Topiramate-induced psychosis: the picture at 12 months

Abstract

A 19-year-old white British man, not previously known to psychiatric services, presented with acute onset of florid psychotic symptoms. His symptoms included auditory hallucinations, misidentification of family members, thought interference and delusions of control. His level of distress was high and did not respond to verbal or medical de-escalation; therefore, he required nursing in seclusion. It was noted that he recently had an increase of his anti-epileptic medication to 100 mg topiramate twice per day. Topiramate was thought to be the cause of his psychosis and, consequently, was changed to phenytoin. Since discontinuation of the topiramate, his psychotic symptoms settled within 4 days and he was discharged shortly afterwards. He was monitored by the Early Intervention services. At 15-months post-discharge, there was no recurrence of any symptoms despite not receiving antipsychotic medication. To our knowledge, this is the first report that describes the progress of a patient past the initial psychotic episode. Therefore, we believe this is an important finding to report.

Timing and Clinical Characteristics of Topiramate-Induced Psychosis in a Patient With Epilepsy and Tuberous Sclerosis

“…6,7 There are several case reports of topiramate-induced psychosis at dosage exceeding 50 mg daily. 2,9 Watkin et al 10 have observed a patient with epilepsy with topiramate-induced psychosis, and there was no recurrence of any symptoms in a 15-month follow-up, despite not receiving antipsychotic medication. 2,9 Watkin et al 10 have observed a patient with epilepsy with topiramate-induced psychosis, and there was no recurrence of any symptoms in a 15-month follow-up, despite not receiving antipsychotic medication.…”

Topiramate-Induced Suicidal Ideation and Olfactory Hallucinations: A Case Report

“…He had made a suicide attempt when his medication reached 50 mg/day [7]. Other cases report psychotic symptoms such as auditory hallucinations linked to the initiation of Topiramate in patients with various medical conditions [8][9][10][11][12]. Many articles suggest that patients with migraine have a higher prevalence of mood disorders [13,14].…”