Suppression of verbal hallucinations and changes in regional cerebral blood flow after intravenous lidocaine: a case report.
Simple and complex auditory phantom-perceptions such as tinnitus and musical hallucinations occur predominantly in elderly subjects and are often associated with hearing impairment. Isolated verbal hallucinations without other psychotic features are rare. It has been shown that an intravenous (i.v.) injection of lidocaine can transiently suppress tinnitus. Here we present the case of a 74 year old left-handed women with severely distressing, continuous verbal auditory hallucinations without other psychotic features. I.v. injections of 100 mg lidocaine but not saline resulted in substantial transient suppressions of the hallucinations for several hours. Using [(15)O]H(2)O positron-emission tomography (PET) decreased regional cerebral blood flow associated with reduced perception of voices was found in the right angular and supramarginal gyrus, right inferior frontal gyrus, orbitofronal cortex and in major parts of the cingulate cortex. These data suggest to further investigate the clinical relevance of i.v. lidocaine in patients with therapy-resistant verbal hallucinations, support the notion of common pathophysiological mechanisms in different forms of auditory phantom-perception and demonstrate the feasibility of a new strategy for imaging studies on auditory hallucinations.
Plewnia
Christian
C
Department of Psychiatry and Psychotherapy, University of Tuebingen, Osianderstrasse 24, D-72076 Tuebingen, Germany. christian.plewnia@uni-tuebingen.de
Bischof
Felix
F
Reimold
Matthias
M
D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000494:pharmacology*; D001921:Brain / Q000000981:diagnostic imaging; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D004569:Electroencephalography; D005260:Female; D006212:Hallucinations / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007275:Injections, Intravenous; D008012:Lidocaine / Q000008:administration & dosage / Q000494:pharmacology*; D049268:Positron-Emission Tomography; D011569:Psychiatric Status Rating Scales
D000779:Anesthetics, Local; D008012:Lidocaine