Epilepsia em um hospital psiquiátrico

Trevisol-Bittencourt, P. C.; Becker, N.; Pozzi, C.M.; Sander, J. W. A. S.

doi:10.1590/S0004-282X1990000300001

Resumos

Um recenseamento de epilepsia foi realizado no Hospital Colônia Sant'Ana, a maior instituição psiquiátrica do Estado de Santa Catarina. Este estabelecimento é mantido pela Secretaria de Saúde do Estado e usualmente encontra-se em regime de superlotação, aceitando pacientes sofredores dos mais diferentes tipos de transtornos mentais e provenientes de todas as partes do Estado. Pacientes com epilepsia, apresentando ou não manifestações psiquiátricas, são também freqüentemente internados. Foram identificados 171 pacientes com epilepsia de um total de 1126 internados, dando a alta prevalência de 152/1000. Além destes foram encontrados mais 23 pacientes «disrítmicos cerebrais» em uso de drogas anti-epilépticas sem, entretanto, terem epilepsia. Polifarmácia sedante era o esquema terapêutico adotado na maioria dos pacientes e nomenclatura bizarra era utilizada para definição das crises. Ao menos 85 dos pacientes com epilepsia não apresentavam qualquer justificativa médica para seu confinamento em ambiente psiquiátrico. A utilização exagerada de medicação sedante e a convivência forçada com psicóticos poderiam ser responsabilizadas não só pela persistência das crises mas, também, pelas alterações cognitivas e comportamentais observadas em grande parte dos pacientes. Paradoxal e surrealmente tais «alterações psiquiátricas» justificavam a perpetuação desta pseudoterapia que, ao invés de integrar o paciente na sociedade, o isola em estruturas fechadas. A criação de ambulatórios para abordagem multidisciplinar parece ser a única alternativa frente a essas concepções equivocadas que transformam o geralmente benigno sintoma epilepsia em devastadora doença mental.

Epilepsy was surveyed in the largest psychiatric hospital in the Santa Catarina State, southern Brazil. This establishment was designed for one thousand long-term beds but at the time of the survey there were 1126 inpatients. Diagnosis ranged from anxiety neurosis to schizophrenia although patients with epilepsy, with or without psychiatric symptoms were also admitted. The following aspects were analyzed: prevalence of epilepsy, seizure types, antiepileptic drug treatment and psychiatric diagnosis. 171 patients with epilepsy were identified (prevalence 152/1000), generalized tonic clonic attacks were the commonest seizure type and polytherapy was the standard treatment. In at least 85 of the epileptic patients there was no reason for prolonged institutionalization in a psychiatric environment. Moreover, most of the sample were prescribed large amounts of sedative drugs. A multi-disciplinary approach and outpatients services are urgently required to improve the prognosis and well-being of patients with epilepsy who are referred to psychiatric care.

P. C. Trevisol-Bittencourt^I; N. Becker^I; C.M. Pozzi^I; J. W. A. S. Sander^II

^IUnidade de Epilepsia, Departamento de Neurologia, Hospital Universitário, Universidade Federal de Santa Catarina (88000 Florianópolis-SC - Brasil)

^IIINSEG/Epilepsy Research Group, Institute of Neurology - Queen Square - London WC1N 3BG - UK). Resumo deste trabalho foi apresentado no 12º Congresso Brasileiro de Neurologia (Belo Horizonte, 1986)

RESUMO

Um recenseamento de epilepsia foi realizado no Hospital Colônia Sant'Ana, a maior instituição psiquiátrica do Estado de Santa Catarina. Este estabelecimento é mantido pela Secretaria de Saúde do Estado e usualmente encontra-se em regime de superlotação, aceitando pacientes sofredores dos mais diferentes tipos de transtornos mentais e provenientes de todas as partes do Estado. Pacientes com epilepsia, apresentando ou não manifestações psiquiátricas, são também freqüentemente internados. Foram identificados 171 pacientes com epilepsia de um total de 1126 internados, dando a alta prevalência de 152/1000. Além destes foram encontrados mais 23 pacientes «disrítmicos cerebrais» em uso de drogas anti-epilépticas sem, entretanto, terem epilepsia. Polifarmácia sedante era o esquema terapêutico adotado na maioria dos pacientes e nomenclatura bizarra era utilizada para definição das crises. Ao menos 85 dos pacientes com epilepsia não apresentavam qualquer justificativa médica para seu confinamento em ambiente psiquiátrico. A utilização exagerada de medicação sedante e a convivência forçada com psicóticos poderiam ser responsabilizadas não só pela persistência das crises mas, também, pelas alterações cognitivas e comportamentais observadas em grande parte dos pacientes. Paradoxal e surrealmente tais «alterações psiquiátricas» justificavam a perpetuação desta pseudoterapia que, ao invés de integrar o paciente na sociedade, o isola em estruturas fechadas. A criação de ambulatórios para abordagem multidisciplinar parece ser a única alternativa frente a essas concepções equivocadas que transformam o geralmente benigno sintoma epilepsia em devastadora doença mental.

