Post-ictal psychosis syndrome : A case report

ABSTRACT

Introduction: Psychiatric comorbidity is prevalent among patients with epilepsy. Post-ictal psychosis syndrome (PIP) is a recent entity important to know. It belongs to the group of epileptic psychoses. The clinical presentation is often atypical, and symptoms are usually related to seizures. Objective(s) This work aimed to study the particularities of PIP. Method(s) It is a case report of PIP, involving a patient hospitalized in psychiatry department. Result(s) We report the case of a 45-year-old woman, with medical history of generalized epilepsy which was stabilized under antiepileptic treatment (phenobarbital 150 mg/day). The patient was hospitalized for psychomotor instability and inconsistent speech after having experienced a generalized tonicclonic seizure in the context of discontinuation of treatment. Psychiatric assessment revealed a hostility, a reluctance , a persecution delirium and auditory and visual hallucinations. A series of examinations have been carried out ;Neurological examination revealed no anomaly , a computed Tomography Scan of the Brain was normal. A lombar puncture was normal. A covid-19 infection was eliminated. The usual antiepileptic medication was reintroduced to the patient (Phenobarbital 150 mg/day), in association to benzodiazepines (clonazepam 4 mg/day). After 72 hours of treatment, psychiatric symptoms improved. The patient returned to its baseline condition after 7 days. A similar episode was reported two months earlier in the same circumstances with a similar symptomatology and a spontaneous resolution within 7 days. Conclusion(s) PPI syndrome, regardless of its good short-term prognosis, can potentially evolve into other psychiatric disorders of less good prognosis. Thus, this syndrome should be managed in collaboration with neurology and psychiatry.