HOW TO TREAT EPILEPTIC 2025

HOW TO TREAT EPILEPTIC 2025

GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF COMMON MENTAL DISORDERS

(Enacted under Decision No. 2058/QĐ-BYT dated May 14, 2020, by the Minister of Health)

Article 35

EPILEPTIC

CHIEF EDITOR

Associate Professor, PhD Nguyễn Trường Sơn

CO-EDITOR

Associate Professor, PhD Lương Ngọc Khuê

PhD Nguyễn Doãn Phương

CONTRIBUTING AUTHORS

PhD Trần Thị Hà An

MSc Trịnh Thị Vân Anh

PhD Vũ Thy Cầm

MSc Trần Mạnh Cường

PhD Nguyễn Văn Dũng

PhD Vương Ánh Dương

PhD Lê Thị Thu Hà

MSc Trần Thị Thu Hà

MSc Phạm Công Huân

MSc Đoàn Thị Huệ

Specialist Doctor II Nguyễn Thị Minh Hương

MSc Vũ Thị Lan

1. Nguyễn Phương Linh

Specialist Doctor II Nguyễn Thị Phương Loan

MSc Bùi Văn Lợi

MSc Nguyễn Thị Phương Mai

PhD Trần Nguyễn Ngọc

MSc Bùi Nguyễn Hồng Bảo Ngọc

MSc Trương Lê Vân Ngọc

MSc Bùi Văn San

PhD Dương Minh Tâm

MSc Phạm Xuân Thắng

MSc Lê Thị Phương Thảo

MSc Lê Công Thiện

MSc Vương Đình Thủy

Associate Professor, PhD Nguyễn Văn Tuấn

Specialist Doctor II Ngô Văn Tuất

MSc Đặng Thanh Tùng

MSc Vũ Sơn Tùng

MSc Cao Thị Ánh Tuyết

MSc Nguyễn Thị Ái Vân

Specialist Doctor II Hồ Thu Yến

MSc Nguyễn Hoàng Yến

CONTRIBUTORS TO EVALUATION AND FEEDBACK

Associate Professor, PhD Nguyễn Thanh Bình

PhD Vũ Thy Cầm

PhD Nguyễn Hữu Chiến

Specialist Doctor II Võ Thành Đông

PhD Lê Thị Thu Hà

Specialist Doctor II Đỗ Huy Hùng

PhD Nguyễn Mạnh Hùng

MSc Nguyễn Trọng Khoa

Specialist Doctor II Ngô Hùng Lâm

Associate Professor, PhD Phạm Văn Mạnh

Specialist Doctor II Trần Ngọc Nhân

PhD Dương Minh Tâm

MSc Đặng Duy Thanh

PhD Vương Văn Tịnh

Specialist Doctor II Lâm Tứ Trung

PhD Lại Đức Trường

PhD Cao Văn Tuân

Associate Professor, PhD Nguyễn Văn Tuấn

SECRETARIAT TEAM

MSc Đặng Thanh Tùng

MSc Trương Lê Vân Ngọc

BA Đỗ Thị Thư

Article 35

EPILEPTIC

I. DEFINITION  

– An epileptic seizure is a clinical manifestation resulting from abnormal, paroxysmal, and excessive neuronal discharges in the brain. Clinically, it presents as sudden, transient symptoms related to the affected cortical region, including alterations in consciousness, motor function, sensation, autonomic function, or psychiatric symptoms.  

– Epilepsy is defined as the recurrence of two or more unprovoked seizures separated by more than 24 hours, not attributable to high fever or acute causes such as metabolic disturbances, abrupt cessation of medications, or alcohol withdrawal.  

II. ETIOLOGY  

Seizures may arise from organic brain lesions or metabolic disturbances, including traumatic brain injury, brain tumors, cerebrovascular disease, intracranial infections (e.g., brain abscess, encephalitis, meningitis), and genetic factors.  

