ACKNOWLEDGMENT

APPROVAL SHEET
CONTENT

Contents
ACKNOWLEDGMENT.................................................................................................................3

ACRONYM/ABBREVIATION......................................................................................................7

ABSTRACT....................................................................................................................................8

CHAPTER ONE- INTRODUCTION.............................................................................................9

1.1 Background............................................................................................................................9

1.2 Statement of the problem.....................................................................................................10

1.3 Significant of the study........................................................................................................11

CHAPTER TWO- OBJECTIVE OF THE STUDY......................................................................12

2.1 General objective.................................................................................................................12

2.2 Specific objective.................................................................................................................12

CHAPTER THREE- LITRATURE REVIEW..............................................................................13

3.1 The prevalence of psychosis among epilepsy patients internationally................................13

3.2 Sociodemographic factors of among epilepsy patients.......................................................14

3.3 Clinical features among epilepsy patients...........................................................................15

CHAPTER FOUR- METHODS AND MATERIALS..................................................................16

4.1 Study Design and Period.....................................................................................................16

4.2 Study Area...........................................................................................................................16

4.3 Source and Study Population...............................................................................................16

4.3.1 Source Population.........................................................................................................16

4.3.2 Study Population...........................................................................................................16

4.3.3 Study Unit.....................................................................................................................16

4.4 Inclusion and Exclusion criteria..........................................................................................16

4.4.1 Inclusion Criteria..........................................................................................................16

 4.4.2 Exclusion Criteria.........................................................................................................16

4.5 Sample size Determination and Sampling Technique.........................................................16

4.5.1 Sample Size Determination..........................................................................................16

4.5.2 Sampling Technique.....................................................................................................16

4.6 Study Variables....................................................................................................................16

4.6.1 Dependent Variable......................................................................................................16

4.6.2 Independent Variable....................................................................................................16

4.7 Data collection Procedure....................................................................................................16

4.7.1 Data Collection.............................................................................................................16

4.7.2 Data Collection Instrument...........................................................................................16

4.8 Data Quality Control............................................................................................................16

4.8.1 Data processing and analysis........................................................................................17

4.8.2 Operational Definition..................................................................................................17

4.8.3 Ethical consideration....................................................................................................17

4.8.4 Plan for Dissemination of Result..................................................................................17

4.9 Limitation of the Study........................................................................................................17

CHAPTER FIVE- WORK PLAN.................................................................................................18

REFERENCES..............................................................................................................................20

ANNEXES.....................................................................................................................................21
LIST OF TABLES
ACRONYM/ABBREVIATION
ABSTRACT
CHAPTER ONE- INTRODUCTION

1.1 Background
1.2 Statement of the problem
1.3 Significant of the study
CHAPTER TWO- OBJECTIVE OF THE STUDY

2.1 General objective

2.2 Specific objective

CHAPTER THREE- LITRATURE REVIEW

3.1 The prevalence of psychosis among epilepsy patients internationally

A systematic review and meta analysis that was conducted among 58 literatures that were all
published concerning the prevalence of psychosis in patients that were diagnosed epileptic
patients established that, the odds ratio for risk of psychosis among people with epilepsy
compared with controls was 7.8, on the other hand the pooled estimate for the prevalence of
psychosis in epilepsy patients came out to be 5.6% (95% CI: 4.8-6.4)(Clancy et al., 2014)

A case control study that was conducted in Royal Melbourne Hospital, Australia on psychotic
disorders induced by antiepileptic drugs on people with epilepsy established that 3.7 % of the
study participants had psychotic manifestations. In addition to that the study also reported that
disorganized behaviors as well as hallucinations were the predominant manifestations ((Chen et
al., 2016)

A case control study that was conducted in London, United Kingdom on post ictal psychosis
among temporal lobe epilepsy indicated that 7% of the study participants had been found
manifesting psychotic symptoms.(Cleary et al., 2013)

According to a retrospective study that was conducted in Barcelona, Spain on psychosis on

epileptic patients established that among the 105 patients that were studied 9% of them had
developed psychosis. The predominant psychotic manifestations were visual hallucinations and
paranoid delusion. (Carren et al., 2009)

