“…In our case, before the full manic syndrome with psychotic features was established, our patient presented with affective-mixed symptoms such as dysphoria, irritability, mood lability, and aggressiveness. Most levetiracetam-associated manic/psychotic episodes reported in the literature were preceded by irritability, 2–5 mood lability, 2,4 aggressiveness, and psychomotor agitation 2 . This affective-mixed symptoms complex may be a prodromal marker of subsequent severe manic/psychotic episodes 12,13 .…”