Causes of epilepsy vary by age group:  

– Neonates: Perinatal asphyxia, birth trauma, intracranial hemorrhage, central nervous system (CNS) infections, or other infections and metabolic disorders.  

– Children: Idiopathic epilepsy, cerebral palsy, CNS infections (e.g., encephalitis, meningitis), structural intracranial lesions, metabolic diseases, intoxications (e.g., medications, lead), neurodegenerative disorders, systemic diseases, genetic conditions, trauma.  

– Adults: Idiopathic epilepsy, traumatic brain injury, cerebrovascular disease, CNS infections, neurodegenerative disorders, systemic diseases.  

– Elderly (over 60 years): Brain tumors, brain metastases, cerebral atherosclerosis, brain atrophy; acute cerebral ischemia requires particular attention.  

III. DIAGNOSIS  

1. Definitive Diagnosis  

Diagnosis relies on clinical features combined with electroencephalogram (EEG) changes. “Epilepsy is not diagnosed if clinical seizures are absent.”  

1.1. Classification of Seizures (International League Against Epilepsy [ILAE], 1981)  

1. Partial (Focal) Seizures  

– Simple Partial Seizures (without impaired consciousness):  

+ Motor symptoms: Focal motor, Jacksonian march, eye/head deviation.  

+ Sensory or special sensory symptoms: Somatosensory disturbances, visual hallucinations, olfactory hallucinations, vertigo.  

+ Autonomic signs or symptoms.  

+ Psychiatric symptoms: Disorders of higher cognitive function, rarely with altered consciousness; memory or emotional disturbances.  

– Complex Partial Seizures (with impaired consciousness):  

+ Simple partial onset followed by complex partial features.  

+ Onset with impaired consciousness, often with automatisms.  

– Partial Seizures with Secondary Generalization:  

+ Simple partial progressing to secondary generalization.  

+ Complex partial progressing to secondary generalization.  

+ Simple partial progressing to complex partial, then secondary generalization.  

1. Generalized Seizures  

– Absence Seizures:  

+ Typical Absence:  

  + Pure impairment of consciousness.  

  + With myoclonic jerks.  

  + With loss of tone.  

  + With hypertonia.  

  + With automatisms.  

  + With autonomic features.  

+ Atypical Absence:  

  + More pronounced tone changes than typical absence.  

  + Less abrupt onset and/or cessation.  

– Generalized Tonic-Clonic Seizures:  

+ Myoclonic seizures.  

+ Clonic seizures.  

+ Tonic seizures.  

+ Tonic-clonic seizures.  

+ Atonic seizures.  

+ Unclassified seizures.  

+ Status epilepticus.  

1. Unclassified Seizures  
2. Status Epilepticus  

1.2. Classification of Epilepsy and Epileptic Syndromes (ILAE, 1989)  

1. Focal Epilepsy and Syndromes  

– Idiopathic:  

+ Benign childhood epilepsy with centrotemporal spikes.  

+ Childhood epilepsy with occipital paroxysms.  

+ Primary reading epilepsy.  

– Symptomatic:  

+ Chronic progressive epilepsia partialis continua of childhood.  

+ Syndromes with seizures triggered by specific stimuli.  

+ Temporal lobe epilepsy.  

+ Frontal lobe epilepsy.  

+ Occipital lobe epilepsy.  

+ Parietal lobe epilepsy.  

+ Cryptogenic causes.  

1. Generalized Epilepsy and Syndromes  

– Idiopathic (age-related onset):  

+ Benign familial neonatal seizures.  

+ Benign neonatal myoclonic seizures.  

+ Benign myoclonic epilepsy of infancy.  

+ Childhood absence epilepsy.  

+ Juvenile absence epilepsy.  

+ Juvenile myoclonic epilepsy.  

+ Epilepsy with grand mal seizures on awakening.  

+ Other idiopathic generalized epilepsies (not listed above).  

+ Epilepsy with seizures provoked by specific stimuli (e.g., photosensitive epilepsy).  