According to a case control study was conducted on risk factors of psychosis among epilepsy
patients in Ireland the prevalence of psychosis was found to be ranging from 4%-7% of the
people with epilepsy’. Furthermore the study indicated that the prevalence of psychosis among
epilepsy patients was 15 times higher than the 0.4% prevalence that is found in the general
population (Irwin et al., 2014)

A prospective study that was conducted on the interictal psychosis in comparison with
schizophrenia in Japan among 619 epileptic patients indicated that 322 (6.5%) of the epilepsy
patients experienced psychosis(Tadokoro, Oshima and Kanemoto, 2007)
A cohort study was undertaken on psychiatry Comorbidity among temporal lobe epilepsy
patients in Brazil which included 186 study participants and revealed that 7.5% of whom
developed interictal psychosis. Furthermore the study also reported that more than half of the
study participants experienced visual hallucinations following the seizure could also last for
weeks.(Guarnieri et al., 2009)

A population based study that was conducted on psychosis on people with epilepsy in USA
established that the prevalence of psychosis among temporal lobe epilepsy patients to be 6.77%.
In addition to that the study indicated that compared to the general population patients with
epilepsy are 9 times more vulnerable than the general population. Furthermore the study also
revealed that the patients with complex partial seizure tend to have acute onset than other types
of seizures.(Kanner, 2009)

Institution based study that was done on psychosis and seizure challenges in diagnosis and
treatment in USA established that the prevalence of psychosis among patients who are diagnosed
with epilepsy is 7%. What’s more is that the study also implicated that higher amounts of
patients with complex partial seizures (31%) had experienced more negative symptoms. In
addition to that hallucinations as well as delusion of paranoia tend to occur frequently.(Roy et
al., 2014)

A case control study was conducted in Netherlands in a 3 year epidemiological survey on

psychosis in epilepsy patients and other chronic medically ill patients and the role of cerebral
pathology in the onset of psychosis among 901 epilepsy patients and 1752 chronic medical
disorders and the study revealed that epilepsy patients who had experienced psychosis were 49
(5.4%). Furthermore the study also indicated that among the epilepsy patients who experienced
psychosis the predominant psychotic manifestation was delusion paranoid type followed by
visual hallucination. (Feltz-cornelis, Aldenkamp and Ade, 2008)

Institution based study that was undertaken in India on psychiatry comorbidity among patients of
complex partial seizure demonstrated that among 117 patients 46 had a psychiatric disorder, and
among these psychiatric comorbidities 1.7 % of them had experienced psychosis (Desai et al.,
2010)
On the basis of a cohort study that was undertaken on Neuropsychiatric Comorbidity in focal
epilepsy among 428 patients in Royal Melbourne Hospital Australia, psychiatric comorbidities
were diagnosed on 58% of the study participants. Among these psychiatric comorbidities 7.2%
of them had experienced psychosis. (Adams et al., 2008)

An observational study that was conducted in England on Interactions between seizure

frequency, psychopathology, and severity of intellectual disability in a population with epilepsy
among 175 patients 97 (55%) had developed psychiatry comorbidities. Amid these psychiatry
disorders 20 of them had experienced psychosis (11%) among the epileptic patients.(Ring et al.,
2007)

A retrospective study was undertaken in Austria on psychoses in epilepsy a comparison of

postictal and interictal psychoses on 1434 epilepsy patients to investigate the potential
association between the psychosis types. Moreover the study also stated that the prevalence of
psychosis among epilepsy patients was 5.9%. In addition to that the study indicated that 78.8 of
the epileptic patients who had experienced psychosis manifested delusion.(Hilger et al., 2016)

A cohort study was conducted in Norway on psychiatric comorbidity and use of psychotropic
drugs in 167 epilepsy patients for a year and the study established that 25.7% of them had
developed psychiatry disorder; consequently among these psychiatric disorder 1.2% of them had
experienced psychosis.(Oj and Ko, 2010)
3.2 Sociodemographic factors associated with psychosis among epilepsy patients
According to a case control study that was conducted on psychotic disorders induced by
antiepileptic drugs on people with epilepsy both inpatient and outpatient in Australia, female
gender and early age of onset epilepsy were significantly associated with the existence of
psychosis among epilepsy patients. Moreover 76.9% of the epilepsy patients who were
diagnosed with psychosis were female. Furthermore the study indicated the median age of onset
of epilepsy was found to be 18.5 years.(IQR 9-31) among those who had psychosis.(Chen et al.,
2016)

