Focal epilepsy and psychosis symptoms: A case report and review of the literature

BACKGROUND: Epilepsy is still a real mental health problem; although most epilepsies are curable, their psychopathological consequences are often significant and complex to manage. In this framework, the association of epilepsy with psychotic disorders has long been known. CASE PRESENTATION: To discuss the links between epilepsy and psychosis, we report the observation of a 52-year-old man, treated for complex focal epilepsy, admitted to a psychiatric department for auditory and visual hallucinations and a behavioural disorder not improved by antiepileptic treatment alone or an antipsychotic alone. DISCUSSION: Psychotic symptoms in epilepsy can be part of intercritical, post-critical or alternative psychoses. In our patient's case, the psychotic symptoms were post-critical and alternative. It was probably an associated schizophreniform disorder. Emotional indifference and activity restriction are rarely encountered in this setting, while rapid mood fluctuations are frequent. Delusional themes are often mystical, fueled by auditory and unusual visual hallucinations. Negative disorders are rare. CONCLUSION: Epileptic psychoses have not been identified as nosographic entities in the psychiatric classification systems (DSM-V and ICD-10), which poses a problem in recognizing these disorders. Therefore, a collaboration between psychiatrists and neurologists is necessary to understand this complex comorbidity better, avoid diagnostic errors, and optimize management.