SUMMARY

Epilepsy was surveyed in the largest psychiatric hospital in the Santa Catarina State, southern Brazil. This establishment was designed for one thousand long-term beds but at the time of the survey there were 1126 inpatients. Diagnosis ranged from anxiety neurosis to schizophrenia although patients with epilepsy, with or without psychiatric symptoms were also admitted. The following aspects were analyzed: prevalence of epilepsy, seizure types, antiepileptic drug treatment and psychiatric diagnosis. 171 patients with epilepsy were identified (prevalence 152/1000), generalized tonic clonic attacks were the commonest seizure type and polytherapy was the standard treatment. In at least 85 of the epileptic patients there was no reason for prolonged institutionalization in a psychiatric environment. Moreover, most of the sample were prescribed large amounts of sedative drugs. A multi-disciplinary approach and outpatients services are urgently required to improve the prognosis and well-being of patients with epilepsy who are referred to psychiatric care.

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Dr. p. c. Trevisol-Bittencourt - National Hospital-Chalfont Centre for Epilepsy - Chalfont St. Peter - Gerrards Cross, Bucks. SL9 ORJ - UK.

1. Beghi E, Mascio RD, Sasanelli F, Tognoni G - Collaborative Group for Epidemiology of Epilepsy. Adverse reactions to antiepileptic drugs: a multicenter survey of clinical practice. Epilepsia 27:323, 1986.
2. Beran RG, Jennings VR, Read T - Doctor's perspectives of epilepsy. Epilepsia 22:397, 1981.
3. Bertilswn Li -* Clinical pharmacokinetics of carbamazepine. Clin Pharmacokin 3:128, 1978.
4 Bittencourt PRM - Disritmia cerebral: termo maldito. Jornal da SBENC (Recife) 9:4 1985.
5. Cukiert A, Pinho E, Marino R - Epidemiological aspects of epilepsy in São Paulo, Brazil. Adv Epileptol 16:759. 1987.
6. Dechaume J - L'epileptique et la societé. Lyon Med 6:861, 1957.
7. Demers-Desrosier LA, Nestoros JN, Vaillancourt P - Acute psychosis precipitated by withdrawal of anticonvulsant medication. Am J Psychiat 135:981, 1978.
8. Dreifuss FE, Penry JK, Bancaud J, Henriksen O, Rubio-Donnadieu F, Seino M - Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 22:489, 1981.
9. Edwards VE - Social problems confronting a person with epilepsy in modern society. Proc Austr Ass Neurol 11:239, 1374.
10. Flor HP - Determinants of psychosis in epilepsy: laterality and forced normalization. Biol Psychiat 18:1045, 1983.
11. Gastaut H - Clinical and eletroencephalographic classification of epileptic seizures. Epilepsia 11:102, 1970.
12. Glaser GH - Epilepsy, hysteria and possession: a historical essay. J Nerv Ment Dis 166:26S, 1978.
13. Gomez JG, Arciniegas E, Torres J - Prevalence of epilepsy in Bogota. Neurology 28:90, 1978.
14. Gunn J - Social factors and epileptics in prison. Br J Psychiat 24:509, 1974.
15. Hermann B, Schwartz MS, Whitman S, Karnes WE - Psychosis and epilepsy: seizure type comparisons and high risk variables. J Clin Psychol 37:714, 1981.
16. Iemolo F, Menendez P - Crisi parziali con sintomatologia affettiva di paura nel bambino. Riv Neurol 51:344, 1981.
17. Iivanainen M, Uutela A, Wilkkumaa I - Public awareness and attitudes toward epilepsy in Finland. Epilepsia 21:413, 1980.
18. Kraft AM, Price TRP, Peltier D - Complex partial seizure and schizophrenia. Compr Psychiat 25:113, 1984.
19. McElroy SL, Keck PE, Pope HG - Sodium valproate: its use in primary psychiatric disorders. J Clin Psychopharm 7:16, 1987.
20. McKenna PJ, Kane JM, Parrish K - Psychotic syndromes in epilepsy. Am J Psychiat 142:895, 1985.
