Clinical Reasoning: An unusual case of auditory hallucinations in a middle-aged manстатья из журнала
Аннотация: A 48-year-old left-handed man presented to our emergency department (ED) with a 2-year history of auditory hallucinations that had become louder over several days.The hallucinations were the voices of the patient's mother and brother.They blamed him for his mother's death and sometimes gave him commands to shoplift, but never to harm himself or others.He denied visual hallucinations and paranoia.He had no significant medical or psychiatric history but did have a brother with schizophrenia.He had a history of cocaine and alcohol abuse but had been sober for over 200 days.Urine toxicology screen was negative.He was started on risperidone and observed overnight in the psychiatric ED.Because the patient's age was atypical for onset of a primary psychotic disorder, a CT scan of his head was obtained and neurology was consulted.On further interview, the patient demonstrated insight into the hallucinatory nature of the voices, remarking that whenever he carried out their commands, his actions felt unreal.He denied any episodes of shaking, loss of awareness, tongue-biting, or urinary incontinence.He reported having had 2 headaches in the prior 6 weeks, the worst of his life, described as severe, bifrontal, and without accompanying focal neurologic symptoms.The patient's neurologic examination was notable only for mildly impaired short-term recall, diminished sensation of light touch over the right forehead, and reduced amplitude and rate of finger taps on the right (his nondominant hand). Questions for consideration:1. What is the differential diagnosis for auditory hallucinations?2. What elements of the patient's presentation raise the possibility of a neurologic diagnosis?
Год издания: 2020
Издательство: Lippincott Williams & Wilkins
Источник: Neurology
Ключевые слова: Hallucinations in medical conditions, Neurology and Historical Studies, Psychosomatic Disorders and Their Treatments
Другие ссылки: Neurology (PDF)
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Том: 94
Выпуск: 20