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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0870

Psychiatric manifestations of temporal lobe epilepsy comorbid with obsessive-compulsive disorder: a case report

PSYCHIATRIC MANIFESTATIONS OF TEMPORAL LOBE EPILEPSY COMORBID WITH OBSESSIVE-COMPULSIVE DISORDER: A CASE REPORT

In a patient who had been followed for years with a diagnosis of schizophrenia, episodes of stereotyped behavior and EEG findings revealed temporal lobe epilepsy comorbid with obsessive-compulsive disorder, leading to a change in treatment.

The aim is to discuss the clinical presentation, diagnostic challenges, and treatment options in a case of co-occurring temporal lobe epilepsy (TLE) and obsessive-compulsive disorder (OCD). The patient is a 41-year-old man with a 25-year psychiatric history and three previous hospitalizations, with no significant medical or surgical history. Symptoms began at age 16 with irritability and intrusive sexual thoughts, which responded well to clomipramine 150 mg daily; at age 18, he experienced an exacerbation involving obsessive thoughts and depressive symptoms, along with an impulsive clomipramine overdose without suicidal intent. At age 21, partial stabilization was achieved with mianserin and amisulpride, but impaired social functioning persisted; at age 40, he was hospitalized for behavioral disturbances with religious content and discharged with a diagnosis of schizophrenia. One year later, he was readmitted with agitation, aggression, disinhibition, depressive symptoms, and intrapsychic hallucinations. During hospitalization, he developed stereotyped episodes of psychomotor agitation involving a fixed gaze, undressing, spitting, and unresponsiveness; brain MRI was normal, whereas EEG showed epileptiform activity in the right temporal region, and lacosamide produced both electroencephalographic and clinical improvement. As his condition settled, obsessions involving aggression, contamination, sexuality, and religion became apparent, along with compulsions consisting of excessive washing, mental rituals, and confessing. His Y-BOCS score was 22, no persistent delusions were identified, and paroxysmal visual hallucinations with recurring themes were reported. An extensive workup for autoimmune encephalitis (CSF analysis, oligoclonal bands, and anti-NMDAR, anti-GAD, anti-VGKC, and anti-GABA antibodies) was negative, and a repeat EEG showed epileptiform activity in the left temporal region; a combination of lacosamide, risperidone, sertraline, clomipramine, levomepromazine, and lorazepam achieved substantial clinical stabilization, improvement in obsessive symptoms, and recovery of social functioning. The authors emphasize that paroxysmal and stereotyped behavioral episodes warrant EEG assessment even when brain MRI is normal, and that TLE can mimic a primary psychiatric disorder.

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