Background: Postictal psychosis (PIP) is a well-recognized but under-researched neuropsychiatric complication of epilepsy. Its presentation with catatonia is rare and often leads to diagnostic and therapeutic challenges. Understanding such presentations offers valuable insight into the overlap between epilepsy and primary psychotic disorders.

Case Presentation: We report a 31-year-old male with a 14-year history of myoclonic epilepsy and comorbid hypothyroidism, who presented with progressive behavioral disturbances over six months, followed by acute onset suspiciousness and sleep disturbance. Subsequently, he developed reduced oral intake, mutism, and psychomotor retardation suggestive of catatonia. Mental status examination revealed poor rapport, increased psychomotor activity, loosening of associations, persecutory and referential delusions, and second-person auditory hallucinations.

Investigations: Electroencephalography demonstrated generalized epileptiform activity with lowered seizure threshold. Neuroimaging revealed features consistent with lissencephaly-pachygyria spectrum along with periventricular white matter hyperintensities.

Discussion: This case highlights the complex interplay between chronic epilepsy and psychosis, with catatonia as a rare manifestation of postictal states. Structural brain abnormalities may further predispose to such neuropsychiatric complications. Early recognition is crucial, as PIP is associated with recurrence, morbidity, and potential progression to chronic interictal behavioral changes.

Conclusion: Postictal psychosis with catatonia represents a diagnostic and therapeutic challenge requiring high clinical suspicion. This case underscores the importance of integrating neurological and psychiatric evaluation to optimize outcomes and prevent recurrence.

Keywords: Postictal psychosis, Catatonia, Myoclonic epilepsy, Neuropsychiatry, Psychosis of epilepsy

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