Treatment Of Hallucinations

For hallucinations in the setting of schizophrenia, medications that alter transmission of dopamine and related neurotransmitters, termed neuroleptics, are the mainstay of treatment. In other settings, the first step in the treatment of hallucinations is to address the condition that underlies their existence. When this is impossible or ineffective, neuroleptic medications may be tried. However, these tend to be less effective in settings that do not involve limbic, striatal, or dopa-minergic pathology. Fortunately, hallucinations in the setting of sensory input disorders, where neuroleptics are least effective, are often less disturbing to those experiencing them, as described previously. Such hallucinations sometimes respond to carbamazepine, a medication often used for seizure prevention, mood stabilization, or control of pain originating in the nervous system. This is consistent with models of aberrant neural activity described previously.

When hallucinations are distressing and unresponsive to medication, psychological treatments may be helpful. Cognitive-behavioral approaches involve distracting activities or sensory input as well as behavioral and cognitive tasks. Supportive approaches involve helping patients understand their condition, solve problems, and adapt to reality. Psychological approaches tend to decrease distress associated with hallucinations and improve overall functioning rather than ameliorate hallucinations per se.

Future developments in the treatment of hallucinations are likely to be guided by the functional neuroanatomic approach. Recent investigations into the mechanism of action of antipsychotic medications have increasingly focused on the specific cerebral regions modulated by relevant neurotransmitters. In addition, a recent study examined the efficacy of transcranial magnetic stimulation (TMS), a novel technique for altering focal cortical activity through application of a magnetic pulse, in the treatment of persistent auditory hallucinations in schizophrenic patients. The results suggest that administration of TMS to the left temporoparietal regions noted (in the PET study discussed previously) to be active during auditory hallucinations can markedly decrease the severity of such events.

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