21. Monroe RR - Limbic ictus and atypical psychoses. J Nerv Ment Dis 170:711, 1982.
22. Neppe VM, Tucker GJ - Modern perspectives on epilepsy in relation to psychiatry: behavioral disturbance of epilepsy. Hosp Community Psychiat 39:389, 1988.
23. O'Neill BP, Ladon B, Harris LM, Riley HL III Dreifuss FE - A comprehensive, interdisciplinary approach to the care of the institutionalized person with epilepsy. Epilepsia 18:243, 1977.
24. Pakalnis A, Drake MEJr, John K, Kellum JB - Forced normalization. Acute psychosis after seizure control in seven patients. Arch Neurol 44:289, 1987.
25. Pruthi N, Dhir A, Murthy RS - Rural community attitude to epilepsy. Neurol India 27:170, 1979.
26. Reynolds EH - Chronic antiepileptic toxicity: a review. Epilepsia 16:319, 1975.
27. Ribeiro MN - A doença psiquiátrica e a morte social. Arq Catar Med 17:49, 1988.
28. Richens A - Interactions with antiepileptic drugs. Drugs 13:266, 1977.
29. Rimmer E, Richens A - An update on sodium valproate. Pharmacotherapy 5:171, 1985.
30. Rivinus TM - Psychiatric effects of the anticonvulsant regimens. Psychopharmacol 2/3:165, 1982.
31. Sander JWAS, Shorvon SD - Prevalence and incidence studies in epilepsy and their methodological problems: a review. J Neurol Neurosurg Psychiat 50:829, 1987.
32. Sander JWAS, Trevisol-Bittencourt PC, Oxley J - Epilepsia como condição disabilitante. Arq Catar Med 15:13, 1986.
33. Sheppard LC, Ballinger BR, Fenton GW - Anticonvulsant medication in a mental handicap hospital: 1972-1982. Br J Psychiat 150:513, 1987.
34. Shervin I - Psychosis associated with epilepsy: significance of the laterality of the epileptogenic lesion. J Neurol Neurosurg Psychiat 44:83, 1981.
35. Shervin I, Peron-Magnan P, Bancaud J, Bonis A, Talairach J - Prevalence of psychosis in epilepsy as a function of the epileptogenic lesion. Arch Neurol 39:621, 1982.
36. Shorvon SD, Chadwick D, Galbraith AW, Reynolds EH - One drug for epilepsy. Br Med J 1:474, 1978.
37. Shukla GD, Srivastasa ON, Katiyar BC - Schizophrenia-like psychosis in epilepsy: a controlled study. Ind Clinician 44:496, 1980.
38. Sillanpaa M - Carbamazepine: pharmacology and clinical uses. Acta Neurol Scand 64:1, 1981.
39. Sorel L - Crises de breve durée a expression psychique. Rev Neuropsychiat Infant 18:531, 1970.
40. Stores G - Behavioural effects of antiepileptic drugs. Mod Med N Zealand 13:8, 1980.
41. Tancredi F - Hospital e assistência social para os epilépticos. Arq Assist Psicopat São Paulo 49:87, 1948.
42. Thompson PJ, Trimble MR - Anticonvulsant drugs and cognitive functions. Epilepsia 23:531, 1982.
43. Trevisol-Bittencourt PC - Dez razões para a criação de um centro catarinense de epilepsia. Arq Catar Med 17:175, 1988.
44. Trevisol-Bittencourt PC - Quando tratar crises únicas ou raras. Arq Catar Med 17:95, 1988.
45. Trevisol-Bittencourt PC, Sander JWAS - Poor compliance em epilepsia: algumas considerações. J Liga Brasil Epilep, (no prelo), 1989.
46. Trevisol-Bittencourt PC, Sander JWAS, Duncan J - O tratamento das crises epilépticas. Arq Catar Med 15:77, 1986.
47. Trimble MR - Psychiatric aspects of epilepsy. Psychiatr Dev 5:285, 1987.
48. Trimble MR, Reynolds EH - Anticonvulsant drugs and mental symptoms: a review. Psychol Med 6:169, 1976.
49. Whitman S, Coleman TE, Patmon C, Bindu TD, Cohen R, Lambert NK - Epilepsy in prison: elevated prevalence and no relationship to violence. Neurology 34:775, 1984.
50. Wieser H - Depth recorded limbic seizures and psychopathology. Neurosci Biobehav Rev 7:427, 1983.
51. Zanda G, Scatena PA, Torre S - Epilepsia e iungodegenza psichiatrica. Rass Studi Psichiatr 66:807, 1977.

