“Rare Manifestation of Concomitant Schizophrenia and Forced thinking”- A Case Report

BACKGROUND -: Patients with schizophrenia are more prone to seizures than the general population. Forced thinking is an incompletely understood and rarely described epileptic aura characterized by recurrent intrusive thoughts, ideas, or crowding of thoughts resulting from the epileptiform activity. It is a heterogeneous phenomenon seen mostly in frontal lobe epilepsy, but as well reported in temporal lobe epilepsy. AIM-: We aim to report a rare case of schizophrenia with focal seizures of non-motor onset with awareness. RESULT/CASE REPORT-: A 17 yr old male had auditory hallucinations, repetitive, intrusive images with other behavioral manifestations. On evaluation, he was diagnosed with schizophrenia and was started on antipsychotics and had improvement in psychotic features but repetitive, intrusive images persisted, subsequently, antidepressants were added but there was no improvement. An EEG was conducted and focal ictal discharges on frontal lead were seen. The patient was started on antiepileptic medications and a marked improvement in intrusive images was seen. DISCUSSION-: Seizures can present with a wide variety of presentations and it is very difficult to diagnose them when they manifest along with other disorders. The schizophrenia and behavioral symptoms of seizure co-occur very rarely. The above case highlights the same. CONCLUSION-: The case highlights the importance of detailed history and investigations when we come across such unusual symptoms in common psychiatric disorders. The schizophrenia-epilepsy coexistence is very rare and hence can be studied further.