A 27-year-old man with epilepsy and a history of complex partial seizures presented with a complaint of extrapyramidal side effects. He had simple auditory hallucinations during the aura, but also psychotic symptoms between seizures. Prior to being on antipsychotic medication, he would typically have a day after the seizures when he felt well, and then become unwell with auditory hallucinations, persecutory delusions, low mood, and irritability. This would last for a few days. In the past, he had also reported seeing fleeting images of people laughing at him.
Three years ago, haloperidol was added to the antiepileptic medication phenytoin. His medication had kept him reasonably well. What additional information would you need to suggest treatment for this patient? What would be your suggested treatment? (Answer is posted in the comment section below!) *This case is from the Docplexus…
