Tactile Hallucinations Research Articles

Assessing symptoms profile and correlates of very late-onset schizophrenia-like psychosis (VLOSLP)

Objective: While the most common causes of late life psychosis are factors other than primary psychosis, but the nosology and clinical features of late life, primary psychotic is a matter of controversy. The goal of this study was to define some correlates and symptoms profile of very late-onset schizophrenia-like psychosis among an Iranian elderly population presenting with psychosis. Method: From 201 psychotic elderly patients, 39 (19.4%) subjects with the most possible diagnosis of very late-onset schizophrenia-like psychosis were selected. Socio demographic characteristics, past psychiatric history, family history of psychiatric problems, personality traits, cognitive status, history of stressful life events, and burden of medical problems assessed and compared between patients and 39 age and sex mathed controls. Results: The mean age of study sample was 76.9 years. Of 39 patients with VLOSLP, 13 (33.3%) were male and 26 (66.6%) were female. In 32 patients (82.05%) some sorts of hallucinatory experiences were detected. Visual hallucinations were the most common types of hallucinations (69.2%) followed by auditory hallucinations (51.35%) and tactile hallucinations (4%). Persecutory delusions (59%); delusions of references (20.5%); and partition delusions (15.4%) were the most common types of delusions. Significant proportion suffered from some sort of sensory deficit like visual or auditory deficits. There was no significant difference in terms of history of traumatic life events, cognitive function; cumulative burden of medical conditions and personality traits between patients and healthy controls (P > 0.05) Conclusions: Female involved two times more than male. The most common types of psychotic symptoms were visual hallucinations and persecutory delusions. Except sex, exploring other demographics, psychological and physical correlates for VLSOLP patients was not conclusive. More controlled studies using neuroimaging and biomarkers are needed in this issue.

2141 – Ekbom's syndrome

According to the literature, this syndrome is based on a delusive idea from a tactile (hallucinations haptic) and visual (dermatozoopsias) alucinatorio mechanism, from a primary delirious occurrence, or from a delusive secondary idea to poisoning, dementia or depression. Two big groups exist: one ectoparasitario (skin) and another endoparasitario (orifices or internal organs). Physically numerous injuries are observed in some accessible regions of the skin open to the plastered and the patients come to the doctor with imaginary pathogenic. Alternative treatment does not exist for this entity even though pimozine and risperidona take the best effect. Our patient shows an upset case- history, that progressing for twenty years, by depending on opiates and cocaine and he carries out a treatment with agonist opioids (methadone). After years of abstinence, he shows an active cocaine taking developing afterward a extensible parasitoids for four mouths long causing an strong pruritus which he intends to relieve taking the parasites out with the help of skin auto injuries. He brings a flask with skin remains, with the parasites recognized, and a magnifying glass in such a way that the doctor can examine them clearly. Several times he comes to the Medical Service. He upbraids the doctors, who don’t pay attention to him, because he doesn’t agree to be admitted in Infectious Service or Internal Medicine. Finally he is admitted involuntarily in Psychiatric Hospitalization Unit. Once a treatment with pimozide is established and the abstinence from poisons is assured, the delirious disorder, that he suffered, disappears.

