Antipsychotic-Induced Paroxysmal Perceptual Alteration

Ms. A, a 49-year-old woman with a 2-year history of generalized anxiety disorder, had suffered from dizziness, anxiety, and syrigmus. Ophthalmologic, otolaryngological, and neurological examinations showed no abnormality, including cataract, and she had good vision and did not wear glasses. Her symptoms did not respond to antidepressants or anxiolytics. Haloperidol, 0.5 mg b.i.d., was added to her regular regimen of alprazolam, 1.2 mg t.i.d., because she became obsessed with her symptoms. Two days after haloperidol treatment was started, the following symptoms occurred: “The fine pattern of the wall and ceiling seems more vivid than usual. I have also noticed that outlines of papers and tiny objects such as dust seem more prominent. These symptoms occur suddenly like an ‘attack’ almost every afternoon and last an hour.”

These symptoms disappeared 2 days after haloperidol treatment was discontinued. Although Ms. A subsequently tried various antidepressants and anxiolytics, none of them ameliorated her original symptoms. Then we prescribed methotrimeprazine (levomepromazine) alone, 10 mg at bedtime, and on the second day she experienced the same symptoms as those induced by haloperidol: “I am having the same ‘attacks.’ Light seems much brighter than usual. Tiny objects like dust and stains seem to be emphasized for a couple of hours every night.”

The bizarre symptoms disappeared soon after we switched the methotrimeprazine to vitamin E, 150 IU/day, as she requested. Her medication regimen has remained the same ever since.