Managing Recurrent Postictal Worsening of Psychosis in Clozapine-Treated Schizophrenia: A Case Report

Postictal worsening of psychosis can be described as the development or exacerbation of psychotic symptoms following a seizure. Patients on clozapine for treatment-resistant schizophrenia are at an increased risk for seizures and subsequent postictal worsening of psychosis. Because patients with schizophrenia may experience ongoing psychotic symptoms, it may be difficult to appreciate the development of postictal worsening of psychosis in these patients. We present the case of a 49-year-old woman with a longstanding history of schizophrenia treated with clozapine who presented to the emergency department (ED) after experiencing a seizure. In the following days, she and her mother reported an exacerbation of psychotic symptoms, which was ultimately attributed to a postictal worsening of psychosis. She was successfully treated after being prescribed an increased nightly dose of clozapine. This dose was eventually reduced to the usual dose she had been taking prior to the postictal exacerbation of psychosis. We also briefly describe a recurrent episode the patient experienced approximately 1 year later. This case contributes to the literature by offering one potential management strategy for postictal worsening of psychosis in a patient with a primary psychotic disorder.