– Cryptogenic and/or Symptomatic:  

+ West syndrome (infantile spasms).  

+ Lennox-Gastaut syndrome.  

+ Epilepsy with myoclonic-astatic seizures.  

+ Epilepsy with myoclonic absences.  

– Symptomatic (non-specific etiology):  

+ Early myoclonic encephalopathy.  

+ Early infantile epileptic encephalopathy.  

+ Other symptomatic generalized epilepsies (not listed above).  

1. Epilepsies and Syndromes Undetermined as Focal or Generalized:  

– With Both Generalized and Focal Seizures:  

+ Neonatal seizures.  

+ Severe myoclonic epilepsy of infancy.  

+ Epilepsy with continuous spike-and-wave during sleep.  

+ Acquired epileptic aphasia (Landau-Kleffner syndrome).  

+ Other epilepsies not clearly focal or generalized (not listed above).  

– Without Clear Focal or Generalized Features:  

+ Seizures tied to a specific state.  

+ Febrile seizures.  

+ Isolated seizures in acute metabolic disturbances.  

+ Single seizures or isolated status epilepticus.  

1.3. Classification of Epilepsy (ICD-10, 1992)  

– G40: Epilepsy.  

– G40.0: Idiopathic focal epilepsy.  

– G40.1: Symptomatic focal epilepsy with simple partial seizures.  

– G40.2: Symptomatic focal epilepsy with complex partial seizures.  

– G40.3: Idiopathic generalized epilepsy.  

– G40.4: Other generalized epilepsy.  

– G40.5: Special epileptic syndromes.  

– G40.6: Unspecified grand mal seizures.  

– G40.7: Unspecified petit mal seizures.  

– G40.8: Other epilepsy.  

– G40.9: Unspecified epilepsy.  

– G41: Status epilepticus.  

2. Ancillary Testing  
3. Electroencephalogram (EEG):  

– A specific tool to confirm seizures, seizure type, and epileptogenic focus location. EEG can be recorded during or between seizures. Depending on the condition, standard EEG, 24-hour continuous EEG, or video EEG may be used.  

1. Laboratory, Imaging, and Functional Tests:  

– In some cases, brain CT, MRI, or other imaging to identify etiology and monitor treatment.  

– Cerebral blood flow studies, ECG, neuropsychological testing.  

– Basic tests: Hematology, liver and kidney function biochemistries.  

3. Differential Diagnosis  

– Hysterical (Dissociative) Seizures: Psychogenic origin; patients exhibit thrashing or arching without loss of consciousness, prolonged and non-stereotyped seizures, normal neurological exam, and no EEG abnormalities.  

– Syncope: Brief loss of consciousness without neurological symptoms, often cardiovascular in origin (e.g., arrhythmia [<15 beats/min or asystole for 1-2 minutes], complete AV block, carotid sinus or vagal hypersensitivity, orthostatic hypotension). EEG is normal.  

– Tetany (Hypocalcemia): Common in neonates/children; focal or generalized muscle contractions, notably “obstetric hand” posture, positive Chvostek sign, and carpal spasm with arm tourniquet (10-15 minutes). Blood tests show low calcium; EEG lacks epileptiform waves.  

– Hypoglycemic Seizures: Occur during fasting; diagnosed by blood glucose measurement.  

– Migraine Attacks, Febrile Seizures in Children: Additional considerations.  

IV. TREATMENT  

1. Treatment Principles  

– Etiological Treatment: Address underlying causes when possible (e.g., brain tumors, hematomas, vascular malformations).  

– Symptomatic Treatment:  

+ Antiepileptic drugs (AEDs) are initiated only after confirming seizure type and syndrome.  

+ Select specific AEDs prioritized by seizure type, starting with monotherapy at a low dose, gradually increasing to an effective dose (seizure control), then maintaining daily. If maximal dose fails, switch drugs by tapering the old drug while titrating the new one, avoiding abrupt cessation.  

