Epilepsy and psychiatry — structured clinical viva

Leading diagnosis: postictal (peri-ictal) psychosis — seizure cluster, lucid recovery, delayed psychosis at ~48 hours. Name Logsdail–Toone timing and violence/self-harm risk.^[1]

Differentials to voice: ongoing postictal delirium (less likely after clear lucid conversation), NCSE if awareness fluctuates (offer EEG), LEV-emergent behavioural toxicity contributing, interictal psychosis less likely for this tempo, forced normalisation only if seizures/EEG have dramatically normalised with inverse psychiatric worsening.^[2][5]

Acute plan: safety, observation, benzodiazepines, do not stop AEDs abruptly, short-term cautious antipsychotic if needed, neurology partnership, capacity/legal principles.^[6]

Depression: NDDI-E 17 is screen-positive (greater than 15); treat interictal depression with therapy ± SSRI, suicide assessment; do not leave untreated after psychosis settles.^[3][7]

Drugs: discuss LEV irritability signal and possible dose/switch with neurology; avoid bupropion; clozapine only with specialist cover; SSRIs preferred for depression.^[4][5]

Close the viva: joint epilepsy–psychiatry follow-up, family education on PIP recurrence, clear contingency for future clusters.^[1][6]