Successful Use of Oxazepam in the Treatment of Delirium Tremens

To the Editor: Delirium tremens is a manifestation of alcohol withdrawal syndrome that occurs in about 5% of patients and has a high mortality rate.1 The withdrawal state involves reduced brain γ-aminobutyric acid (GABA) levels and GABA receptor sensitivity and activation of glutamate systems, which leads to neuronal overactivity in the absence of alcohol.2,3 Longer-acting benzodiazepines such as diazepam with active metabolites are preferred over shorter-acting ones for detoxification because they are associated with a lesser chance of recurrent withdrawal.4 Benzodiazepines with a short half-life (eg, oxazepam and lorazepam) have potential benefit for patients with liver disease, which is a common comorbid medical condition in alcohol-dependent individuals. The efficacy and safety of the short-acting benzodiazepine oxazepam in alcohol withdrawal–related delirium are not clear. To our knowledge, this is the only case reported in the literature of the use of oxazepam in the treatment of delirium tremens. Case report. Mr A, a 42-year-old man, presented to the psychiatric emergency services with a 15-year history of alcohol use. He met DSM-IV-TR criteria for alcohol dependence with a history suggestive of craving, tolerance, salience, loss of control, and withdrawal symptoms for the past 5 years. After being abstinent from alcohol for 4 days, he had developed symptoms characterized by disorientation to time, place, and person; tactile hallucinations; severe tremulousness; and autonomic instability signs. On the day of admission in July 2010, the patient’s Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar)5 score was 42, corresponding to severe withdrawal. Mr A did not have a history of seizures, loss of consciousness, or significant head injury. Neurologic examination revealed no focal deficits, and there were no signs or symptoms suggestive of neuroinfection. Computed tomographic scanning of the brain was normal except for mild cerebral atrophy. Biochemical investigations revealed abnormal liver function values, while the results of other tests including sugar levels, renal function parameters, and electrolyte levels were within normal range. In view of the patient’s liver function values, we started treatment with the shorter-acting benzodiazepine oxazepam 90 mg/d in 3 divided doses of 30 mg each, with the dose tapered every 3 days. With tapering doses of oxazepam, Mr A showed improvement, with reduction of CIWA-Ar score to less than 10 by the fifth day. In this case, oxazepam, which is a shorter-acting benzodiazepine, was used to treat delirium tremens. Most benzodiazepines have active metabolites, and hence their duration of action seems to exceed their plasma half-life.4 Oxazepam has no cytochrome P450 interactions and no active metabolites. It does not have initial euphoric effects because of its slow resorption, and therefore there is less risk of misuse. The half-life of oxazepam is 4–10 hours, and it has a better therapeutic window compared to other short-acting agents. Oxazepam has been used in the treatment of uncomplicated alcohol withdrawal syndrome.6 Safety data on the use of oxazepam in medical emergencies such as delirium tremens would be of benefit in cases with associated impaired liver functioning. The outcome of this case, as well as the pharmacokinetics of oxazepam, suggests that it may be a good alternative to lorazepam for patients with significant comorbid hepatic illnesses.

Empirical redefinition of delusional disorder and its phenomenology: the DELIREMP study

AimsSince Kraepelin, the controversy has persisted surrounding the nature of delusional disorder (DD) as a separate nosological entity or its clinical subtypes. Nevertheless, there has been no systematic study of its psychopathological structure based on patient interviews. Our goal was to empirically explore syndromic subentities in DD. MethodsA cross-sectional study was conducted in 86 outpatients with DSM-IV-confirmed DD using SCID-I. Psychopathological factors were identified by factor analysis of PANSS scores. The association between these factors and clinical variables (as per standardized instruments) was analyzed using uni- and multivariate techniques. ResultsPANSS symptoms were consistent with four factors (Paranoid, Cognitive, Schizoid, and Affective dimensions), accounting for 59.4% of the total variance. The Paranoid Dimension was associated with premorbid paranoid personality disorder, more adverse childhood experiences, chronic course, legal problems, worse global functioning, and poorer treatment adherence and response. The Cognitive Dimension was associated with poorer cognitive functioning, premorbid substance abuse, comorbid somatic diseases, mainly non-prominent visual hallucinations, fewer comorbid depressive disorders, and poorer global functioning. The Schizoid Dimension was associated with being single, a family history of schizophrenia, premorbid personality disorders (largely schizoid and schizotypal), non-prominent auditory hallucinations, and dysthymia. Finally, the Affective Dimension was associated with a family history of depression, premorbid obsessive personality, somatic delusions, absence of reference delusions, tactile and olfactory hallucinations, depressive and anxiety disorders, risk of suicide, and higher perceived stress. ConclusionThe identification and clinical validation of four separate psychopathological dimensions in DD provide evidence toward a more accurate conceptualization of DD and its types.

