Treatment of Visual Hallucinations in Schizophrenia by Acetylcholinesterase Inhibitors: A Case Report

Article excerpt

Schizophrenia and various neurological disorders have some signs and symptoms. Visual hallucinations are one of such disorders. The related studies in some diseases for example Parkinson Disease and Lewy Body Dementia indicate that Acetylcholine (Ach) plays a significant role in neuropsychiatric manifestation and its association with visual hallucination; therefore, visual hallucinations occur due to the depletion of Ach. Drug therapies such as Cholinesterase inhibitors (ChEIs) for increasing Ach level may be beneficial in treating visual hallucination. AchEI's have been used in the treatment of visual hallucinations in Dementia and Parkinson's Disease. We thought that a similar Ach depletion may cause visual hallucinations in patients with schizophrenia and may provide a target for drug treatment. We had a patient with schizophrenia whose psychotic symptoms responded to the treatment plan, but her visual hallucination did not. However, the patient's visual hallucination successfully responded to Rivastigmine (AchEI).

This case illustrates the use of an AchEI in the treatment of refractory visual hallucinations in a patient with schizophrenia.

Keywords: Acetyl cholinesterase inhibitors, Hallucinations, Schizophrenia, Visual Perception

Iran J Psychiatry 2011; 6:161-163

The annual incidence of schizophrenia averages 15 per 100000, the point prevalence averages 4.5 per population of 1000(1). Visual hallucinations are one of the symptoms of schizophrenia and of various other neurological disorders (2, 3). Acetylcholine (ACh) plays an important role in a wide variety of cognitive tasks such as perception, selective attention, associative learning, and memory (4). The cholinergic disturbance may contribute to neuropsychiatric manifestation of the disease particularly for such symptoms as hallucination and delusion (5). A more recent study focused on acetylcholine depletion and its association with visual hallucination. The treatment of the visual hallucination often targets the underling illness rather than the symptom (6). Drug therapies to increase the level of Ach, and cholinesterase inhibitors (ChEIs) may be beneficial in treating visual hallucination of various

neurological disorders such as Dementia with Lewy Bodies (DLB) and Parkinson's disease. The introduction of Rivastigmine led to improvement in cognitive and functional abilities as well as resolution of behavioral problems and visual hallucinations. As indicated in some researches, Rivastigmine, Donepezil, Galantamine are some ChEIs that may be effective in the treatment of visual hallucination (7, 14).

We had a patient with schizophrenia whose psychotic symptoms responded to treatment plan, but not her visual hallucination. We observed a case presentation by Sachin ,SP: Acetylcholinesterase inhibitors (AchEI,s) for the treatment of visual hallucination in schizophrenia(6) ,and used Rivastigmine (an AchEIs) to treat our patient's resistant and distressing visual hallucination. The patient's visual hallucination successfully responded to Rivastigmine (AchEI).

Case presentation

The case was a 28- year old single female, with primary education degree who had been diagnosed with schizophrenia. She was admitted to the psychiatry ward of the Rajaee Hospital (Yasouj city, south of Iran). When she was admitted, she presented abnormal behavior, agitation, self talking, self laughing, and occasional aggression. She had paranoid delusions, auditory and visual hallucinations of her both parents with their dog, and she had no insight into her illness. Despite managing these symptoms with antipsychotic medications for 6 months, they remained unchanged. These visual experiences were evident during the day and night, especially when she was alone. The patient had a past history of schizophrenic features since 6 years ago, with 3 exacerbated episodes. She referred to a local physician, received antipsychotic drugs, and as a result her condition improved temporarily. …