Psychosis and schizophrenia among patients with epilepsy: A systematic review and meta-analysis

Abstract

Background: Prior research has indicated an association between epilepsy and psychosis. This review aimed to estimate the global prevalence rate of psychosis and schizophrenia in epilepsy and assess the odds of psychosis and schizophrenia among patients with epilepsy (PWE).

Method: A comprehensive literature search was carried out utilizing relevant keywords in PubMed/MEDLINE and Scopus, covering from January 1, 1990, to November 18, 2023. The meta-analysis was performed using R software employing a random-effect model to establish the overall prevalence and odds ratio (OR), with 95 % confidence intervals (95 % CI), of psychosis and schizophrenia in epilepsy.

Result: Eighty-one studies encompassing 970,497 PWE met the inclusion criteria. The meta-analysis revealed that the overall prevalence of psychosis and schizophrenia among PWE was 7.8 % (95 % CI: 6.3-9.2 %, I² = 100 %) and 3 % (95 % CI: 1.7-4.3 %, I² = 95 %), respectively. Moreover, epilepsy was associated with a threefold rise in the odds of psychosis (OR = 3.41, 95 % CI: 2.3-5.08, p-value < 0.01, I² = 99 %, p-heterogeneity < 0.01). Furthermore, epilepsy was found to be significantly correlated with a fivefold increased odds of schizophrenia (OR = 5.22, 95 % CI: 2.99-9.11, p-value < 0.01, I² = 94 %, p-heterogeneity < 0.01) CONCLUSION: Epilepsy can increase the risk of developing psychosis and schizophrenia. Additional longitudinal research is warranted to elucidate the influence of epilepsy and its treatments on the risk of psychosis and schizophrenia, and also a comprehensive suite of confounding adjustments will be requisite.

Keywords: Epilepsy; Psychosis; Psychotic disorders; Schizophrenia.