Case Presentation
A 44-year-old female patient was admitted to the psychiatric ward with complaints of self-referent, mystical delusions and confusion.
Physical Examination
- During the hospitalization, biochemical and hematological screening, folic acid, thyroid function, and cyanocobalamin were normal.
- Levels of valproic acid were subtherapeutic.
- Serologies for B and C hepatitis were negative.
- She also underwent a computed tomography (CT) scan which did not indicate other neuroimaging findings.
Medical History
- Since the early thirties, her past medical history was relevant for epilepsy which had developed after a moderate to severe traumatic brain injury (TBI)
- She was irregular in attending the follow-up neurology appointments and had poor compliance to antiepileptic therapy.
- Ancillary tests undergone during a previous hospitalization had reported a focal slowing activity in the left frontotemporal topography on electroencephalogram and a
- right cortico-subcortical parieto-occipital lesion of encephalomalacia on magnetic resonance imaging.
- Also, she presented an amnestic mild cognitive impairment, maybe secondary to both the poorly controlled epilepsy and the prior traumatic brain injury.
Family History
- There was no personal or family history of psychiatric illness.
Clinical Examination
- The patient was experiencing perplexity, irritability, disorganized behavior, and aggressiveness that had arisen soon after a cluster of nocturnal generalized tonic-clonic seizures.
- Additionally, some extent of cognitive confusion with temporal disorientation divided attention and memory deficits were noticed during hospitalization.
Treatment
- Treatment includes aripiprazole 10 mg/day, diazepam 10 mg, and valproic acid 1000 mg/day
- The aripiprazole dose was decreased in the following months.
Clinical Outcome
- The psychotic symptoms lessened in the first 36 hours after admission when treated with aripiprazole, valproic acid, and diazepam.
- There was no recurrence of psychotic symptoms.
- There was an improvement in seizure control in the outpatient follow-up of neurology appointments.