Autoimmune encephalitis associated with Graves’ disease: a case report

Almost all patients who developed autoimmune thyroid disease associated with encephalopathy were diagnosed to have Hashimoto's thyroiditis, but a few patients with Graves' disease who developed encephalopathy have been reported. A 36-year-old female with a 10-year history of Graves' disease had experienced three episodes of tonic-clonic seizure. At admission, the patient's status was confused, and she also developed tactile and visual hallucinations. The cranial MRI confirmed white-matter lesion and showed subcortical high signal lesions on T2-weighted images. In EEG record, diffuse slow activity was noticed in both sides. T3 and TSH were decreased, T4 remained normal and thyroid peroxidase antibody (TPO) was evaluated to be more than 2,000 (T4=8.4, T3=12/9, TSH=0/14, TPO >2,000). The diagnosis of autoimmune thyroid disease is probable in all patients with signs of encephalopathy with unknown origin, while they have a previous history of thyroid disease.

Alucinações táteis: aspectos conceituais e históricos

Uma breve análise histórica do conceito geral de alucinação é apresentada e sugere-se que ela surgiu como a generalização injustificada de um modelo perceptual que estava destinado a ser aplicado apenas para a visão e os "sentidos de distância". Neste contexto, considera-se a evolução das alucinações táteis e explora-se sua interação com a teoria psicológica vigente no século XIX. Conclui-se que as alucinações táteis são fenômenos sui generis que não se encaixam no modelo convencional e que a identificação de seu quadro clínico baseia-se, até o momento, em critérios pouco claros. Apresenta-se uma breve revisão da sua taxonomia e utilidade diagnóstica. Algumas implicações mais amplas são delineadas, as quais podem ser relevantes para a concepção geral da alucinação.

Visual and Auditory Hallucinations During Normal Use of Paroxetine for Treatment of Major Depressive Disorder

Visual and Auditory Hallucinations During Normal Use of Paroxetine for Treatment of Major Depressive Disorder

Misusing Volatile Substances for Their Hallucinatory Effects: A Qualitative Pilot Study With Mexican Teenagers and a Pharmacological Discussion of Their Hallucinations

This work describes the solvent-induced hallucinatory experiences of 10 male and seven female teenagers in Mexico City from 1998 to . The youth were recruited from public schools through a combined snowball and convenience sampling procedure. Inclusion criteria were: 13–18 years of age, school attendance, living with family, and weekly toluene-based solvent misuse. Interested students were interviewed and transcripts were analyzed. Hallucinations and illusions were common, including changes in color perception, visual, somatic, auditory, and tactile hallucinations. Some users described their hallucinatory experience as being able to be shared by a group and modulated by their environment. The pharmacological linkages with hallucinations are discussed. The study's limitations are noted.

Ekbom Syndrome: A Delusional Condition of “Bugs in the Skin”

Entomologists estimate that more than 100,000 Americans suffer from "invisible bug" infestations, a condition known clinically as Ekbom syndrome (ES), although the psychiatric literature dubs the condition "rare." This illustrates the reluctance of ES patients to seek mental health care, as they are convinced that their problem is bugs. In addition to suffering from the delusion that bugs are attacking their bodies, ES patients also experience visual and tactile hallucinations that they see and feel the bugs. ES patients exhibit a consistent complex of attributes and behaviors that can adversely affect their lives.

