Table 1 Risk Factors for Postictal Psychosis

A cluster of seizures.

Insomnia within 1 week, but particularly within 1–3 days.

Epilepsy of > 10 years duration.

Generalized tonic-clonic seizures or complex partial secondarily generalized.

Prior episodes of PIP.

Prior psychiatric hospitalizations or history of psychosis.

Bilateral independent seizure foci (particularly temporal).

History of traumatic brain injury or encephalitis.

Low intellectual function.

In a patient with chronic epilepsy with the above risk factors, patients should be monitored vigilantly and low dose antipsychotic should be considered at the first signs of insomnia, or the earliest signs of psychosis or thought disorder. If patient has a history of recurrent PIP, antipsychotics may be considered prophylatically after seizure cluster.