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The 83-year-old woman in this case report developed paranoid delusions and auditory hallucinations in association with toxic serum levels of digoxin, while remaining alert, unagitated, and coherent in thinking. No cardiovascular or metabolic abnormalities were discovered to account for her psychiatric symptoms. Her mental status rapidly returned to normal as serum digoxin declined to therapeutic levels.
College students tested in groups were given brief suggestions either to "see" or to "imagine" a kitten. Subjects responded twice, once with eyes open and once with eyes closed. They rated the duration, transparency, and vividness of their imagery, and also their involvement in and belief in the reality of their imaginings under both eye closure conditions. "Imagine" suggestions elicited imagery of longer duration than "see" suggestions. Although subjects reported longer, more vivid, and less transparent imagery with their eyes closed, this effect was dependent on the order of eye closure (i.e., whether the eyes closed instruction preceded or followed the eyes open instruction). The three dimensions of imagery intercorrelated, and each dimension also correlated with subjects' degree of involvement in and belief in their imaginings. A minority of subjects given both the "see" and "imagine" suggestions reported believing that their imaginings were real events during the suggestion period. Furthermore, belief in imaginings was the only variable that correlated with hypnotic susceptibility. These data indicate that hallucinations (i.e., believed-in imaginings) can be elicited from a minority of "norman" subjects with brief instructions.
The majority of schizophrenic patients from Western backgrounds develop strategies to cope with the positive symptoms of their condition. However, there is little evidence to indicate how these coping mechanisms are affected by cultural background. Seventy schizophrenic patients from Saudi Arabia (SA) and the United Kingdom (UK) who reported auditory hallucinations were interviewed to explore the ways in which they coped with their voices and sounds. Patients from both cultures had several coping mechanisms, but these varied between cultures. The majority of SA patients used strategies associated with their religion whereas UK patients were more likely to use distraction or physiologically based approaches. The majority of patients were slightly or not at all confident about the effectiveness of their coping strategies. This study suggests that clinicians, when they attempt to facilitate the use of such strategies, may find greater patient acceptance and efficacy if they are familiar with culturally specific factors.
This report describes a precocious eight-year-old child who presented with hallucinations from excessive use of albuterol inhalers. Shifting the child to a powdered form of albuterol (without the fluorocarbon propellant) controlled his asthma, and his behavior improved rapidly. The potential harmful effects of fluorocarbons used as propellants for inhalers are discussed.
A patient with chronic schizophrenia had two hemodialyses and two sham dialyses in a single-blind design. There was no change in the patient's affect after either procedure, but her auditory hallucinations disappeared after both hemodialysis and sham dialysis, with hemodialysis inducing a much longer partial remission.
The authors describe the use of cisapride (Propulsid), a potent 5-HT(3) antagonist, in the treatment of visual hallucinations in two patients with vision loss (the Charles Bonnet syndrome).
Neuroborreliosis has become the most frequently recognized tick-borne infection of the nervous system in Europe and the United States. In addition to dermatological, cardiac, articular, and neurologic manifestations, psychiatric disorders such as depression, panic attacks, and schizophrenia-like psychosis can also arise. We report on a 61-year-old woman who developed a severe pain syndrome following several tick bites. She was diagnosed with neuroborreliosis; she received various courses of antibiotics over several years, but without any clinical improvement in her condition. Her eventual admission to a psychiatric ward due to mental symptoms and neuroleptic treatment led to a dramatic improvement of her pain symptoms. However, increasing delusions disclosed a psychotic episode, which ceased over time. We discuss therapeutic difficulties and psychiatric complications in the absence of a clear-cut diagnosis of neuroborreliosis. Although this patient might have suffered from late-onset schizophrenia with painful hallucinations right from the start of her disease, the case highlights psychiatric complications that might be associated with neuroborreliosis.
Five children, ages 3 to 6 years, developed visual hallucination and inappropriate behavior within 3 days of the onset of an influenza-like illness. Electroencephalographic examinations showed generalized slow waves in all five cases. Evidence of acute influenza A viral infection was documented in all five cases. Within 8 days all five children were discharged in stable condition. Influenza A-associated central nervous system dysfunction may be more common than previously recognized, and the prognosis is not necessarily poor.
We have described a patient with occipital lobe infarction and CVH in the hemianopic field. Increased uptake in the right temporal lobe was documented on the brain Tc SPECT scan. We propose that activation of this area might be the underlying mechanism for visual hallucinations. This case report is a clear example of the wide spectrum of the clinical manifestations in stroke victims. We also emphasize the importance of educating the medical staff about the organic basis for human behavior.