A cohort study that was conducted on interictal psychotic episode among epilepsy patients in
Japan among 155 patients reported that there is an association between early age of onset of
epilepsy and the experience of psychosis. 58% of those who had psychosis were diagnosed with
epilepsy between12-18 years of age. In addition to that the also indicated that the age of onset of
psychosis to be 30.9 years with SD 10.5. Furthermore the study also stated the interval between
onset of epilepsy and that of the IIP episode to be mean 18.3 years with SD 9.0. In addition to
that the study indicated that epilepsy patients who had developed psychosis at early age tend to
last longer duration with illness.(Adachi et al., 2012)
3.3 Clinical features among epilepsy patients
CHAPTER FOUR- METHODS AND MATERIALS

4.1 Study Design and Period

4.2 Study Area

4.3 Source and Study Population

4.3.1 Source Population

4.3.2 Study Population

4.3.3 Study Unit

4.4 Inclusion and Exclusion criteria

4.4.1 Inclusion Criteria

4.4.2 Exclusion Criteria

4.5 Sample size Determination and Sampling Technique

4.5.1 Sample Size Determination

4.5.2 Sampling Technique

4.6 Study Variables

4.6.1 Dependent Variable

4.6.2 Independent Variable

4.7 Data collection Procedure

4.7.1 Data Collection

4.7.2 Data Collection Instrument

4.8 Data Quality Control

4.8.1 Data processing and analysis

4.8.2 Operational Definition

4.8.3 Ethical consideration

4.8.4 Plan for Dissemination of Result

4.9 Limitation of the Study

CHAPTER FIVE- WORK PLAN
CHAPTER SIX- BUDGET BREAKDOWN
REFERENCES
Adachi, N. et al. (2012) ‘Interictal psychotic episodes in epilepsy : Duration and associated
clinical factors’, 53(6), pp. 1088–1094. doi: 10.1111/j.1528-1167.2012.03438.x.

Adams, S. J. et al. (2008) ‘Neuropsychiatric morbidity in focal epilepsy’, pp. 464–469. doi:
10.1192/bjp.bp.107.046664.

Carren, M. et al. (2009) ‘Postictal psychosis : A retrospective study in patients with refractory
temporal lobe epilepsy’, 18, pp. 145–149. doi: 10.1016/j.seizure.2008.08.009.

Chen, Z. et al. (2016) ‘Psychotic disorders induced by antiepileptic drugs in people with
epilepsy’, Brain, 139(10), pp. 2668–2678. doi: 10.1093/brain/aww196.

Clancy, M. J. et al. (2014) ‘The prevalence of psychosis in epilepsy ; a systematic review and
meta-analysis’.

Cleary, R. A. et al. (2013) ‘Postictal psychosis in temporal lobe epilepsy : Risk factors and
postsurgical outcome ?’, Epilepsy Research, 106(1–2), pp. 264–272. doi:
10.1016/j.eplepsyres.2013.03.015.

Desai, S. D. et al. (2010) ‘Epilepsy & Behavior Study of DSM-IV Axis I psychiatric disorders in
patients with refractory complex partial seizures using a short structured clinical interview’,
Epilepsy & Behavior, 19(3), pp. 301–305. doi: 10.1016/j.yebeh.2010.07.005.

Feltz-cornelis, C. M. Van Der, Aldenkamp, A. P. and Ade, H. J. (2008) ‘Psychosis in epilepsy

patients and other chronic medically ill patients and the role of cerebral pathology in the onset of
psychosis : A clinical epidemiological study’, 49, pp. 446–456. doi:
10.1016/j.seizure.2007.12.004.

Guarnieri, R. et al. (2009) ‘Epilepsy & Behavior Do psychiatric comorbidities predict

postoperative seizure outcome in temporal lobe epilepsy surgery ?’, Epilepsy and Behavior,
14(3), pp. 529–534. doi: 10.1016/j.yebeh.2009.01.002.

Hilger, E. et al. (2016) ‘Epilepsy & Behavior Psychoses in epilepsy : A comparison of postictal
and interictal psychoses’, Epilepsy & Behavior, 60, pp. 58–62. doi:
10.1016/j.yebeh.2016.04.005.
Irwin, L. G. et al. (2014) ‘Risk Factors for Psychosis Secondary to Temporal Lobe Epilepsy : A
Systematic Review’, pp. 5–23.

