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

By Abad, Nazir Hashemi; Doulatabad, Najafi Shala et al. | Iranian Journal of Psychiatry, Fall 2011 | Go to article overview

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


Abad, Nazir Hashemi, Doulatabad, Najafi Shala, Mohammadi, Ali, Srazi, Hamid Reza Ghafarian, Iranian Journal of Psychiatry


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. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

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

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Full screen

matching results for page

Cited passage

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

"Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited passage

Welcome to the new Questia Reader

The Questia Reader has been updated to provide you with an even better online reading experience.  It is now 100% Responsive, which means you can read our books and articles on any sized device you wish.  All of your favorite tools like notes, highlights, and citations are still here, but the way you select text has been updated to be easier to use, especially on touchscreen devices.  Here's how:

1. Click or tap the first word you want to select.
2. Click or tap the last word you want to select.

OK, got it!

Thanks for trying Questia!

Please continue trying out our research tools, but please note, full functionality is available only to our active members.

Your work will be lost once you leave this Web page.

For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

Already a member? Log in now.