Keratoconus and Psychosis

Mr. A was a 23-year-old man admitted to our inpatient psychiatric service after a 5-month history of delusions, including the belief that his corneal transplants were radio transmitters implanted in his head. He had been diagnosed with keratoconus at age 17 and underwent bilateral corneal transplantation at age 21. He had had one previous psychiatric hospitalization in his late teens after an incident in which he lost his temper, doused his car with gasoline, and set it afire. He also had a history of cocaine, amphetamine, and LSD abuse. His last use of LSD was 2 years before admission, and his last use of amphetamines and cocaine was a month before admission.

Mr. A had illogical speech, inappropriate affect, and frequent thought derailment. He felt that his problems were due to the “audiovisual stuff” implanted in his eyes. He also complained of the sensation of being burned by cigarettes on his legs and back. Mr. A was given olanzapine, 20 mg/day. Soon after admission he became less agitated, although his thoughts easily became derailed when he discussed his delusions, which persisted throughout his 3-week hospitalization.