+ If monotherapy fails, use polytherapy (typically 2 drugs, rarely 3). If 3 drugs fail, consider drug-resistant epilepsy, reassess diagnosis, drug choice, or patient adherence.  

+ Monitor clinical progress and side effects, adjusting doses accordingly. Avoid combining drugs of the same class (e.g., phenobarbital with primidone).  

+ Schedule periodic evaluations: EEG, blood tests, liver/kidney function.  

+ Tailor diet, activity, work, rest, and recreation to the patient’s condition.  

2. Treatment Framework  

2.1. Pharmacotherapy  

Select 1-3 drugs from the following:  

Classic Antiepileptic Drugs:  

Newer Antiepileptic Drugs:  

– Additional AEDs under investigation: Logisamon, remacemide, pregabalin.  

– Treat co-occurring psychiatric disorders and comorbidities.  

– Hepatic support: Aminoleban, silymarin, boganic.  

– Cognitive enhancers, nutritional support: Vitamins, trace elements, balanced diet, IV nutrition as needed.  

2.2. Surgical Treatment  

– Indications:  

+ Drug-resistant epilepsy.  

+ Focal epilepsy with small, localized foci.  

+ Focal seizures with secondary generalization.  

2.3. Considerations for Pregnant and Breastfeeding Women  

– AEDs may cause fetal malformations and are excreted in breast milk, requiring cautious use in pregnant or breastfeeding women.  

V. PROGNOSIS AND COMPLICATIONS  

Epilepsy is a chronic condition, but with proper diagnosis and treatment, prognosis is favorable:  

– Approximately 60% of patients achieve seizure freedom with initial treatment; 40% experience persistent seizures, necessitating alternative approaches.  

– Drug discontinuation may be considered after 2.5-5 years of seizure freedom from the last event. Some patients relapse upon cessation, requiring lifelong treatment.  

– Complications include occupational or daily life accidents during seizures, impaired consciousness, and loss of purposeful movements. Prolonged seizures may cause brain damage, hypoxia, airway obstruction, and psychological issues such as inferiority or stigma.  

VI. PREVENTION  

No specific preventive measures exist.  

– Pregnant women should attend regular prenatal care to prevent birth-related brain injuries in neonates.  

– Vaccinations (e.g., Japanese encephalitis B) reduce brain-damaging infections.  

– Patients must adhere to treatment and avoid abrupt discontinuation to prevent recurrence.