Kanner, A. M. (2009) ‘Epilepsy & Behavior Psychiatric issues in epilepsy : The complex relation
of mood , anxiety disorders , and epilepsy’, Epilepsy and Behavior, 15(1), pp. 83–87. doi:
10.1016/j.yebeh.2009.02.034.

Oj, H. and Ko, N. (2010) ‘Psychiatric comorbidity and use of psychotropic drugs in epilepsy
patients’, 122, pp. 18–22.

Ring, H. et al. (2007) ‘Interactions between seizure frequency , psychopathology , and severity
of intellectual disability in a population with epilepsy and a learning disability q’, 11, pp. 92–97.
doi: 10.1016/j.yebeh.2007.04.002.

Roy, K. et al. (2014) ‘Psychosis and Seizure Disorder : Challenges in Diagnosis and Treatment’.
doi: 10.1007/s11920-014-0509-1.

Tadokoro, Y., Oshima, T. and Kanemoto, K. (2007) ‘Interictal psychoses in comparison with
schizophrenia — A prospective study’, 48(12), pp. 2345–2351. doi: 10.1111/j.1528-
1167.2007.01230.x.

Adachi, N. et al. (2012) ‘Interictal psychotic episodes in epilepsy : Duration and associated
clinical factors’, 53(6), pp. 1088–1094. doi: 10.1111/j.1528-1167.2012.03438.x.

Adams, S. J. et al. (2008) ‘Neuropsychiatric morbidity in focal epilepsy’, pp. 464–469. doi:
10.1192/bjp.bp.107.046664.

Carren, M. et al. (2009) ‘Postictal psychosis : A retrospective study in patients with refractory
temporal lobe epilepsy’, 18, pp. 145–149. doi: 10.1016/j.seizure.2008.08.009.

Chen, Z. et al. (2016) ‘Psychotic disorders induced by antiepileptic drugs in people with
epilepsy’, Brain, 139(10), pp. 2668–2678. doi: 10.1093/brain/aww196.

Clancy, M. J. et al. (2014) ‘The prevalence of psychosis in epilepsy ; a systematic review and
meta-analysis’.

Cleary, R. A. et al. (2013) ‘Postictal psychosis in temporal lobe epilepsy : Risk factors and
postsurgical outcome ?’, Epilepsy Research, 106(1–2), pp. 264–272. doi:
10.1016/j.eplepsyres.2013.03.015.

Desai, S. D. et al. (2010) ‘Epilepsy & Behavior Study of DSM-IV Axis I psychiatric disorders in
patients with refractory complex partial seizures using a short structured clinical interview’,
Epilepsy & Behavior, 19(3), pp. 301–305. doi: 10.1016/j.yebeh.2010.07.005.

Feltz-cornelis, C. M. Van Der, Aldenkamp, A. P. and Ade, H. J. (2008) ‘Psychosis in epilepsy

patients and other chronic medically ill patients and the role of cerebral pathology in the onset of
psychosis : A clinical epidemiological study’, 49, pp. 446–456. doi:
10.1016/j.seizure.2007.12.004.

Guarnieri, R. et al. (2009) ‘Epilepsy & Behavior Do psychiatric comorbidities predict

postoperative seizure outcome in temporal lobe epilepsy surgery ?’, Epilepsy and Behavior,
14(3), pp. 529–534. doi: 10.1016/j.yebeh.2009.01.002.

Hilger, E. et al. (2016) ‘Epilepsy & Behavior Psychoses in epilepsy : A comparison of postictal
and interictal psychoses’, Epilepsy & Behavior, 60, pp. 58–62. doi:
10.1016/j.yebeh.2016.04.005.

Irwin, L. G. et al. (2014) ‘Risk Factors for Psychosis Secondary to Temporal Lobe Epilepsy : A
Systematic Review’, pp. 5–23.

Kanner, A. M. (2009) ‘Epilepsy & Behavior Psychiatric issues in epilepsy : The complex relation
of mood , anxiety disorders , and epilepsy’, Epilepsy and Behavior, 15(1), pp. 83–87. doi:
10.1016/j.yebeh.2009.02.034.