Epilepsia em um hospital psiquiátrico

Epilepsy in a psychiatric hospital

Datas de Publicação

Publicação nesta coleção
26 Maio 2011
Data do Fascículo
Set 1990

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Beghi E, Mascio RD, Sasanelli F, Tognoni G - Collaborative Group for Epidemiology of Epilepsy. Adverse reactions to antiepileptic drugs: a multicenter survey of clinical practice. Epilepsia 27:323, 1986.

[2] 2. Beran RG, Jennings VR, Read T - Doctor's perspectives of epilepsy. Epilepsia 22:397, 1981.

[3] 3. Bertilswn Li -* Clinical pharmacokinetics of carbamazepine. Clin Pharmacokin 3:128, 1978.

[4] 4 Bittencourt PRM - Disritmia cerebral: termo maldito. Jornal da SBENC (Recife) 9:4 1985.

[5] 5. Cukiert A, Pinho E, Marino R - Epidemiological aspects of epilepsy in São Paulo, Brazil. Adv Epileptol 16:759. 1987.

[6] 6. Dechaume J - L'epileptique et la societé. Lyon Med 6:861, 1957.

[7] 7. Demers-Desrosier LA, Nestoros JN, Vaillancourt P - Acute psychosis precipitated by withdrawal of anticonvulsant medication. Am J Psychiat 135:981, 1978.

[8] 8. Dreifuss FE, Penry JK, Bancaud J, Henriksen O, Rubio-Donnadieu F, Seino M - Proposal for revised clinical and electroencephalographic classification of epileptic seizures. Epilepsia 22:489, 1981.

[9] 9. Edwards VE - Social problems confronting a person with epilepsy in modern society. Proc Austr Ass Neurol 11:239, 1374.

[10] 10. Flor HP - Determinants of psychosis in epilepsy: laterality and forced normalization. Biol Psychiat 18:1045, 1983.

[11] 11. Gastaut H - Clinical and eletroencephalographic classification of epileptic seizures. Epilepsia 11:102, 1970.

[12] 12. Glaser GH - Epilepsy, hysteria and possession: a historical essay. J Nerv Ment Dis 166:26S, 1978.

[13] 13. Gomez JG, Arciniegas E, Torres J - Prevalence of epilepsy in Bogota. Neurology 28:90, 1978.

[14] 14. Gunn J - Social factors and epileptics in prison. Br J Psychiat 24:509, 1974.

[15] 15. Hermann B, Schwartz MS, Whitman S, Karnes WE - Psychosis and epilepsy: seizure type comparisons and high risk variables. J Clin Psychol 37:714, 1981.

[16] 16. Iemolo F, Menendez P - Crisi parziali con sintomatologia affettiva di paura nel bambino. Riv Neurol 51:344, 1981.

[17] 17. Iivanainen M, Uutela A, Wilkkumaa I - Public awareness and attitudes toward epilepsy in Finland. Epilepsia 21:413, 1980.

[18] 18. Kraft AM, Price TRP, Peltier D - Complex partial seizure and schizophrenia. Compr Psychiat 25:113, 1984.

[19] 19. McElroy SL, Keck PE, Pope HG - Sodium valproate: its use in primary psychiatric disorders. J Clin Psychopharm 7:16, 1987.

[20] 20. McKenna PJ, Kane JM, Parrish K - Psychotic syndromes in epilepsy. Am J Psychiat 142:895, 1985.

[21] 21. Monroe RR - Limbic ictus and atypical psychoses. J Nerv Ment Dis 170:711, 1982.

[22] 22. Neppe VM, Tucker GJ - Modern perspectives on epilepsy in relation to psychiatry: behavioral disturbance of epilepsy. Hosp Community Psychiat 39:389, 1988.

[23] 23. O'Neill BP, Ladon B, Harris LM, Riley HL III Dreifuss FE - A comprehensive, interdisciplinary approach to the care of the institutionalized person with epilepsy. Epilepsia 18:243, 1977.