Peripheral neuropathy is a common side effect of vincristine therapy. However, side effects due to central nervous system (CNS) toxicity following intravenous administration are rare. We report two patients who developed visual hallucinations during treatment with vincristine.
A case of erotic delusion and concurrent somatic sexual hallucination is described in a 66-year-old mentally handicapped woman. The history, mental state and biological investigations convey the impression of erotomania, or de Clerambault's syndrome. Treatment with Pimozide has resulted in a remarkable improvement such that the patient has been symptom free for 8 months at the time of reporting. In the authors' opinion, the case lends support to the argument that erotomania exists as a mono-delusional disorder and is equivalent to the DSM-III-R classification of Paranoid Disorder, Erotomanic Type.
A 6-year-old fit girl experienced convulsions 44 h after an otherwise uneventful anaesthesia with propofol, alfentanil and nitrous oxide. As an underlying pathology was suspected, the child was kept sedated for 6.5 h for further investigations. During this period she received a continuous infusion of propofol amounting in total to 1600 mg. After having regained consciousness, she was strikingly ataxic and remained so for 5 days. During this period she also experienced two episodes of hallucinations lasting about 2 h. Investigations including lumbar puncture, EEG, cerebral CT and MR scan could not explain the neurological symptoms. She recovered without long-term sequelae.
Music creation requires a highly orchestrated temporal pattern. The study of a patient with repetitive musical hallucinations enabled us to examine temporal pacemakers in music production. Here, we show that the pattern of faster silent production of a chosen tune compared with its production aloud was reversed when the patient produced the hallucinatory tune. This observation might suggest the utilization of a pacemaker(s), which functions differentially during the disease.
A patient with right hemisphere complex partial seizures exhibited extreme emotional lability resembling mania, neologisms resembling those found in fluent aphasia, and hallucinations during ictal periods. The electroencephalographic and clinical findings in this case suggest that cortical and subcortical structures of the right hemisphere may play a role in mediating the expression of language content.
A patient without a previous history of seizures had a generalized tonic-clonic seizure followed by multiple complex visual hallucinations and illusions (CVHIs) lasting weeks. The patient reported a total of 19 different CVHIs. EEGs performed revealed rhythmic right temporal activity occurring only during the CVHIs. Treatment with antiepileptic drugs (AEDs) resolved the CVHIs and normalized the EEG. An attempt at discontinuation of one AED resulted in a resurgence of the CVHIs and EEG abnormality.
The Norwegian author Tryggve Andersen (1867-1920) had epilepsy, but was not aware of the diagnosis until late in life. In one novel, Towards Night (Mot Kvaeld), published in 1900, he described in detail nocturnal attacks with formed visual hallucinations as the initial event, seeing always the same face. He was familiar with the works of Ernst Hoffmann and probably also with those of Fiodor Dostoyevsky, but deduction of the literary influence leaves a precise description corresponding to an epileptogenic focus in the right posterotemporal region. Knowledge of his work may elucidate the subjective experience of initial epileptic manifestations, uncontaminated by previous knowledge of what can be expected in epilepsy. The descriptions provided by Andersen's writings are compared with more formal contemporary definitions of seizure events.
In 13 elderly patients, 12 of whom had Parkinson's disease, visual hallucinations and delirium developed as a side effect of amantadine hydrochloride (Symmetrel) therapy. The symptoms promptly disappearred when amantadine was discontinued. Thereafter, each parkinsonian patient was treated satisfactorily with levo-dopa. Treatment with a combination of amantadine and an anticholinergic agent increases the likelihood of delirium because of the hazard of retention of urine. Although amantadine is effective in the treatment of Parkinson's disease in the elderly, the incidence of delirium as a complication seems higher in this age group.
Khat is a plant whose leaves are chewed for their stimulating effect. This effect is attributed to cathinone, an alkaloid identical to dextroamphetamine. Khat chewing is widespread among eastern African and Yemenite populations and is believed to be innocuous. Our experience shows, however, that a substantial number of chronic khat chewers experience persistent hypnagogic hallucinations - a symptom that has not yet been described. Three vignettes illustrates this phenomena, which often interferes with psychiatric diagnosis. Different explanatory models are discussed, among them chronic suppression of REM sleep.