Oj, H. and Ko, N. (2010) ‘Psychiatric comorbidity and use of psychotropic drugs in epilepsy
patients’, 122, pp. 18–22.

Ring, H. et al. (2007) ‘Interactions between seizure frequency , psychopathology , and severity
of intellectual disability in a population with epilepsy and a learning disability q’, 11, pp. 92–97.
doi: 10.1016/j.yebeh.2007.04.002.

Roy, K. et al. (2014) ‘Psychosis and Seizure Disorder : Challenges in Diagnosis and Treatment’.
doi: 10.1007/s11920-014-0509-1.
Tadokoro, Y., Oshima, T. and Kanemoto, K. (2007) ‘Interictal psychoses in comparison with
schizophrenia — A prospective study’, 48(12), pp. 2345–2351. doi: 10.1111/j.1528-
1167.2007.01230.x.

Adachi, N. et al. (2012) ‘Interictal psychotic episodes in epilepsy : Duration and associated
clinical factors’, 53(6), pp. 1088–1094. doi: 10.1111/j.1528-1167.2012.03438.x.

Adams, S. J. et al. (2008) ‘Neuropsychiatric morbidity in focal epilepsy’, pp. 464–469. doi:
10.1192/bjp.bp.107.046664.

Carren, M. et al. (2009) ‘Postictal psychosis : A retrospective study in patients with refractory
temporal lobe epilepsy’, 18, pp. 145–149. doi: 10.1016/j.seizure.2008.08.009.

Chen, Z. et al. (2016) ‘Psychotic disorders induced by antiepileptic drugs in people with
epilepsy’, Brain, 139(10), pp. 2668–2678. doi: 10.1093/brain/aww196.

Clancy, M. J. et al. (2014) ‘The prevalence of psychosis in epilepsy ; a systematic review and
meta-analysis’.

Cleary, R. A. et al. (2013) ‘Postictal psychosis in temporal lobe epilepsy : Risk factors and
postsurgical outcome ?’, Epilepsy Research, 106(1–2), pp. 264–272. doi:
10.1016/j.eplepsyres.2013.03.015.

Desai, S. D. et al. (2010) ‘Epilepsy & Behavior Study of DSM-IV Axis I psychiatric disorders in
patients with refractory complex partial seizures using a short structured clinical interview’,
Epilepsy & Behavior, 19(3), pp. 301–305. doi: 10.1016/j.yebeh.2010.07.005.

Feltz-cornelis, C. M. Van Der, Aldenkamp, A. P. and Ade, H. J. (2008) ‘Psychosis in epilepsy

patients and other chronic medically ill patients and the role of cerebral pathology in the onset of
psychosis : A clinical epidemiological study’, 49, pp. 446–456. doi:
10.1016/j.seizure.2007.12.004.

Guarnieri, R. et al. (2009) ‘Epilepsy & Behavior Do psychiatric comorbidities predict

postoperative seizure outcome in temporal lobe epilepsy surgery ?’, Epilepsy and Behavior,
14(3), pp. 529–534. doi: 10.1016/j.yebeh.2009.01.002.
Hilger, E. et al. (2016) ‘Epilepsy & Behavior Psychoses in epilepsy : A comparison of postictal
and interictal psychoses’, Epilepsy & Behavior, 60, pp. 58–62. doi:
10.1016/j.yebeh.2016.04.005.

Irwin, L. G. et al. (2014) ‘Risk Factors for Psychosis Secondary to Temporal Lobe Epilepsy : A
Systematic Review’, pp. 5–23.

Kanner, A. M. (2009) ‘Epilepsy & Behavior Psychiatric issues in epilepsy : The complex relation
of mood , anxiety disorders , and epilepsy’, Epilepsy and Behavior, 15(1), pp. 83–87. doi:
10.1016/j.yebeh.2009.02.034.

Oj, H. and Ko, N. (2010) ‘Psychiatric comorbidity and use of psychotropic drugs in epilepsy
patients’, 122, pp. 18–22.

Ring, H. et al. (2007) ‘Interactions between seizure frequency , psychopathology , and severity
of intellectual disability in a population with epilepsy and a learning disability q’, 11, pp. 92–97.
doi: 10.1016/j.yebeh.2007.04.002.

