Musical Hallucinations Treated with Atypical Antipsychotics in a Geriatric Population – A Case Series

Musical hallucinations have been likened to the auditory equivalent of Charles Bonnet Syndrome, which involves complex visual hallucinations, most often in the context of visual impairment. Musical hallucination frequently take the form of hymns, carols, and show-tunes and are strongly associated with hearing loss, with some studies suggesting a prevalence of 2.5–3.6% in the hearing impaired. Musical hallucinations are typically treated with anticonvulsant and anticholinesterase medications, with some studies having evaluated the efficacy of sedative hypnotics, antipsychotics and antidepressants in various psychiatric and medical subpopulations suggesting a heterogeneous spectrum of causes for this disorder. We present two cases of musical hallucinations in both a 70-year-old African American female with past psychiatric history of major depressive disorder who developed hymnal auditory hallucinations during an acute medical and psychiatric admission and an 86-year-old Caucasian female, who complained of hearing gospel music with eventual onset of visual hallucinations after a fall at age 80. Our patients were successfully treated in both the inpatient and outpatient settings with atypical antipsychotics. The presented cases add to the paucity of literature regarding utilization of atypical antipsychotics for treatment of musical hallucinations and demonstrate efficacy to this effect. This study lends further validity to the use of psychopharmacologic agents for novel purposes that have yet to be fully explored

Use of Memantine in Autism Spectrum Disorder: a Case Report

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder of varying severity and phenotypic expression that is characterized by persistent deficits in social relatedness, communication skills, and interfering repetitive behaviors. Associated behavioral pathology can include inattention, aggression, irritability, hyperactivity, anxiety, and self-injury. Currently, FDAapproved treatments exist to treat secondary symptoms but not core symptomatology. The etiology of autism and other ASD is thought to be multifactorial but is not well understood. Some studies suggest that glutamate excitotoxicity may play a role in the pathogenesis of ASD. Memantine, an NMDAreceptor antagonist, could potentially address core symptoms in ASD by targeting disease-specific pathophysiology. Our patient, an 11-year-old Caucasian male, began treatment with memantine following parental request after learning of a phase II clinical trial utilizing the drug for treatment in autism. Following one month of receiving memantine 5mg daily the patient reportedly began showing increased verbal communication at home. Despite the patient not exhibiting verbal communication on patient interview at the clinic, the guardians reported that the patient had begun using 30 plus newly learned words, and had learned to communicate via sign language. Continued improvement in communication was noted over the course of one year of treatment with memantine. Memantine is not yet approved for treatment of ASD. However, in this case it appeared effective for treating core deficits in verbal and non-verbal communication in a child with autism

Topical administration of psychotropic medications in pluronic lecithin organogel to treat patients with dementia: A retrospective observational study

OBJECTIVE: Treatment of mood and behavioral symptoms in geriatric patients with advanced dementia may be impeded by poor compliance with oral medications. Pluronic lecithin organogel (PLO) is a compounding substrate that can be used for the topical administration of psychotropic medications. METHODS: Charts of patients treated with psychotropic medications compounded with PLO cream were reviewed for treatment outcomes. All patients were treated by a nursing home outreach service. RESULTS: Records from twenty-four patients, mean age 86.8 + 5.9, were reviewed. Common psychiatric symptoms included agitation, aggressive behavior, and depression. Medications most commonly administered as a PLO cream included quetiapine and venlafaxine. All patients had mild to marked improvement in psychiatric symptoms. CONCLUSIONS: Pluronic lecithin organogel (PLO) may be an effective option for the topical administration of psychiatric medications in geriatric patients with dementia who are not compliant with oral medications