REFERENCES

Vietnamese

1. Department of Psychiatry, Hanoi Medical University (2016), Lectures on Psychiatry. Medical Publishing House.  
2. Department of Psychiatry, Hanoi Medical University (2000), Organic Mental Disorders. Postgraduate Lecture Series.  
3. Department of Psychiatry & Medical Psychology, Military Medical Academy (2007), Psychiatry and Psychology. People’s Army Publishing House.  
4. Military Medical Academy (2016), Textbook of Psychiatric Disorders. People’s Army Publishing House, Hanoi.  
5. World Health Organization (1992), The International Classification of Diseases, 10th Revision (ICD-10): Mental and Behavioral Disorders. WHO, Geneva, 1992.  
6. World Health Organization (1992),ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research (translated by the Department of Psychiatry, Hanoi Medical University).  
7. David A., et al. (2010), Geriatric Psychiatry, Medical Publishing House, 2014. Translated by Nguyễn Kim Việt.  
8. Eduard V. (2009), Bipolar Disorder in Clinical Practice, Medical Publishing House, Hanoi.  
9. Kaplan & Sadock (2013), Pervasive Developmental Disorders, Synopsis of Child and Adolescent Psychiatry, Translated book, Medical Publishing House.  
10. Trần Hữu Bình (2016), Textbook of Psychiatric Disorders: Depressive Phase,Medical Publishing House, Hanoi.  
11. Lê Quang Cường (2005), Epilepsy, Medical Publishing House.  
12. Cao Tiến Đức (2017), Epilepsy: Mental Disorders in Epilepsy and Treatment, Medical Publishing House, pp. 9-15.  
13. Trần Viết Nghị (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use, Department of Psychiatry, Hanoi Medical University.  
14. Trần Viết Nghị, Nguyễn Minh Tuấn (1995), Treatment of Drug Addiction with Psychotropic Medications, Proceedings of the Scientific Conference on Drug Addiction Treatment Methods, Ministry of Health, Institute of Mental Health.  
15. Nguyễn Viết Thiêm (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use, Department of Psychiatry, Hanoi Medical University, pp. 103-111.  
16. Nguyễn Minh Tuấn (2016), Textbook of Psychiatric Disorders, Medical Publishing House.  
17. Nguyễn Minh Tuấn (2004), Heroin Addiction: Treatment Methods, Medical Publishing House.  
18. Nguyễn Minh Tuấn (2004), Diagnosis and Treatment of Dependence (Addiction), Medical Publishing House.  
19. Nguyễn Kim Việt (2016), Textbook of Psychiatric Disorders, Medical Publishing House, Hanoi.  
20. Nguyễn Kim Việt (2000), Mental and Behavioral Disorders Due to Psychoactive Substance Use,Department of Psychiatry, Hanoi Medical University.  
21. Nguyễn Kim Việt (2000), Organic Mental Disorders, Department of Psychiatry, Hanoi Medical University.  
22. Nguyễn Kim Việt, Nguyễn Văn Tuấn (2016), Textbook of Psychiatric Disorders, Department of Psychiatry, Hanoi Medical University, Medical Publishing House, pp. 74-79.

