M.A. / Himmehoch (1984, 1987) in discussion of major mood disorders related to epilepsy, describes an affective condition termed subictal mood disorder. Patients with subictal mood disorder are divided into manic-depressive and dysthymic subtypes, the former resembling an atypical, usually rapid-cycling bipolar mood disorder. The latter dysthymic group, are characterised by a baseline dysthymia, severe recurrent depressive episodes, and transient euphorias. In addition, these dysthymic patients are described as being especially prone to impulsive suicide attempts, extreme irritability, rage outbursts and deliberate self-harm. Himmelhoch (1984, 1987) postulates temporolimbic dysfunction with both ictal and subictal (subclinical) changes as the underlying aetiology. Temporolimbic phenomena such as anamnesic, dissociative and perceptive distortions are important aspects of neuropsychiatric phenomenology. Clinical evidence, however, suggests that these occurrences are not routinely sought for or uncovered during the clinical evaluation of patients and their relevance for atypical affective presentations not clearly understood. The aim of this clinical survey was to evaluate the presence and nature of both temporolimbic dysfunction and subictal mood disorder among a subpopulation of private psychiatric patients. Furthermore in order to explicate a possible association between the above, the electroencephalographic records of these patients were examined. Records of 761 patients who attended a private practice over a two-year period were retrospectively reviewed. 546 patients had been questioned in sufficient detail and were deemed reliable in their responses. Of the 546 patients reviewed 128 (23,4%) were found to have experienced significant temporolimbic phenomena. The most common features were dissociative states, deja vu, premonitions, jamais vu and tactile hallucinations. 150 (27,5%) patients met Himmelhoch's criteria for the presence of subictal mood disorder. Of those 150, 100 (66,7%) demonstrated significant temporolimbic phenomena. EEG results, with the exclusion of 16 patients (the appropriate records not being available), highlighted 64 iY (76,2%) ofthe probands as having met the criteria for significant temporolimbic phenomena and subictal mood disorder and demonstrating unequivocal abnormality onEEG. Taking into account the sample bias of this particular private practice, and the obvious flaws of a retrospective, naturalistic survey of this nature, the concept of sub ictal mood disorder is discussed. Case vignettes are used to illustrate the phenomenological presentation ofthese patients and the potential benefits of the addition of anticonvulsants in their management.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uj/uj:1778 |
| Date | 06 December 2011 |
| Creators | Hartman, Lee-Ann Betty |
| Source Sets | South African National ETD Portal |
| Detected Language | English |
| Type | Thesis |
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