Abstract
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.