The underlying cause of seizures is due to abnormal and excessive discharge of neurons in the brain. The clinical manifestations are diverse, so it is very easy to misdiagnose or miss the diagnosis. A case with clinical manifestations of psychomotor seizures and episodic dyscontrol syndrome is reported below for your reference. The patient, Xue, male, 26 years old, was admitted to the emergency room with the complaints of “easy temper, destroying things for 6 years, talking about gods and ghosts, and being suspicious for 4 days”. The patient was 16 years old when the disease started without any obvious cause, and at that time he had a temper tantrum and smashed things, which lasted for a few minutes and got better on its own. In the past two years, the number of tantrums has increased, with one attack every 2-3 months, lasting from a few minutes to an hour or so, mostly due to unpleasant events. He was able to work part-time during the intervals, and was dismissed from each job because he was prone to temper tantrums for a short period of time (about a few days to two months). Four days before admission, his condition worsened, he was afraid, shouting, gesturing with a knife in the air, seeing people around himself, seeing his deceased grandmother walking with a cane into a picture frame or walking in through the door, saying that he wanted to kill the person sitting next to him with a knife, not daring to turn off the light in bed, smashing things, touching his head, hitting himself, shaking all over, and saying: I can’t control myself anymore; feeling discomfort in his throat I felt a sense of suffocation; I fainted once on the day of admission, and then woke up on my own a few minutes later and started yelling, cursing, swearing, and being unusually unstable and uncontrollable; I said I was Chen Guanxi; I was suspicious, saying that someone was playing a conspiracy to harm me and that people on the Internet were bad-mouthing me. Past history: no special, plainly physically fit. Personal history: difficult birth lack of oxygen, growth and development is slightly later than the same age, 1.5 years old walking, 3 years old can talk, poor academic performance, elementary school graduation, low literacy. Usually has a strong personality and is prone to tantrums after being criticized. Family history: no positive family history. Physical examination on admission: no significant abnormalities were seen. Mental examination: clear consciousness, emotional instability, psychomotor paroxysmal excitement, cursing the surrounding people, unpleasant verbal content and hitting people, saying he was handsome and was Chen Guanxi, further mental examination could not be performed for the time being. No abnormality was found in the CT scan of the head at the external hospital before admission. After admission, routine EEG as well as 24-hour dynamic EEG results were checked without abnormalities. The preliminary diagnosis was: hysterical psychosis. After admission, the patient was given haloperidol 10mg/d for 10 days, magnesium valproate extended-release tablets 0.5-1.0/d, and quetiapine 0.1-0.7 was added gradually, while suggestive psychotherapy was given. He said he could see an old man on crutches sitting at the edge of his bed, looking at himself, asking himself, but the other party did not answer, ignoring himself, and then he left, sometimes into the picture frame, sometimes through the door; he felt that someone had played a conspiracy to himself, to make himself whole, and when he went online, he saw that people on the Internet were bad-mouthing him, and the picture of a girl on the Internet was very similar to his girlfriend, and he had people identify him; he admitted that he was wrong, and never cursed again, but he could not explain exactly why he was wrong. I can’t explain why I was wrong, but simply repeat: I was wrong. He had poor calculation, comprehension, and common sense, and no self-awareness. On the fourth day of admission, he had episodes of emotional instability, abnormal excitement, uncontrollable, kneeling, crying, nervous expression, and saying he was wrong, which lasted about ten minutes to an hour each time, and was relieved by temporary intramuscular injection of haloperidol and clonazepam. He began to stabilize on about the 6th day of admission. He was able to participate in group activities in the ward during the day. On the 21st day of admission, the patient was switched to zopiclone to avoid dependence and tolerance due to the long duration of lorazepam use. On the third day of discontinuation of lorazepam, the patient had recurrent episodes of sudden excitement, panic attacks, shouting, saying that he was sorry to the people around him, and then sudden injury without any warning, self-injury, touching his head, staring at the people around him with his eyes, in paroxysmal attacks, almost once a day, after which he only repeatedly said that he was wrong and could not recall the injury or self-injury. The episodes lasted for about ten minutes to about an hour each time, and were relieved after falling asleep by intramuscular clonazepam 2mg or haloperidol 5mg and waking up. Based on the patient’s clinical presentation, personal history, and recurrence of lorazepam discontinuation, the diagnosis was revised on the 34th day of hospitalization as: epilepsy-induced mental disorder, and the patient was discharged on the 48th day of hospitalization after being treated with nitrazepam 20mg/d, magnesium valproate 0.75/d, oxcarbazepine 0.9/d, and quetiapine reduced to 0.5/d, which gradually stabilized the patient’s condition. The patient was discharged from the hospital in 48 days. After discharge, he was reviewed regularly at the outpatient clinic and has been stable for six months. Discussion: The clinical symptoms of epilepsy-related psychiatric disorders vary due to different etiologies and focal sites, and can be manifested as sensory, perceptual, thinking, psychomotor seizures, mood changes and schizoid symptoms. Clinicians often call it “four different”, so it is very easy to misdiagnose. In this case, the main clinical manifestation was psychotic symptoms, and the patient was considered to be excited at the beginning of the admission, and was controlled with haloperidol, magnesium valproate, lorazepam and psychotherapy, and the condition was stabilized. tended to stabilize. Reasons for misdiagnosis: 1. The patient gave a simple answer during the psychiatric examination and expressed the symptoms inaccurately; 2. The family was influenced by superstitious thoughts and lacked medical knowledge, attributing the cause to the deceased old man and creating a psychological implication for the patient, while the family may have described the patient’s atypical seizures as “shaking”; 3. The doctor was a psychiatrist and was limited by his discipline, plus he did not see the patient “shaking”, and combined with the patient’s ability to say “I can’t control it”, he subjectively judged it as hysterical convulsions; 4. Due to the limitation of our hospital, the 16-lead arrangement of EEG is limited to prefrontal, frontal, central, parietal, occipital, anterior, middle and posterior temporal unipolar lead connection (bilateral), without using pterygoid electrodes, drug induced, coupled with the high false negative rate of routine EEG results, reaching 30%, and some patients still do not find characteristic epileptic waves even during grand mal seizures, and no abnormal EEG results are related to this. Therefore, as a clinician, we should be alert to physical diseases with psychiatric symptoms as the first or main clinical symptom in the treatment process to reduce the misdiagnosis rate.