Cocaine Induced Postictal Psychosis: a Rare Cause of Antipsychotic Resistant Psychosis

Cocaine induced postictal psychosis is a rare and underreported phenomenon. When patients ingest large amounts of cocaine, patients can experience seizures. Despite returning to baseline after several days to weeks, patients can suddenly decompensate, exhibiting what is called postictal psychosis despite being abstinent from the substance. This condition can lead to chronic psychosis if not properly treated. In this case, a male in his twenties, presented with 1 month of auditory hallucinations, visual hallucinations, and paranoid delusions. After his last cocaine use 1 month ago, the patient developed seizure-like activity and shortly after returned to baseline. Approximately 1 week later, the patient started to experience psychosis. Due to persistent symptoms, the patient was admitted and started on Risperidone 2mg twice a day but did not respond. Clonazepam 1mg twice a day was added, which helped patient to return to baseline. Cocaine induced postictal psychosis is underreported, and it can be difficult to recognize. Similarly, there are few guidelines as to how to treat this condition. Clinicians need to rapidly address if they suspect that the patient is experiencing possible postictal psychosis given that this can lead to chronic psychosis.