A 67-Year-Old Woman with Depression

A 67-year-old woman had been residing in a nursing home after having a bilateral knee amputation as a complication of long-standing diabetes. She was brought to the attention of psychiatric services due to longterm depression, recent onset of visual hallucinations of insects fl ying in the room, and tactile hallucinations of insects crawling on her body. The sensation of insects crawling on her body caused her to scratch herself repeatedly, resulting in multiple skin lesions. A dermatology consult was placed, but upon no evidence of infection or infestation, psychiatry was consulted. She appeared depressed with increased fatigue, decreased appetite, nonspecifi c weight changes, decreased sleep of 4 to 5 hours per night with late insomnia, and reduced concentration. She remained predominantly isolative and withdrawn but was not suicidal. In the past, the patient was hospitalized five times for depression, with an episode of delusions of parasitic infestation resulting in her calling the sanitation department to her home. Her social history revealed a lifestyle marked by meticulousness, obsessions about order, and cleanliness. She grew up in a low-income family, and her parents separated when she was very young. Her family’s financial limitations caused her to interrupt her education and obtain employment at an early age. As a child, she described herself as being self-reliant and resilient due to her distant and harsh parents. She married at an early age. She said her husband was unsupportive and physically abusive. They later divorced. She was disengaged from her family, departed her home country, and immigrated to the US at an early age. Since arriving in the US, she has been living alone with no close relationships. She continued to work a low-income job in the US. She had initial adjustment diffi culties, stemming from the language barrier. Over time, she adjusted well and assimilated into the culture. After her medical illness started, she again had diffi culties supporting herself and, gradually, her behavior changed. She then became very withdrawn. However, she displayed a marked indifference to her social isolation and loneliness. Treatment began with initial laboratory tests including CBC with differentials, P14, vitamin B1, B6, B12, folate levels, RPR, and urine analysis. The results of the tests were within normal limits. A computerized tomography (CT) scan of the brain, without contrast, revealed no pathologies or focal lesions. A magnetic resonance image (MRI) of the brain was scheduled to rule out any lesions secondary to the diabetes mellitus, but the patient refused the procedure. The patient was initially treated with duloxetine 60 mg once daily for depression. The dose was increased to 120 mg daily. She continued to exhibit a decrease in fatigue and appeared less withdrawn. Her sleep and appetite were initially impaired Asad Amir, MD, is Psychiatry Resident, Bergen Regional Medical Center, Paramus, NJ. Amel Badr, MD, is Assistant Program Director, Bergen Regional Medical Center. Javed Iqbal, MD, is Program Director, Psychiatry Residency Program, Bergen Regional Medical Center. Address correspondence to: Asad Amir, MD: aamir@bergenregional.com; drasadamir05@yahoo.com. Dr. Amir; Dr. Badr; and Dr. Iqbal have disclosed no relevant fi nancial relationships. The authors would like to acknowledge Sree Latha Krishna Jadapalle, MD; and Eric Fletcher, MA, for their assistance with this manuscript. doi: 10.3928/00485713-20110203-04

Pituitary Microadenoma Treated with Antipsychotic Drug Aripiprazole

Male patient 24 years old with a pituitary microadenoma and mental and behavioural disorders due to multiple drug use and use of other psychoactive substances (cocaine, cannabis and alcohol) were treated with haloperidol (dopamine receptor blocker) 10 mg daily. In the last control, the patient presented mammary hypertrophy; laboratory testing and brain magnetic resonance imaging (MRI) was performed, reporting the presence of a pituitary microadenoma syndrome with hormonal alteration (Prolactin levels 28.4 ng/ml). Haloperidol, carbamazepine and levomepromazine were then discontinued. He was started on aripiprazole 15 mg po daily for 4 days; the dosage was then increased to 30 mg po daily, with Valproic Acid 500 mg po tid. After 3 weeks on aripiprazole, the mammary hypertrophy that had increased in the patient had resolved. After 10 weeks follow up of prolactin revealed a normal level, at 4.33 ng/ml. Insomnia, aggressiveness, irritability, visual, tactile and auditory hallucinations remained absent after treatment with aripiprazole which is not a first line drug in multiple drug use patient with psychosis. We also consider the correlation of drug use in patient with psychosis, haloperidol treatment, pituitary microadenoma syndrome, hyperprolactinemia, and dopamine D2- receptor partial agonist aripiprazole treatment. This article also summarizes some relevant patents.

