Acute Psychotic symptoms in an Epileptic and Depressive Patient Following Medication Non-Compliance: A Case Report

Background Psychotic symptoms that are present in persons with seizure disorder must be carefully distinguished with primary psychotic disorders. Post ictal psychosis is a known yet underdiagnosed side effect of epilepsy, especially in patients with low adherence to medication. Case presentation: Here is the case of a 35-year-old patient who had a known case of depressive disorder with seizure disorder since 2023 and presented with one year history of low mood, anhedonia, easy fatigability, and medication non-compliance followed by acute onset of irritability, crying spells, sleep disturbance, and auditory hallucinations one day ago. Two days before presentation, he had had an episode of generalized seizure during a family outing. No manic history, no obsessive-compulsive, panic or substance use. Family history was not of significance with respect to psychiatric illness. Physical and neurological check-ups were normal. Hostility, dysphoric affect, auditory hallucinations and impaired judgment were first identified during Mental Status Examination. Day 1 was associated with the administration of injectable haloperidol with promethazine owing to acute agitation. Diagnosis and Intervention: The tentative diagnosis was severe depressive episode along with psychotic symptoms. Nevertheless, after the resolution of the sedation, depressive symptoms were moderate (Depression Inventory (Beck): 20), and the psychotic symptoms were quickly resolved. A final diagnosis of the Post-Ictal Psychosis was confirmed considering the relationship with the timing of seizure and the presence of diagnostic symptoms. The patient was reinstated on prior anti-epileptic drug and dose up-titration of SSRIs were continued. Short-term use of antipsychotic medication was maintained. Prognosis: By Day 3, none of the hallucinations and delusions were present. Mild symptoms of depression remained. Days 4–7 Serial Mental status Examinations indicated improvement. The patient was released on the optimum anti-epileptic and SSRI therapy with guidance on good compliance and psychiatric follow-ups. Conclusion It is emphasized in the case in the need to know about post-ictal psychosis and distinguish it with primary psychotic disorder or severe depressive episodes with psychotic characteristics. Ample chronological evaluation and underlining of anti-epileptic adherence play a crucial role in avoiding relapse.