A 52-year-old man presented to our outpatient psychiatry department due to elevated mood, reduced need of sleep, elevated energy, disinhibition and grandiose delusions during the last two months. This patient is married, has two children and lives with his family. He is partially dependent in activities of daily living (walking with help). Of relevance, he had a left lenticulo-capsular hematoma and underwent decompressive craniectomy two years before the onset of psychiatric symptoms. After stroke, the patient presented sequelae of right hemiparesis, motor aphasia and late-onset seizures, without evidence of cognitive impairment (normal Mini Mental State Examination score). Past medical history included hypertension, dyslipidemia and hyperuricemia. No previous history of any psychiatric disorder, including mood or substance use disorders, could be evidenced. When psychiatric symptoms occurred, he was medicated with levetiracetam for the seizures. The first option of his neurologist was excluded medical conditions that could justify these psychiatry symptoms. Then, it was decided to change the antiepileptic drug and the patient stopped levetiracetam and started lamotrigine, without psychiatric improvement. He started quetiapine up 400 mg/day and after olanzapine up 20 mg/day was associated, both without psychiatry improvement. Then, the patient started pimozide up 8 mg/day with clinical improvement and after 6 months of treatment it was progressively discontinued, without psychopathological decompensation.