Ekbom's Syndrome as the First Manifestation of Diabetes Mellitus

Back to table of contents Previous article Next article LETTERFull AccessEkbom’s Syndrome as the First Manifestation of Diabetes MellitusJoana Mesquita M.D.Sónia Simões M.D.,Álvaro Machado M.D.,Luísa Siva M.D.,Joana Mesquita M.D.Search for more papers by this authorSónia Simões M.D.Search for more papers by this author,Álvaro Machado M.D.Search for more papers by this author,Luísa Siva M.D.Search for more papers by this author,Published Online:1 Oct 2010https://doi.org/10.1176/jnp.2010.22.4.451.e36AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Ekbom’s syndrome is a rare and mostly unknown psychiatric disorder that is characterized by the fixed and false conviction of being infested with parasites. 1 Patients frequently experience tactile, visual, haptic, or auditory hallucinations, giving detailed descriptions of the characteristics and the activities of the offending parasites. Insomnia is a common complaint as the patients are frequently quite disturbed by the parasites. 2 It can be primary or secondary to several medical and psychiatric disorders or to the use of prescribed or illicit drugs. 3Case ReportA 62-year-old woman with a medical history of congenital idiopathic mental retardation and arterial hypertension presented with tactile, haptic, and visual hallucinations of bugs over the head and members. She reported that they would crawl and bite her arms even at night, preventing her from sleeping. She tried to catch them and show to the physician. She explained these symptoms in a delusional manner, saying that she had been previously bitten by a fly which first inoculated her with the eggs that originated the bugs. An analytic study showed fasting glucose of 283 mg/dL, with no other abnormality, including blood count, vitamin B 12 and folic acid levels, liver, renal, and thyroid functions. A brain MRI was normal. The patient was admitted and treated with pimozide, gliclazide, and metformin. When hospitalized, she brought a napkin that she said was full with bugs and made a drawing of the insects she thought were infesting her. She was discharged 40 days later with discrete improvement of the delusional ideas and fasting glucose levels ranging from 112 to 140 mg/dL. Discussion Ekbom’s syndrome was first methodically described by Karl Axel Ekbom in 1938. 4 It can occur at any age, though the average is in the fifth decade, particularly among females. 3 There are several medical disorders which have been found to be related to Ekbom’s syndrome, including tuberculosis, syphilis, dermatitis, hypothyroidism, renal and heart failure, hepatic disorders, leukemias, lymphomas, vitamin B 12 deficiency, pellagra, diabetes mellitus, dementias, Huntington’s disease, cerebral infarction, CNS tumors, multiple sclerosis, and Parkinson′s disease. 1 , 2Though there were several cases of Ekbom’s syndrome occurring in diabetics, a thorough search on MEDLINE did not retrieve any case of Ekbom’s syndrome revealing a previously unknown diabetes mellitus. The contribution of mental retardation to the development of the syndrome in our patient is unclear, but, because it is more prevalent in such cases, mental retardation might have acted as a predisposing factor.Our case highlights the need for a thorough laboratory workup in patients with Ekbom’s syndrome, as treatable conditions can be found and properly managed.Psychiatry and Mental Health Department, Hospital de São Marcos, Braga, PortugalNeurology Department, Hospital de São Marcos, Braga, PortugalPsychiatry and Mental Health Department, Hospital de São Marcos, Braga, Portugal

Relationship between gender and psychotic symptoms in cocaine-dependent and methamphetamine-dependent participants

It has been well documented that cocaine and methamphetamine use can lead to the onset of psychotic symptoms similar to schizophrenia. However, the research and literature on gender differences and stimulant-induced psychosis have been mixed. The primary aim of this study was to investigate gender differences in the reporting of psychotic symptoms in cocaine- versus methamphetamine-dependent individuals. Participants were recruited from the Los Angeles, California, community via radio and newspaper advertisements. All met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for cocaine or methamphetamine dependence, and all reported either methamphetamine or cocaine as their primary drug of abuse. During a screening interview, participants answered questions from the Psychotic Symptom Assessment Scale, which characterizes various types of psychotic symptoms during drug use ("while high") or during periods of nonuse ("while abstinent"). Participants included 42 cocaine-dependent individuals (27 men, 15 women) and 43 methamphetamine-dependent individuals (25 men, 18 women). Among cocaine users, there were no significant differences between men and women with regard to ethnicity, years of use, route of administration, and amount used in the past week, though they differed significantly with regard to age (P = 0.029). In the "while abstinent" condition, women were significantly more likely than men to report experiencing auditory hallucinations (13% vs 0%, respectively; P = 0.050) and tactile hallucinations (20% vs 0%; P = 0.016), whereas men were more likely to report delusions of grandeur (48% vs 6%; P = 0.006). During the "while high" condition, women were significantly more likely than men to report delusions of grandeur (13% vs 0%, respectively; P = 0.050), tactile hallucinations (33% vs 0%; P = 0.001), and olfactory hallucinations (13% vs 0%; P = 0.050). Among methamphetamine users, there were no significant differences between men and women with regard to age, ethnicity, years of use, route of administration, or amount used in the past week. In the "while abstinent" condition, women were significantly more likely than men to report feeling that something was wrong with the way a part of their body looked (72% vs 32%, respectively; P = 0.009), olfactory hallucinations (39% vs 8%; P = 0.010) and dressing inappropriately (22% vs 0%; P = 0.010). During the "while high" condition, women were more likely than men to report delusions of grandeur (33% vs 16%, respectively; P = 0.030), paranoia (50% vs 16%; P = 0.017), and tactile hallucinations (61% vs 32%; P = 0.050). The findings of the present study revealed that cocaine- and methamphetamine-dependent women were more likely than their male counterparts to report experiencing various psychotic symptoms. This information may be useful for clinicians and mental health professionals, who should take these symptoms into account as potential barriers that may impede effective treatment.

