Successful treatment with olanzapine in severe hallucinatory-paranoid state during the course of treatment of inflammatory demyelination disease: a case report

Abstract

Inflammatory demyelination diseases (IDDs) frequently cause various psychiatric symptoms such as depression, but psychosis is uncommon. The patient was a 23-year-old man treated for IDDs with a steroid for 8 years. Somnolence, right femoral pain, dysuria, and walking difficulty had been observed, and these symptoms recovered after several rounds of steroid pulse therapy. He experienced severe psychotic symptoms, such as visual and auditory hallucinations and xenopathic experiences, even though the steroid dose was 5 mg/day. Successful treatment of the psychotic state was obtained using olanzapine (20 mg/day). The patient’s Positive and Negative Syndrome Scale (PANSS) score decreased from 104 to 62. We concluded that the psychotic features may have been induced by IDDs and successfully treated by olanzapine in some patients.