Background: The prevalence of psychiatric disorders in people with epilepsy is as high as 43% and, among them, psychoses represent a severe comorbidity.
Aims: This is a narrative review discussing the interplay between epilepsy and psychosis and identifying challenges in diagnosing and managing psychotic symptoms in epilepsy, focusing on the past 10 years.
Method: Articles published between June 2014 and December 2024 were identified through searches in PubMed using the search terms 'psychosis', 'seizure, epilepsy and convulsion', 'epile*', 'seizure*' and 'convuls*'.
Results: The association between epilepsy and psychosis was shown to be bidirectional, with people with psychosis being at increased risk of epilepsy. In epilepsy, psychotic symptoms may occur in three clinical scenarios, with clinical presentation and management varying in relationship to these: seizure-related (peri-ictal), treatment-related or independent of the former.
Conclusions: There are no guidelines for the management of psychotic symptoms in epilepsy, but it is possible to apply policies for the treatment of psychoses, taking into account the peculiarities and needs of people with epilepsy.
Keywords: Epilepsy; antipsychotic drugs; antiseizure drugs; lurasidone; psychosis.