Abstracts
Abstract
Late-onset auditory verbal hallucinations (AVH) present diagnostic and therapeutic challenges, particularly when antipsychotic treatment is limited by poor tolerability.
We report a case of a 75-year-old woman with de novo AVH temporally related to hemp oil use, in the general context of longstanding hearing impairment. Symptoms persisted and progressively worsened over 12 months despite discontinuation and antipsychotic treatment, resulting in marked distress and functional impairment. Adjunctive repetitive transcranial magnetic stimulation (rTMS) targeting the left temporoparietal cortex was administered in 2 separate treatment courses. Each course was associated with a marked reduction in AVH severity and enabled substantial tapering of antipsychotic medication. In both instances, symptom relapse occurred within 2-3 months after rTMS discontinuation. This case highlights the multifactorial nature of late-onset AVH and suggests that rTMS may serve as a time-limited, adjunctive intervention in selected older patients when pharmacological strategies are constrained, with potential implications for maintenance-based approaches.
Keywords:
- older adult,
- late-onset psychosis,
- auditory hallucinations,
- repetitive transcranial magnetic stimulation
Résumé
Les hallucinations auditives verbales (HAV) tardives posent des défis diagnostiques et thérapeutiques, en particulier lorsque le traitement antipsychotique est limité par une mauvaise tolérance. Nous rapportons le cas d’une femme de 75 ans présentant des HAV de novo liées à la consommation d’huile de chanvre, dans un contexte général de déficience auditive de longue date. Les symptômes ont persisté et se sont progressivement aggravés pendant 12 mois malgré l’arrêt de l’huile de chanvre et la prise d’antipsychotiques, entraînant une détresse marquée et un déclin fonctionnel. La stimulation magnétique transcrânienne répétitive (SMTr) adjuvante ciblant le cortex temporo-pariétal gauche a été administrée en 2 cycles de traitement distincts. Chaque cycle a été associé à une réduction marquée de la gravité des AVH et a permis une diminution substantielle de la posologie des antipsychotiques. À la suite des 2 cycles, une rechute des symptômes est survenue dans les 2 à 3 mois suivant l’arrêt de la SMTr. Ce cas met en évidence la nature multifactorielle des hallucinations auditives tardives et suggère que la SMTr peut servir d’intervention adjuvante à durée limitée chez certains patients âgés lorsque les stratégies pharmacologiques sont limitées, avec des implications potentielles pour les approches basées sur le maintien.
Mots-clés :
- personne âgée,
- psychose tardive,
- hallucinations auditives,
- stimulation magnétique transcrânienne répétitive
Appendices
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