Olfactory hallucinations in schizophrenia and schizoaffective disorder: A phenomenological survey

Olfactory hallucinations (OHs), so it has been argued, are prognostic of a poorer outcome, are unpleasant, and cannot be well explained within current theoretical accounts of hallucinations. We examined these and related issues by conducting structured interviews with 51 participants who experienced OHs and who were previously diagnosed with schizophrenia or schizoaffective disorder. We found no relationship between disease severity measures and type or frequency of OHs. As with prior research, we too noted the predominance of negative OHs, but with many reports of positive OHs, and also found significant relationships between frequency of OHs and severity of tactile hallucinations. We then examined whether odor imagery or involuntary memory might account for the presence of OHs, but these possibilities were not well supported. We then explored, using cluster analysis, whether or not our sample was homogenous. Two clusters were of especial interest; one which may reflect a ‘sensory dysfunction group’ and one characterized by more severe tactile hallucinations. The presence of tactile hallucinations may suggest a further novel cause of OHs, which we discuss. Our data suggest diverse causes for OHs in schizophrenia, none of which are consistent with current models of hallucinations in other modalities.

Medically Unexplained Physical Symptoms Masking (Cenesthopathic) Schizophrenia: A Case Series

The authors present a case series involving four patients who were referred to a specialized somatoform disorders clinic because of chronic medically unexplained physical complaints. The patients were eventually diagnosed with cenesthopathic schizophrenia, a term that has been proposed for a type of schizophrenia in which tactile hallucinations and delusional somatosensory beliefs are prominent. Two of the four had definite responses to antipsychotic medication. All of the patients were immigrants to the United Kingdom, and cultural and language barriers were likely factors in delayed diagnoses.

Rituximab Induced Serum Sickness Masquerading as Septic Shock

Purpose We describe a case of serum sickness following rituximab infusion in Waldenström macroglobulinemia. Introduction Rituximab is a chimeric monoclonal anti-CD20 antibody used to treat hematologic malignancies and autoimmune diseases. Infusion reactions are very common with rituximab (77%), occurring within 30-120 min of the beginning of the infusion (rituximab package insert; Genentech, Inc); however, rituximab may cause a delayed serum sickness–like reaction as well. Description Our patient is a 51-year-old Caucasian woman diagnosed with Waldenström macroglobulinemia in 2004. At that time, she was treated with 3 cycles of rituximab therapy followed by plasmapheresis for a hyperviscosity reaction. Over the next 3 years she had an uneventful course. However, beginning in 2007 she started having unexplained severe headaches, painful peripheral sensory neuropathy, and night sweats. After a thorough work-up to rule out other etiological causes, we decided to re-challenge her with rituximab in November 2009. She was to undergo 3 cycles of plasmapheresis followed by rituximab infusions (375 mg/m2/week for 4 weeks). Prior to initiation of rituximab, her IgM level was 2447 mg/dL, and her serum viscosity was 2.0. She underwent 3 uneventful cycles of plasmapheresis, after which she received her first rituximab infusion. During the infusion, she did experience some nausea, abdominal pain, tactile hallucinations, and perioral numbness; however, these resolved with extra doses of steroids and antihistaminics. One week after the administration of the first rituximab infusion, she was found to be hypotensive with her systolic BP in the 60s mmHg and was febrile to 1015. She needed admission to the intensive care unit and was presumptively treated as having a catheter-related sepsis needing Norepinephrine pressor support and broad spectrum antibiotic coverage. Her IgM level at the time of admission was 1049 mg/dL, and her serum viscosity was 1.5. She did not have any skin rashes, thrombocytopenia, or proteinuria. During her hospital stay, all of her chemistries were within normal limits, and her microbiologic cultures were repeatedly negative. She did have elevated inflammatory biomarkers such as ESR (66 mm/hr) and CRP (17.5 mg/dL). On her third day in the intensive care unit, she complained of excruciating joint pains with swelling, particularly of her wrists and knees. At this point, her antibiotics were discontinued, and she was treated with systemic steroids leading to a significant improvement in her symptoms and discharge from the hospital. Conclusion Rituximab may present with a severe serum sickness like reaction masquerading as septic shock when used to treat hematologic malignancies. Almost all of the case reports that we reviewed on rituximab-induced serum sickness documented reactions such as fever, arthralgias, and rashes (Jacobs; Clin Nucl Med; 2007; 32:12, and Helfgott; J Rheumatol; 2007; 34:430-3); however, to our knowledge this is the first documented case of rituximab-induced serum sickness presenting with hypotension necessitating pressor support.

