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This text discusses people with mental disorders in conflict with the law in Brazil and the Custody and Psychiatric Treatment Hospitals, institutions included in the prison system and considered a hybrid between health and justice. When we present the reality in the national context, we show that the Psychiatric Reform did not reach these institutions, and these individuals continue to be stigmatized, and their human rights are violated. We substantiate the need to advance the debate and raise some questions to establish new solutions to tackle the issue and ensure well-structured, scientific evidence-based health care.

We report the case of a patient with temporal lobe epilepsy, nonresponsive to antiepileptic drugs, who became seizure-free, but developed recurrent excessive irritability and psychotic symptoms after successful mesial temporal lobectomy. This patient was refractory to various pharmacological treatments including antipsychotics, mood stabilizers, and benzodiazepines before being successfully treated with olanzapine.