. Individuals battling both epilepsy and schizophrenia have a high mortality rate. Different types of psychosis can affect patients battling both epilepsy and schizophrenia. Treatment such as medication, therapy, social skills training, and vocational training can help people who are battling epilepsy and schizophrenia.


Aarhus University (2019, May 16). Patients with both schizophrenia and epilepsy die alarmingly early. ScienceDaily. Retrieved September 27, 2021, from

Andersen, K.M., Petersen, L.V., Vestergaard, M., Pedersen, C.B., & Christensen, J. (2019). Premature mortality in persons with epilepsy and schizophrenia: A population-based nationwide cohort study. Epilepsia (Copenhagen), 60(6), 1200-1208.

Benavente López, S., Salgado Borrego, N., de la Hera Cabero, M., Oñoro Carrascal, I., Flores, L., & Jiménez Rico, R. (2016). Neurological symptoms in schizophrenia: A case report. European Psychiatry, 33(S1), S573-S573.

Cascella, N.G., Schretlen, D.J., & Sawa, A. (2009). Schizophrenia and epilepsy: is there a shared susceptibility? Neuroscience research, 63(4), 227-235.

de Toffol, B., Adachi, N., Kanemoto, K., El-Hage, W., & Hingray, C. (2020). Les psychoses épileptiques interictales [Interictal psychosis of epilepsy]. L’Encephale, 46(6), 482-492.  

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Morrow, E.M., Lafayette, J.M., Bromfield, E.B. et. al. Postictal psychosis: presymptomatic risk factors and the need for further investigation of genetics and pharmacotherapy. Ann Gen Psychiatry, 5, 9 (2006).

Nathaniel-James, D.A., Brown, R.G., Maier, M., Mellers, J., Toone, B., & Ron, M.A. (2004). Cognitive Abnormalities in Schizophrenia and Schizophrenia-Like Psychosis of Epilepsy. The Journal of Neuropsychiatry and Clinical Neurosciences, 16(4), 472-479.

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Schizophrenia and epilepsy (2012). In Harvard Mental Health Letter. Harvard Health Publications Group.

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The National Institute of Mental Health (2020). Schizophrenia. The National Institute of Mental Health. Retrieved from:

Toone, B.K. (2000). The psychoses of epilepsy. Journal of Neurology, Neurosurgery, & Psychiatry, 69,1-3.

Torres, F. (2020). What is Schizophrenia? American Psychiatric Association. Retrieved from:

Trimble, Michael R. FRCP, FRC Psych. The Schizophrenia-like Psychosis of Epilepsy, Neuropsychiatry, Neuropsychology & Behavioral Neurology; April 1992-Volume 5- Issue 2- P 103-107.

Wotton, C.J. and Goldacre, M.J. (2012). Coexistence of schizophrenia and epilepsy: Record-linkage studies. Epilepsia, 53: e71-e74. 

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