Positive psychosis symptom structure in the general population: Assessing dimensional consistency and continuity from “pathology” to “normality”

The current study assessed the dimensionality of positive psychosis symptoms. Data from the National Comorbidity Survey (1990–1992) was used to examine the underlying factor structure of positive psychosis symptoms based on participants’ responses to the 13 Composite International Diagnostic Interview (CIDI) psychosis screening items. Confirmatory factor analysis (CFA) was used to compare four theoretically based competing factor analytic models of positive psychosis. Fit statistics indicated that the best fitting model was comprised of three correlated factors: a hallucinations factor, a Schneiderian delusions factor, and a paranoid delusions factor. There were no significant differences between the sexes on scores for the Schneiderian Delusions and Paranoid dimensions; however, females scored significantly higher on the Hallucinations dimension. At an item level, male respondents were significantly more likely to report experiences of paranoia; being controlled by an external force; and having their thoughts stolen by another. Females, on the other hand, were significantly more likely to experience auditory, olfactory, and tactile hallucinations. They were also more likely to believe that others were reading their mind. The three underlying factors were consistent with existing clinical models of positive psychosis symptom dimensionality and provide further evidence of a continuum of psychosis.

Out-of-Body Experiences and Hallucinatory Experiences: A Psychological Approach

In an out-of-body experience (OBE), the “self,” or center of awareness, seems to temporarily occupy a position spatially remote from one's body. In support of previous studies, undergraduate students reporting OBEs ( N = 132) showed a higher level of cognitive-perceptual schizotypy, absorption, dissociation, fantasy, and hallucination proneness, and visual imagery than did non-OBErs ( N = 516). Absorption and cognitive-perceptual schizotypy were the best discriminators for visual and tactile hallucinations ( p < .001). The results support a dissociation model of OBEs. Some persons reported beneficial adaptive effects from their OBEs. Despite the widespread occurrence of anomalous perceptual experiences, including OBEs, in the general population, the term hallucination still has pejorative overtones. The present results are in agreement with other studies in which measures of fantasy proneness seemed to be successful predictors of psychic phenomena (Myers, Austrin, Grisso, & Nickeson, 1983; Wilson & Barber, 1982). Such findings suggest that OBEs may be related to fantasy proneness and cognitive-perceptual schizotypy, which are correlated with each other. Future research should focus on the role of different types of OBEs in personality and cognitive processing.