English

1. The British Association for Psychopharmacology (2011). Evidence-based guidelines for the pharmacological treatment of schizophrenia: recommendations from the British Association for Psychopharmacology. J Psychopharmacol (Oxf), 25(5), 567–620.
2. The National Institute for Health and Care Excellence (NICE) (2014). Psychosis and schizophrenia in adults: prevention and management. NICE guideline. CG178, 5-46.
3. The National Institute for Health and Care Excellence (2014). Bipolar disorder: the assessment and management of bipolar disorder in adults,children and young people in primary and secondary care. September 2014.
4. The National Institute for Health & Care Excellence – NICE (2010). The Treatmentand Management of Depression in Adults (updated edition). National Clinical Practice Guideline 90, 2010.
5. NICE(2012), “Epilepsies: diagnosis and management ”, NICE 
6. Abdul S. K., Manjula M, Paulomi M. S., et al (2013), “Cognitive Behavior Therapy for Patients with Schizotypal Disorder in an Indian Setting: A Retrospective Review of Clinical Data”, the German Journal of Psychiatry, pp 1-7.
7. Addington D., Abidi S., Garcia-Ortega I., et al. (2017). Canadian Guidelines for the Assessment and Diagnosis of Patients with Schizophrenia Spectrum and Other Psychotic Disorders. Can J Psychiatry, 62(9), 594–603.
8. American Psychiatric Association (1994), “Amphetamine-type stimulants” Diagnostic and Statistical Manual of Mental Disorders”, Fourth Edition, DSM-Washington, DC
9. American Psychiatric Association (2013). Alcohol-Related Disorders, Diagnostic and statistical manual of mental disorders DSM-5, American Psychiatric Publishing, 490-503.
10. AmericanPsychiatric Association (2013). Opioid  Diagnostic and statistical manual of mental disorders DSM-5, American Psychiatric.
11. AmericanPsychiatric Association (2013). Diagnostic and statistical manual of mental disorders DSM-IV.
12. Apurv K., Pinki D., Abdul K. (1997), “Treatment of acute and transient psychoticdisorders with low and high doses of oral haloperidol”, Indian Journal of Psychiatry, pp 2-8
13. American psychiatric association (2010). Practice guideline for the Treatment of Patients With Schizophrenia, Second Edition. 184.
14. Andreas M. (2012), “Schizoaffective Disorder”, Korean J Schizophr Res, pp 5-12.
15. American Psychiatric Association (1994). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
16. Babalonis S, Haney M, Malcolm R.J, et al (2017). Oral cannabidiol does not produce a signal for abuse liability in frequent marijuana smokers. DrugAlcohol Depend. 172, 9-13.
17. Benjamin J. S, Virginia A. S, Pedro R (2017). Substance-Related Disorders, Kapland & Sadock’s Comprehensive Textbook of Psychiatry, Lippincott Williams & Wilkins, Baltimore, Vol. 1.
18. Benjamin J. S., Virginia A. S. (2007), “Substance-Related Disorders- Amphetamine (or Amphetamine-like) Behavioral Sciences/Clinical Psychiatry ”, Kaplan & Sadock’s Synopsis of Psychiatry 10th Edition, Lippincott Williams & Wilkins (2007)
19. Bergamaschi M.M, Queiroz R.H.C, Zuardi A.W., et al (2011). Safety and side effects of cannabidiol, a Cannabis sativa constituent. Curr Drug Saf. 6(4), 237-249.
20. Benzoni O., Fàzzari G., Marangoni C., Placentino A., Rossi A. (2015), “Treatment of resistant mood and schizoaffective disorders with electroconvulsive therapy: a case series of 264 patients”, Journal of Psychopathology, pp 266-268.
21. Daniel R. R., Larry J. S., et al (2014), “Schizotypal personality disorders: a current review”, New York, pp 1-10.
22. Dervaux A.M. (2010). Influence de la consommation de substances sur l’émergence et l’évolution des troubles psychotiques: le cas du cannabis. La these doctotraie, Universit ´e Pierre et Marie Curie – Paris VI, Paris, France.
23. Dieter S., Steven C. S. (2014). “Drug treatment of epilepsy in adults ”, BMJ, p2-19.
24. Early Psychosis Guidelines Writing Group (2010). Australian clinical guidelines for earlypsychosis 2nd  Natl Cent Excell Youth Ment Health Melb, 2, 4–24.
25. Elisa C., Amir H. C., Peter B. (2009), “Treatment of Schizoaffective Disorder”, Psychiatry (Edgemont),p 15-17.
26. Felix-Martin W., Rafael C., (2016), “Current Treatment of Schizoaffective Disorder According to a Neural Network”, Neural Network. J Cytol Histol, pp 2-5
27. Gary R., Donald A., Wiliam H., et al (2017), “Guideline for the pharmacotherapy of schizophrenia in adul”, The canadian journal of schiatry,pp 605-612.
28. Galletly C., Castle D., Dark F., et al. (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for themanagement of schizophrenia and related disorders. Aust N Z J Psychiatry, 50(5), 410–472.
29. Gautam S., Jain A., Gautam M., Vahia V. N., et al (2017). Clinical Practice Guidelines for the management of Depression. Indian J Psychiatry;59, Suppl
30. Grunze H., et al. (2009). The World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Biological Treatment of Bipolar
31. Hasan A., Falkai P., Wobrock T., et al. (2012). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia, Part 1: Update 2012 on the acute treatment of schizophrenia and the management of treatment resistance. World J Biol Psychiatry, 13(5), 318–
32. Hasan A., Falkai P., Wobrock T., et al. (2013). World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for Biological Treatment of Schizophrenia,Part 2: Update 2012 on the long-term treatment of schizophrenia and management of antipsychotic-induced side  World J Biol Psychiatry, 14(1), 2–44.
33. JakobsenD., Skyum E., Hashemi N., et al. (2017). Antipsychotic treatment of schizotypy and schizotypal personality disorder: a systematic review. J Psychopharmacol (Oxf), 31(4), 397–405.
34. Jinsoo C., Theo C. M. (2017), “Current Treatments for Delusional Disorder”, Psychiatry, pp 5-20
35. Jonathan K. B., Saeed F. (2012), “Acute and transient psychotic disorders: An overview of studies in Asia”, International Review of Psychiatry, pp 463-466
36. Jochim, J., Rifkin-Zybutz, R., Geddes, J., et al (2019).Valproate for acute mania. Cochrane Database of Systematic Reviews.
37. Kaplan& Sadock’s. Pocket Handbook of Psychiatric Drug Treatment
38. Kennedy S. H., Lam R. W., McIntyre R. S., et al (2016). Canadian Network forMood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder. The Canadian Journal of Psychiatry, 61(9), 540–560.
39. Krishna R.P., Jessica C., et al(2014), “Schizophrenia: overview and treatment options”, New York, pp 638-643.
40. Lakshmi N. Y., Sidnay H. K., Saga V. P., et al (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patient with bipolar disorder. Bipolar disorders; 20:97-170
41. Laskshmi N.Y., Sidney H. K. (2017). Kaplan and Sadock’s Comprehensive Textbook of Psychiatry: Pharmacological treatment of depression and bipolar disorders, Wolters Kluwer.
42. Lakshmi N. Y., Sidney H. K., Saga V. P., et al (2018). Canadian network for mood and anxiety treatments (CANMAT) and international society for bipolar disorders (ISBD) 2018 guidelines for the management of patient with bipolar disorder. Bipolar disorders; 20:97-170
43. Loya M., Dubey V., Diwan S., Singh H. (2017), “Acute and transient psychotic disorder and schizophrenia: On a continuum or distinct? A study of cognitive functions”, International Journal of Medicine Research, pp-4-7.
44. Manschrec, Nealia L. K. (2006), “Recent Advances in the Treatment of Delusional Disorder”, The Canadian Journal of Psychiatry, pp-114-118
45. Marcos E. M. B., Hermes M. T. B. (2016), “Schizoaffective Disorder and Depression. A case Study of a patient from ceará, Brazil”, iMedPub Journals, pp1-8
46. Mesut Cetin (2015), “Treatment of Schizophrenia: Past, Present and Future”, Bulletin of Clinical Psychopharmacology, pp 96-98.
47. Michael S., Christina Z., Gerd B., (2011), “Prevalence of delusional disorder among psychiatric inpatients: data from the German hospital register”, Neuropsychiatry, pp 319-322.

