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This paper aimed to discuss diagnostic and therapeutic processes in a rare pediatric case with psychotic episodes characterized by vivid hallucinations and sleep-activated electroencephalogram (EEG) findings consistent with epilepsy, who improved with antiepileptic therapy without the need for any antipsychotic treatment. A male pediatric case of 11 years of age, who was under state protection presented with seeing tiny creatures in his dreams and behavioral changes. On his interrogation, he told that he saw, especially at evening hours, undefined tiny creatures resembling human beings, which scratched his hands and told him to do evil things like “hurting others”. He stated that this continued for approximately 5 minutes each time. During psychiatric examination, these creatures, which considered as independent from dream content, were explained by the patient as “dreaming”, and he thought he was possessed by an evil spirit. Institution employees stated that he had behavioral alterations that began within the same time period. The patient had a suspicious diagnosis of epilepsy and luminaletten use at the age of 4. Considering the episodic course and the past history of epilepsy, he was referred to neurology clinic for detailed assessment. Sleep-activated EEG revealed focal epileptic disorder starting from centrotemporal part of the left hemisphere and showing secondary generalization. In line with history and examination findings, he was diagnosed to have epilepsy for which valproate 10 mg/kg/day was begun and increased to 20 mg/kg/day one week later. A marked improvement was detected in psychotic symptoms one week after dose increase. He had no active clinical findings after an 8-weeks follow-up. His control EEG was normal. Epileptic psychosis involves a group of disorders closely associated with epileptic seizures. Interictal psychosis, postictal psychosis, ictal psychosis, and alternative psychosis are in this diagnostic group. The rarer ictal form of psychotic episode is considered as a distinct diagnosis from other epileptic psychoses. Ictal psychosis is associated with visual and auditory hallucinations accompanied by affective changes such as agitation, fear, or paranoia. Insight to psychotic symptoms and short attacks helps differentiate ictal psychosis from interictal psychoses. It has also been reported that psychotic signs arising during seizure activities in this disorder are, unlike those in other psychoses, stereotypic and exhibit no differences between seizures. Ictal psychosis is generally short-lived, lasting for hours or days. Many partial seizures terminate in below 3 minutes. Likewise, short-lived psychotic symptoms that are experienced “especially at evening hours” for “approximately 5 minutes” and stereotypically described as “seeing undefined humanoid tiny creatures” are quite decisive for ictal psychosis. A short symptom history, normal functionality between attacks, an active impairment in EEG and absence of clinically observed seizure attacks led us to the diagnosis of ictal psychosis. In this case, unlike other forms of epileptic psychosis, a marked improvement in patient symptoms with antiepileptic therapy without the need of any antipsychotic treatment is striking. Thus, as a result of differences in treatment protocol and prognosis, a detailed assessment prior to medications is important in cases presenting with atypical