Auditory Hallucinations in Dissociative Identity Disorder and Schizophrenia With and Without a Childhood Trauma History

Little is known about similarities and differences in voice hearing in schizophrenia and dissociative identity disorder (DID) and the role of child maltreatment and dissociation. This study examined various aspects of voice hearing, along with childhood maltreatment and pathological dissociation in 3 samples: schizophrenia without child maltreatment (n = 18), schizophrenia with child maltreatment (n = 16), and DID (n = 29). Compared with the schizophrenia groups, the DID sample was more likely to have voices starting before 18, hear more than 2 voices, have both child and adult voices and experience tactile and visual hallucinations. The 3 groups were similar in that voice content was incongruent with mood and the location was more likely internal than external. Pathological dissociation predicted several aspects of voice hearing and appears an important variable in voice hearing, at least where maltreatment is present.

Baclofen Withdrawal Causes Psychosis in Otherwise Unclouded Consciousness

Back to table of contents Previous article Next article LETTERFull AccessBaclofen Withdrawal Causes Psychosis in Otherwise Unclouded ConsciousnessTina Malhotra M.B.B.S., M.R.C.Psych.,Ivana Rosenzweig M.D., Ph.D., M.R.C.Psych.,Tina Malhotra M.B.B.S., M.R.C.Psych.Search for more papers by this author,Ivana Rosenzweig M.D., Ph.D., M.R.C.Psych.Search for more papers by this author,Published Online:1 Oct 2009AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Baclofen is a well known GABA B receptor agonist, and intrathecal baclofen therapy is increasingly used to treat medically intractable spasticity. 1 In recent studies of rodent models, activation of GABA B receptors with baclofen was reported to reverse sensory gating deficits, a known endophenotype of psychosis. 2 There needs to be a greater awareness of the dangers of baclofen toxicity and withdrawal, including its neuropsychiatric effects. 1 Here we report an unusual case of repeated exposure to baclofen toxicity and a subsequent withdrawal state resulting in the emergence of frank psychotic symptomatology without concomitant clouding of consciousness and with retained attention and orientation. Case ReportA 45-year-old patient suffering from progressive spastic quadriparesis of unknown origin went from a comatose state to a fulminant psychotic episode following elective insertion of an intrathecal baclofen pump. She was on oral baclofen, with no previous psychiatric diagnosis or other relevant medical history. Inadvertently, a 20 times higher than usual daily dose of baclofen was given via pump, as a result of which she became progressively drowsy and unresponsive (Glasgow Coma Scale=3). The pump was promptly stopped, and within 24 hours she regained consciousness and stabilized, but developed vivid visual, auditory, and tactile hallucinations. She was found to experience intensive feelings of derealization and depersonalization and appeared to have developed a complex paranoid delusional system. On assessment she also reported Schneiderian first-rank symptoms, but, interestingly, otherwise appeared cognitively intact, fully orientated throughout, and with retained attention. A withdrawal reaction was diagnosed and baclofen reintroduced. Although the patient’s mental state improved following the reestablishment of baclofen, the elaborate delusional ideation and feelings of depersonalization continued, prompting introduction of risperidone, 1 mg at night. Over the following days further improvement was noted, and eventually risperidone was stopped. Once discharged, the patient was followed in the psychiatric outpatient clinic where she continued to report some altered perceptions and paranoid overvalued ideation, but no frank psychotic symptoms during the next few months.Comment The pathophysiology of the effect of baclofen in humans in producing psychotic symptoms during withdrawal states, such as were present in our patient, is as of yet unclear and warrants further investigation. 1 Interestingly, Leo and Baer 3 recently suggested that delirium rather than psychiatric symptoms consistent with a psychiatric disorder, or an exacerbation of a preexisting psychiatric illness, was the result of the withdrawal. In their review of all reported cases in the literature so far, a fluctuation of consciousness, inattention, memory impairments, and/or perceptual disturbances emerged abruptly in association with the withdrawal of baclofen. Moreover, the psychiatric symptoms were reported to emerge in the context of disturbed physical parameters, including tachycardia, autonomic changes, seizures, and spasticity. 3 This is in clear contrast to our case where an unambiguous set of psychiatric symptoms developed in the background of unclouded consciousness, retained attention, intact cognition and without disturbed autonomic parameters and hence forfeited the syndromal diagnosis of delirium. Brain Mapping Unit, Addenbrookes Hospital, Cambridge, UKLiaison Psychiatry, Addenbrookes Hospital, Cambridge, UK.