EEG and clinical neurophysiology in psychiatry — structured clinical viva

Role of EEG. Clinical tool for organic/seizure differentials; not a diagnostic blood test for schizophrenia. Normal EEG excludes nothing absolute. ^[1]

This case. Witnessed seizure on high-dose clozapine is a recognised adverse effect (dose-related risk in large series); EEG abnormalities are common on clozapine. Staring and fluctuating confusion raise concern for ongoing seizures or NCSE — consider urgent/prolonged or continuous EEG with neurology rather than attributing all change to primary psychosis alone. ^[2][3][4][5]

Bands (brief). Diffuse slowing suggests encephalopathy; benzodiazepine beta is medication effect; epileptiform discharges need clinical correlation; critical-care patterns use standardised terminology. ^[1][3]

Research biomarkers. MMN and P300 group findings inform models of auditory/attention processing in schizophrenia research; they do not prove diagnosis to the family. ^[6]

Communication. Explain clozapine can lower seizure threshold especially at higher doses/levels; EEG checks brain electrical activity for seizures or encephalopathy, not to 'photograph schizophrenia'; brain is not permanently destroyed by one seizure; plan may include level check, dose review, possible antiseizure cover, and continued psychosis treatment jointly decided. ^[4][5]

Management steps. ABC and acute seizure care; investigations (glucose, electrolytes, levels, imaging if indicated); EEG timing; do not abruptly stop all treatment without plan; safety nursing; document risk. ^[5]