Treatment Of Hallucinations Research Articles

Tratamiento de los síntomas neuropsiquiátricos en la enfermedad de Alzheimer

The overall goal of all therapeutic interventions in Alzheimer s disease (AD) is the optimisation of the adaptive functions and quality of life of these patients. The general strategy for the use of pharmacological interventions in the treatment of neuropsychiatric manifestations of AD includes the following: 1) An exhaustive evaluation of the psychiatric symptomatology; 2) Establish a hierachy of the simptoms to treat based on their severity of symptoms and on their impact on the caregiver; 3) The identification of an adequate agent based on the type of symptoms and subject s characteristics; 4) The initial use of low doses with gradual titration, and 5) Changing one drug at a time. Regarding psychotic symptons, the introduction of new agents (e.g., risperidone) has replaced the use of traditional treatments (e.g., thioridazine) in patients with AD. The presence of psychomotor agitation and aggression can be treated with great variety of drugs, such as antipsychotics, anticonvulsants, antidepressants, and sedatives. Selective serotonine re uptake inhibitors are the treatment of choice for depressive symptomatology. The cholinesterase inhibitors have shown to be useful in the treatment of hallucinations, anxiety and apathy.

Diffuse Lewy Body Disease.

Diffuse Lewy body disease (DLB) is a neurodegenerative disorder characterized by dementia, fluctuations in mental status, hallucinations, and parkinsonism. Diffuse Lewy body disease is the second most common cause of dementia, following Alzheimer's disease. The treatment of DLB includes cholinergic therapy for cognitive impairment, atypical neuroleptics to alleviate hallucinations, and levodopa/carbidopa to improve parkinsonism. The recognition and diagnosis of DLB has critical treatment implications. Centrally acting cholinesterase inhibitors, such as rivastigmine, donepezil, and galantamine partially reverse decreased cortical cholinergic activity and may improve cognition and neuropsychiatric symptoms in DLB. Rivastigmine has been demonstrated to improve cognition and neuropsychiatric symptoms in patients with DLB without worsening parkinsonian features. Due to the potential adverse events associated with neuroleptics in this population, treatment with cholinesterase inhibitors is currently considered first-line therapy in the treatment of hallucinations and mental status fluctuations in DLB. Exquisite sensitivity to neuroleptic medications is a hallmark of DLB and life-threatening complications have been reported. Caution should be exercised when implementing antipsychotic therapy for the treatment of behavioral disturbances of DLB. When required, atypical neuroleptics with the least extrapyramdial side effects, such as quetiapine, should be used. The parkinsonian features of DLB may respond to dopaminergic therapy with levodopa. If parkinsonian symptoms result in clinical disability, a trial of levodopa is warranted. Unfortunately, dopaminergic medications may worsen hallucinations. Because dopamine agonists have a greater tendency to induce hallucinations and somnolence, levodopa is the treatment of choice for parkinsonism in DLB. Rapid eye movement (REM) sleep behavior disorder (RBD) is now recognized as a feature of DLB. Awareness of the presence of this symptom in patients with DLB is important and treatment with low dose clonazepam may help. Cholinergic aumentation may also improve these symptoms in patients with DLB.

401. One Hertz rTMS of left temporoparietal cortex in schizophrenic patients reporting auditory hallucinations

Studies suggest that auditory hallucinations (AHs) of spoken speech arise partly from brain regions responsible for speech processing. One Hz repetitive transcranial magnetic stimulation (rTMS) of ∼15 minutes duration has been shown to reduce cortical activation. We will present two studies testing the hypothesis that 1 Hz rTMS delivered to left temporoparietal cortex, a brain region critical for speech processing, reduces AHs. The first study used once daily rTMS at 80% motor threshold for 4–16 minutes duration built up over four days. Twelve schizophrenic patients with medication-resistant AHs were randomized to active versus sham stimulation and studied using a double-blind, cross-over design. Significant improvements in AHs were detected following 12 minutes (p < .02) and 16 minutes (p < .0001) of active rTMS but not following sham stimulation. Endpoint hallucination severity following the active stimulation trial was significantly less than hallucination severity following sham stimulation trial (p < .006). Duration of symptomatic improvement ranged from 1 day to 2 months. Results of a second, double-blind trial of rTMS utilizing seven instances of rTMS at 16 minutes duration will also be presented. Data from our first nine patients suggest that this more extended trial produces robust and sustained reductions in AHs in ∼70% of patients. Our findings emphasize the role of posterior, speech processing areas of the brain in the generation of AHs. One Hz rTMS deserves further study as a possible treatment for hallucinations and other psychotic symptoms.

