Abstract
BackgroundVisual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach) plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEI's have been used in the targeted treatment of visual hallucinations in dementia and Parkinson's Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatmentCase PresentationWe present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully.ConclusionsThis case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field.
Highlights
Visual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia
This case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia
Visual hallucinations occur in a variety of neurological and psychiatric disorders and are prominent in the dementias and psychotic illness
Summary
This case illustrates a novel use for AchEI’s in the targeted treatment of visual hallucinations in Schizophrenia. Often the most challenging cases faced in clinical psychiatry are those with treatment resistant symptoms which can prove distressing to patients. Our approach in this case was to combine current thinking in neurophysiology and therapeutic evidence in related disorders and to apply these to clinical practice in a targeted way. We appreciate that this is a single case and a novel therapeutic use we feel that further research in this field is indicated. Competing interests Authors have no competing interests to declare that are relevant to the content of this submission
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