title: Acetylcholinesterase Inhibitors (AChEI's) for the treatment of visual hallucinations in schizophrenia: a case report.
abstract: BACKGROUND
  Visual hallucinations are commonly seen in various neurological and psychiatric disorders including schizophrenia. Current models of visual processing and studies in diseases including Parkinsons Disease and Lewy Body Dementia propose that Acetylcholine (Ach) plays a pivotal role in our ability to accurately interpret visual stimuli. Depletion of Ach is thought to be associated with visual hallucination generation. AchEI's have been used in the targeted treatment of visual hallucinations in dementia and Parkinson's Disease patients. In Schizophrenia, it is thought that a similar Ach depletion leads to visual hallucinations and may provide a target for drug treatment
  
  
  METHODS
  We present a case of a patient with Schizophrenia presenting with treatment resistant and significantly distressing visual hallucinations. After optimising treatment for schizophrenia we used Rivastigmine, an AchEI, as an adjunct to treat her symptoms successfully.
  
  
  CONCLUSIONS
  This case is the first to illustrate this novel use of an AchEI in the targeted treatment of visual hallucinations in a patient with Schizophrenia. Targeted therapy of this kind can be considered in challenging cases although more evidence is required in this field.
authors.affiliation: National Psychosis Unit, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Rd, Beckenham BR33BX, UK.
authors.forename: Sachin S
authors.initials: SS
authors.lastname: Patel
authors.forename: Azizah
authors.initials: A
authors.lastname: Attard
authors.forename: Pamela
authors.initials: P
authors.lastname: Jacobsen
authors.forename: Sukhi
authors.initials: S
authors.lastname: Shergill
mesh_terms: D000328:Adult; D014150:Antipsychotic Agents / Q000627:therapeutic use; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D004351:Drug Resistance; D005260:Female; D006212:Hallucinations / Q000188:drug therapy*; D006801:Humans; D048448:Phenylcarbamates / Q000627:therapeutic use*; D000068836:Rivastigmine; D012559:Schizophrenia / Q000188:drug therapy*; D012565:Schizophrenic Psychology; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D002800:Cholinesterase Inhibitors; D048448:Phenylcarbamates; D000068836:Rivastigmine
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