Roy, K. et al. (2014) ‘Psychosis and Seizure Disorder : Challenges in Diagnosis and Treatment’.
doi: 10.1007/s11920-014-0509-1.

Tadokoro, Y., Oshima, T. and Kanemoto, K. (2007) ‘Interictal psychoses in comparison with
schizophrenia — A prospective study’, 48(12), pp. 2345–2351. doi: 10.1111/j.1528-
1167.2007.01230.x.

Adachi, N. et al. (2012) ‘Interictal psychotic episodes in epilepsy : Duration and associated
clinical factors’, 53(6), pp. 1088–1094. doi: 10.1111/j.1528-1167.2012.03438.x.

Adams, S. J. et al. (2008) ‘Neuropsychiatric morbidity in focal epilepsy’, pp. 464–469. doi:
10.1192/bjp.bp.107.046664.

Carren, M. et al. (2009) ‘Postictal psychosis : A retrospective study in patients with refractory
temporal lobe epilepsy’, 18, pp. 145–149. doi: 10.1016/j.seizure.2008.08.009.

Chen, Z. et al. (2016) ‘Psychotic disorders induced by antiepileptic drugs in people with
epilepsy’, Brain, 139(10), pp. 2668–2678. doi: 10.1093/brain/aww196.
Clancy, M. J. et al. (2014) ‘The prevalence of psychosis in epilepsy ; a systematic review and
meta-analysis’.

Cleary, R. A. et al. (2013) ‘Postictal psychosis in temporal lobe epilepsy : Risk factors and
postsurgical outcome ?’, Epilepsy Research, 106(1–2), pp. 264–272. doi:
10.1016/j.eplepsyres.2013.03.015.

Desai, S. D. et al. (2010) ‘Epilepsy & Behavior Study of DSM-IV Axis I psychiatric disorders in
patients with refractory complex partial seizures using a short structured clinical interview’,
Epilepsy & Behavior, 19(3), pp. 301–305. doi: 10.1016/j.yebeh.2010.07.005.

Feltz-cornelis, C. M. Van Der, Aldenkamp, A. P. and Ade, H. J. (2008) ‘Psychosis in epilepsy

patients and other chronic medically ill patients and the role of cerebral pathology in the onset of
psychosis : A clinical epidemiological study’, 49, pp. 446–456. doi:
10.1016/j.seizure.2007.12.004.

Guarnieri, R. et al. (2009) ‘Epilepsy & Behavior Do psychiatric comorbidities predict

postoperative seizure outcome in temporal lobe epilepsy surgery ?’, Epilepsy and Behavior,
14(3), pp. 529–534. doi: 10.1016/j.yebeh.2009.01.002.

Hilger, E. et al. (2016) ‘Epilepsy & Behavior Psychoses in epilepsy : A comparison of postictal
and interictal psychoses’, Epilepsy & Behavior, 60, pp. 58–62. doi:
10.1016/j.yebeh.2016.04.005.

Irwin, L. G. et al. (2014) ‘Risk Factors for Psychosis Secondary to Temporal Lobe Epilepsy : A
Systematic Review’, pp. 5–23.

Kanner, A. M. (2009) ‘Epilepsy & Behavior Psychiatric issues in epilepsy : The complex relation
of mood , anxiety disorders , and epilepsy’, Epilepsy and Behavior, 15(1), pp. 83–87. doi:
10.1016/j.yebeh.2009.02.034.

Oj, H. and Ko, N. (2010) ‘Psychiatric comorbidity and use of psychotropic drugs in epilepsy
patients’, 122, pp. 18–22.

Ring, H. et al. (2007) ‘Interactions between seizure frequency , psychopathology , and severity
of intellectual disability in a population with epilepsy and a learning disability q’, 11, pp. 92–97.
doi: 10.1016/j.yebeh.2007.04.002.

Roy, K. et al. (2014) ‘Psychosis and Seizure Disorder : Challenges in Diagnosis and Treatment’.
doi: 10.1007/s11920-014-0509-1.

Tadokoro, Y., Oshima, T. and Kanemoto, K. (2007) ‘Interictal psychoses in comparison with
schizophrenia — A prospective study’, 48(12), pp. 2345–2351. doi: 10.1111/j.1528-
1167.2007.01230.x.
ANNEXES