Chronic Psychosis and Hypothalamic Hamartoma: A Case of Schizophrenia with Epileptic Comorbidity

This clinical case describes a 45-year-old man with chronic psychosis associated with drug-resistant epilepsy since adolescence. Psychiatric symptoms included persecutory and witchcraft-related delusional ideas, auditory hallucinations, aggressive behavior, and suicide attempts. Brain MRI revealed a hypothalamic hamartoma, a rare benign lesion that can cause seizures, endocrine disturbances, and psychiatric manifestations. Treatment with amisulpride and carbamazepine led to partial improvement, with a reduction in hallucinations but partial persistence of delusional thinking. Management required multidisciplinary coordination between psychiatrists and neurologists, with consideration of a specialized surgical approach. This case highlights the importance of brain imaging in atypical and treatment-resistant psychiatric presentations, especially when associated with difficult-to-control epilepsy. It also underscores the potential role of hypothalamo-limbic circuits in the development of severe psychiatric disorders and the value of a comprehensive approach addressing both neurological and psychiatric aspects.