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March 1987

Forced Normalization: Acute Psychosis After Seizure Control in Seven Patients

Author Affiliations

From the Department of Neurology, The Ohio State University College of Medicine, Columbus.

Arch Neurol. 1987;44(3):289-292. doi:10.1001/archneur.1987.00520150039018

• An antagonistic relationship between psychosis and seizures has been described in some patients and is sometimes termed "forced normalization." We saw seven epileptic patients without a previous psychiatric history, who developed acute psychotic states on establishment of seizure control and normalization of previously abnormal electroencephalograms with frank epileptiform activity. A possible hypothetical relationship between psychosis and epilepsy regarding the mesolimbic dopaminergic system and kindling of this system with epileptic discharge in temporal-limbic circuits could induce a florid psychotic state in some patients. This biochemical relationship to schizophrenia with heightened dopamine activity would also easily explain the amelioration of acute psychotic activity in our seven patients with neuroleptic agents and their antagonism of this increased dopaminergic outflow state.

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