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Novel treatment (new drug/intervention; established drug/procedure in new situation)
CASE REPORT
Successful treatment of intractable visual hallucinations with 5-HT2A antagonist ketanserin
  1. Iris E C Sommer1,2,
  2. Hidde Kleijer1,3,
  3. Lucy Visser3,
  4. Teus van Laar4
  1. 1Department of Psychiatry and Department of Neuroscience, Rijksuniversiteit Groningen (RUG), Universitair Medisch Centrum Groningen (UMCG), Groningen, The Netherlands
  2. 2Department of Psychology, Universitetet i Bergen Det Psykologiske Fakultet, Bergen, Norway
  3. 3Department of Psychiatry, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
  4. 4Department of Neurology, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
  1. Correspondence to Professor Iris E C Sommer, I.e.c.sommer{at}umcg.nl

Summary

Hallucinations, visual, auditory or in another sensory modality, often respond well to treatment in patients with schizophrenia. Some, however, do not and can be very chronic and debilitating. We present a patient with schizophrenia with intractable hallucinations despite state of the art care, including high-dose clozapine and transcranial magnetic stimulation. Based on the possible role of the 5-HT2A receptor in hallucinations, we treated her with the antihypertensive drug ketanserin, a 5-HT2A receptor antagonist.

This significantly reduced her visual but not her auditory hallucinations, suggesting a possible role of the 5HT2A receptor in the pathophysiology of specifically visual hallucinations. This is the first time ketanserin has been described to successfully reduce visual hallucinations in a patient with schizophrenia.

  • schizophrenia
  • therapeutic indications
  • parkinson’s disease
  • psychiatry (drugs and medicines)

https://doi.org/10.1136/bcr-2018-224340

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    Footnotes

    • Contributors IECS: main editor, background and treating physician. HK: main drafting and revising. LV: main case description and patient’s perspective together with the patient. TvL: revising interpretation.

    • Funding This study was funded by ZonMw (10.13039/501100001826) (grant number: 017106301).

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.