Skip to main content
MMedVellum
MCQsExamsAtlas
DashboardPricing
MMedVellum

The exam atlas that feels like a flagship product — evidence-graded topics and exam tools for MBBS and fellowship preparation. Built to scale to fifty specialties. Educational content only — not medical advice.

llms.txt·psychiatry LLM catalog · sitemap

Atlas

  • Specialty atlas
  • MBBS / Core medicine
  • Dermatology
  • ICU Fellowship (CICM)
  • Anaesthesia
  • Emergency Medicine
  • Psychiatry Fellowship

Study & account

  • MCQ practice
  • Practice alias
  • Exam tools
  • Dashboard
  • Pricing
  • Sign in

© 2026 MedVellum. For education only — not a substitute for clinical judgement.

Clinical Atlas Prestige · Evidence-first

Psych VivasConsultation-liaison psychiatry

Psych Vivas · Consultation-liaison psychiatry

Epilepsy and psychiatry — structured clinical viva

Fellowship viva on postictal psychosis, NDDI-E depression, LEV effects, and psychopharmacology at the epilepsy interface.

clinical
On this page & tools

Target exams

FRANZCPMRCPsychABPNMD-DNB

Target exams

FRANZCPMRCPsychABPNMD-DNB
Prompt
You are the CL psychiatry registrar. Neurology asks you to review a 36-year-old woman with temporal lobe epilepsy who, 48 hours after a seizure cluster and a period of normal conversation, has developed persecutory delusions and is pacing the corridor. Her NDDI-E last month was 17. She was recently up-titrated on levetiracetam. Discuss classification, differential including forced normalisation and NCSE, acute management, depression treatment, AED psychiatric effects, psychotropics and seizure threshold, and how you negotiate the joint plan.

Interpretation

Reveal interpretation

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]

Key points

Lucid interval

Hallmark discriminator of postictal psychosis versus immediate confusion.[1]

NDDI-E

Score greater than 15 prompts full depression assessment.[3]

LEV and threshold drugs

Behavioural AEDs vs bupropion/clozapine seizure risk are staple exam traps.[4][5]

References

  1. [1]Logsdail SJ, Toone BK Post-ictal psychoses. A clinical and phenomenological description Br J Psychiatry, 1988.PMID 3167343
  2. [2]Krishnamoorthy ES, Trimble MR, Sander JW, Kanner AM Forced normalization at the interface between epilepsy and psychiatry Epilepsy Behav, 2002.PMID 12609326
  3. [3]Gilliam FG, Barry JJ, Hermann BP, et al. Rapid detection of major depression in epilepsy: a multicentre study Lancet Neurol, 2006.PMID 16632310
  4. [4]Alper K, Schwartz KA, Kolts RL, Khan A Seizure incidence in psychopharmacological clinical trials: an analysis of Food and Drug Administration (FDA) summary basis of approval reports Biol Psychiatry, 2007.PMID 17223086
  5. [5]Mula M Epilepsy and Psychiatric Comorbidities: Drug Selection Curr Treat Options Neurol, 2017.PMID 29046989
  6. [6]de Toffol B, Trimble M, Hesdorffer DC, et al. Pharmacotherapy in patients with epilepsy and psychosis Epilepsy Behav, 2018.PMID 30241054
  7. [7]Barry JJ, Ettinger AB, Friel P, et al. Consensus statement: the evaluation and treatment of people with epilepsy and affective disorders Epilepsy Behav, 2008.PMID 18502183