48. MIMS neurology & psychiatry disease management guidelines

49. RajivTandon (2018), “Pharmacological Treatment of Schizophrenia 2017-2018 Update Summary”, org, pp 37-40.
50. Robert E., et al (2014). Substance-Related and Addictive Disorders. The AmericainPsychiatric Publishing Textbook of Psychiatry, 6 th, DSM-5 Edition, Bristish Library, USA, 735 – 814.
51. Rong C, Lee Y., Carmona N.E., et al (2017). Cannabidiol in medical marijuana: Research vistas and potential opportunities. Pharmacol Res. 121, 213-8.
52. Skelton M., Khokhar W.A., Thacker S.P. (2015). Treatments for delusional disorder. Cochrane Database Syst Rev.
53. Stahl S.M, Stein D.J, Lerer B (2012). Evidence based pharmacotherapy of illicit substance use disorders, Essential evidence based psychopharmacology
54. Stephen M.S., Dan J.S., Bernard L. (2012). Evidence based pharmacotherapy of illicit substance use disorders, Essential evidence based
55. Stahl S. (2009). Stahl’s essential psychopharmacology: neuroscientific basis and practical implications: Cambridge University Press.
56. Stahl, M. (2013). Stahl’s essential psychopharmacology: neuroscientific basis and practical applications, Cambridge University Press.
57. Vieta, Berk M., Schulze&nbspT. G., et al (2018). Bipolar disorders. Nature Reviews Disease Primers, 4, 18008
58. Update2009 on the Treatment of Acute  The World Journal of Biological Psychiatry. 10(2); 85-116.

If you need legal consulting, please Contact Us at NT International Law Firm (ntpartnerlawfirm.com)

You can also download the .docx version here.