title: Combined duloxetine and benzodiazepine-induced visual hallucinations in prodromal dementia with Lewy bodies.
abstract: OBJECTIVE
  We describe a patient with prodromal dementia with Lewy bodies (DLB) presenting with drug-induced visual hallucinations (VHs).
  
  
  METHODS
  A 78-year-old woman complained of daytime recurrent VHs characterized by seeing her face and arms covered in fur and viewing moustaches on her daughter's face. VHs started a few days after the beginning of a combination therapy with duloxetine and lorazepam and ceased within 24 h after their discontinuation. Nonamnestic mild cognitive impairment with profound visual perception deficits and very mild extrapyramidal signs, with abnormal brain DaTscan single photon emission tomography, were present. Three years later, cognitive and neurological follow-up assessments supported the diagnosis of DLB.
  
  
  CONCLUSIONS
  Perturbation of cerebral serotonergic tone induced by duloxetine, associated with reduced attentional control due to benzodiazepine use, may be the physiopathological substrate of transient VHs in prodromal DLB.
authors.affiliation: Department of Neurosciences: Sciences NPSRR, University of Padova, Padova, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rolma
authors.forename: Nela
authors.initials: N
authors.lastname: Jelcic
authors.forename: Francesca
authors.initials: F
authors.lastname: Gnoato
authors.forename: Diego
authors.initials: D
authors.lastname: Cecchin
authors.forename: Annachiara
authors.initials: A
authors.lastname: Cagnin
mesh_terms: D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects*; D000928:Antidepressive Agents / Q000009:adverse effects*; D001921:Brain / Q000000981:diagnostic imaging; D060825:Cognitive Dysfunction / Q000000981:diagnostic imaging* / Q000523:psychology*; D004347:Drug Interactions; D000068736:Duloxetine Hydrochloride; D005260:Female; D006212:Hallucinations / Q000139:chemically induced* / Q000523:psychology; D006801:Humans; D020961:Lewy Body Disease / Q000000981:diagnostic imaging / Q000523:psychology*; D008140:Lorazepam / Q000009:adverse effects*; D009483:Neuropsychological Tests; D062706:Prodromal Symptoms; D013876:Thiophenes / Q000009:adverse effects*; D015899:Tomography, Emission-Computed, Single-Photon
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D013876:Thiophenes; D000068736:Duloxetine Hydrochloride; D008140:Lorazepam
keywords: Attention; Dementia with Lewy bodies; Duloxetine; Hallucinations; Visual perceptual deficit