engleski

Command hallucinations in schizoaffective disorder

Schizoaffective disorder is a specific mental disorder involving both psychotic and affective symptoms. During acute psychosis in schizophrenia, the appearance of command hallucinations is possible. Command hallucinations are verbal hallucinations in which the affected individual hears specific instructions. The aim of this case is to show how discontinuation of long-term therapy in schizoaffective disorder can lead to strong imperative hallucinations. A 35-year-old female with schizoaffective disorder was admitted to the Department of Psychiatry because of severe command hallucinations. She has positive psychiatric heredity. Her sister suffers from schizophrenia while both parents are alcoholics. She has been hospitalized in psychiatry severaltimes in the last two years since her diagnosis was determined. The last hospitalization was a month before the onset of command hallucinations. Since that she adhered to the prescribed pharmacotherapeutic regimen and the only change was the exclusion of depot preparation of paliperidone palmitate. During the examination, she was frightened, suspicious, contactable after encouragement with a prominent low mood. She admits hearing voices that were insulting her and telling her to kill herself. On presentation, the patient was in consciousness, contactable, oriented in place and time but slow to questioning. Psychomotor tension, anxiety, and depressive mood were noted. During hospitalization, she was treated with a combination of psychopharmaceuticals (aripiprazole, diazepam, flurazepam, lamotrigine, biperidine) with re-introduction of the depot preparation paliperidone palmitate. Upon discharge, the patient was significantly psychomotorly calm without the imperative hallucinations described at admission. This case clearly shows how the abrupt exclusion of long-term depot therapy in patients with schizoaffective disorders can affect the onset of powerful deceptions that can result in imperative suicidal ideas. It is also important to emphasize that monitoring patients with schizoaffective disorder after discontinuation of any psychopharmaceutical plays an important role in preventing poor outcomes.

hallucinations, schizophrenia, paliperidone

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