Risperidone treatment of drug-related psychosis in patients with parkinsonism

Risperidone, a novel neuroleptic with approximately equal D2 and 5HT2A receptor blocking properties, has been used to treat drug-related hallucinations in patients with Parkinson's disease. However, the results of only small numbers of patients have been reported with the drug demonstrating limited usefulness. We report our experience with this drug in 39 patients (25 women and 19 men) with parkinsonism. Monitored clinical data included duration of disease, Hoehn and Yahr score, Mini-Mental State Score, Unified Parkinson's Disease Rating Scale (UPDRS) prior to drug administration and after 3 and 6 months of treatment, and response to treatment. Twenty-three patients with Parkinson's disease had either complete or near-complete resolution of hallucinations whereas an unsatisfactory response (N = 6) or worsening of parkinsonism (N = 6) was noted in 12 patients, only six of whom had Parkinson's disease. Excluding patients with diffuse Lewy body disease, there was no significant worsening of the UPDRS scores after either 3 or 6 months of treatment. The presence of dementia did not predict response to treatment. Our results suggest that risperidone is a useful treatment for hallucinations in patients with parkinsonism.

Profiles of the Affinity of Antipsychotic Drugs for Neurotransmitter Receptors and Their Clinical Implication.

The binding affinities of 12 different neurotransmitter receptors were measured using a radio-labeled receptor assay.The profiles of the pharmacological affinities of 20 antipsychotic drugs were assessed. Based on the Ki values for the D2 receptor, 5HT2 receptor, and α1 receptor, the antipsychotic drugs were classified into five groups (i.e., three anti-DA activity predominant groups and two anti-5HT activity predominant groups).A theoretical basis for drug choice in clinical settings is also proposed. We recommend that the groups of the drugs having predominantly anti-DA activity be used in the treatment of hallucinations and delusions and that the drugs in the anti-5HT activity predominant group be used to treat hypobulia. If it is necessary to administer two or more of these drugs together, we propose that they should be drugs with different profiles. Extrapyramidal symptoms, side effects of antipsychotic drugs, were interpreted in terms of interaction among the anti-D2 activity, anti-5HT2 activity, and anti-Ach activity.

Origin and treatment of hallucinations.

Origin and treatment of hallucinations.

Behavioral Treatment of Chronic Psychiatric Patients

Behavioral treatments for hallucinations and delusions, aggressive and destructive responses, inappropriate social behavior, poor self-care and grooming, and deficient recreational and vocational skills in chronic psychiatric patients are reviewed. Consideration is given to the short-term, long-term, and generalized effects of these interventions. Three case studies illustrate behavioral procedures of consumable reinforcement, response cost, graphic feedback, differential reinforcement of other behavior (DRO), and overcorrection. The potential contribution of clinical social workers in applying such programs on a psychiatric unit is discussed.

Hypnotic Treatment of Hallucinations and Disordered Impulse Control

A highly motivated, fifty-nine-year-old, male patient with psychotic episodes of unknown etiology involving visual and auditory hallucinations was treated successfully using nonauthoritarian hypnotic interventions in the absence of any psychotropic medication. His hallucinations remitted completely as did the occurrence of bizarre, impulsive nocturnal behaviors that often accompanied the hallucinations. Speculations regarding the therapeutic mechanisms involved are presented. Stress reduction, especially that resulting from increased acceptance of his hallucinations, is postulated as having been largely responsible for the gains achieved.

Diazepam in the Treatment of Hallucinations

Diazepam in the Treatment of Hallucinations

Diazepam in the treatment of hallucinations

Diazepam in the treatment of hallucinations

Thought-stopping and anger induction in the treatment of hallucinations and obsessional ruminations.

Thought-stopping and anger induction in the treatment of hallucinations and obsessional ruminations.

On the treatment of Hallucination by Electrization

So much difficulty is experienced in producing the slightest alleviation of the sufferings of those affected with that form of derangement of the nervous centres which gives rise to what has been termed a hallucination, that the suggestion of any means by which this disease can be directly attacked, must be regarded as a decided advance in the treatment of this affection. Such a suggestion has recently been made by M. Baillarger, of Paris, in the recommendation of electrization.

On the treatment of hallucinations by datura stramonium

On the treatment of hallucinations by datura stramonium