[24] 24. Pakalnis A, Drake MEJr, John K, Kellum JB - Forced normalization. Acute psychosis after seizure control in seven patients. Arch Neurol 44:289, 1987.

[25] 25. Pruthi N, Dhir A, Murthy RS - Rural community attitude to epilepsy. Neurol India 27:170, 1979.

[26] 26. Reynolds EH - Chronic antiepileptic toxicity: a review. Epilepsia 16:319, 1975.

[27] 27. Ribeiro MN - A doença psiquiátrica e a morte social. Arq Catar Med 17:49, 1988.

[28] 28. Richens A - Interactions with antiepileptic drugs. Drugs 13:266, 1977.

[29] 29. Rimmer E, Richens A - An update on sodium valproate. Pharmacotherapy 5:171, 1985.

[30] 30. Rivinus TM - Psychiatric effects of the anticonvulsant regimens. Psychopharmacol 2/3:165, 1982.

[31] 31. Sander JWAS, Shorvon SD - Prevalence and incidence studies in epilepsy and their methodological problems: a review. J Neurol Neurosurg Psychiat 50:829, 1987.

[32] 32. Sander JWAS, Trevisol-Bittencourt PC, Oxley J - Epilepsia como condição disabilitante. Arq Catar Med 15:13, 1986.

[33] 33. Sheppard LC, Ballinger BR, Fenton GW - Anticonvulsant medication in a mental handicap hospital: 1972-1982. Br J Psychiat 150:513, 1987.

[34] 34. Shervin I - Psychosis associated with epilepsy: significance of the laterality of the epileptogenic lesion. J Neurol Neurosurg Psychiat 44:83, 1981.

[35] 35. Shervin I, Peron-Magnan P, Bancaud J, Bonis A, Talairach J - Prevalence of psychosis in epilepsy as a function of the epileptogenic lesion. Arch Neurol 39:621, 1982.

[36] 36. Shorvon SD, Chadwick D, Galbraith AW, Reynolds EH - One drug for epilepsy. Br Med J 1:474, 1978.

[37] 37. Shukla GD, Srivastasa ON, Katiyar BC - Schizophrenia-like psychosis in epilepsy: a controlled study. Ind Clinician 44:496, 1980.

[38] 38. Sillanpaa M - Carbamazepine: pharmacology and clinical uses. Acta Neurol Scand 64:1, 1981.

[39] 39. Sorel L - Crises de breve durée a expression psychique. Rev Neuropsychiat Infant 18:531, 1970.

[40] 40. Stores G - Behavioural effects of antiepileptic drugs. Mod Med N Zealand 13:8, 1980.

[41] 41. Tancredi F - Hospital e assistência social para os epilépticos. Arq Assist Psicopat São Paulo 49:87, 1948.

[42] 42. Thompson PJ, Trimble MR - Anticonvulsant drugs and cognitive functions. Epilepsia 23:531, 1982.

[43] 43. Trevisol-Bittencourt PC - Dez razões para a criação de um centro catarinense de epilepsia. Arq Catar Med 17:175, 1988.

[44] 44. Trevisol-Bittencourt PC - Quando tratar crises únicas ou raras. Arq Catar Med 17:95, 1988.

[45] 45. Trevisol-Bittencourt PC, Sander JWAS - Poor compliance em epilepsia: algumas considerações. J Liga Brasil Epilep, (no prelo), 1989.

[46] 46. Trevisol-Bittencourt PC, Sander JWAS, Duncan J - O tratamento das crises epilépticas. Arq Catar Med 15:77, 1986.

[47] 47. Trimble MR - Psychiatric aspects of epilepsy. Psychiatr Dev 5:285, 1987.

[48] 48. Trimble MR, Reynolds EH - Anticonvulsant drugs and mental symptoms: a review. Psychol Med 6:169, 1976.

[49] 49. Whitman S, Coleman TE, Patmon C, Bindu TD, Cohen R, Lambert NK - Epilepsy in prison: elevated prevalence and no relationship to violence. Neurology 34:775, 1984.

[50] 50. Wieser H - Depth recorded limbic seizures and psychopathology. Neurosci Biobehav Rev 7:427, 1983.

[51] 51. Zanda G, Scatena PA, Torre S - Epilepsia e iungodegenza psichiatrica. Rass Studi Psichiatr 66:807, 1977.