Cured the Seizures, Created the Storm: A Case of Psychosis Linked to Levetiracetam

Abstract Levetiracetam is a commonly prescribed anti epileptic drug known for its broad-spectrum efficacy and minimal drug interactions. However, it has been associated with rare but significant psychiatric side effects, including psychosis. We present the case of a 47-year-old male with well-controlled epilepsy who developed persistent psychotic symptoms – such as irritability, inflated self-esteem, decreased sleep, and paranoid ideation – while on levetiracetam. These symptoms were unresponsive to antipsychotic treatment (olanzapine 15 mg/day) but resolved entirely within 1 week of discontinuing levetiracetam and did not recur upon reintroduction of valproate monotherapy. The patient had no prior psychiatric history, and the EEG remained normal. A Naranjo score of 8 indicated a probable adverse drug reaction. Differential diagnoses, including interictal psychosis, primary psychosis, mood disorder, and forced normalization, were considered and ruled out. This case emphasizes the need to consider levetiracetam-induced psychosis in patients presenting with new-onset behavioral symptoms, particularly when they are atypical, chronic, and resistant to conventional psychiatric treatment.