Postictal Psychosis: A Case Report

Postictal psychosis (PIP) is one of the most common psychoses for patients with epilepsy and is defined as psychotic symptoms presenting at least 1 week after a cluster of seizures. This case report illustrates an important example of a clinical presentation of postictal psychosis.

This case report identifies a 29-year-old male with a medical history of asthma and epilepsy who presented with multiple seizures and delirium. He has had multiple hospital admissions and ED visits over the past 1 to 2 years for recurrent seizure-like activity suggestive of PNES. On previous admissions for seizure-like activity, he has been intubated due to uncooperativeness. On this admission, he presented to the ED after multiple at-home seizures. In the ED, he became increasingly delirious with no return to baseline mental status between seizures. He was then intubated with bilateral wrist restraints for nonsensical speech and agitation.

On day 4 in the ICU, he returned to baseline mental status. The patient was cooperative with medical treatment, alert, aware and attentive, and no longer agitated. The patient was able to remember the previous episode of seizure that led him to the ED. He was discharged on lacosamide 200 mg twice daily.

It is important to consider postictal psychosis as a diagnosis in a patient with epilepsy and changes in affect, mood, or the presence of delusions with no clear lucid interval to ensure timely and effective treatment and limit potential future complications.