Tiapride for the Treatment of Auditory Hallucinations in Schizophrenia
A 37-year-old right handed female Christian graduate was brought to the out-patient department by family members with chief complains of hearing voices inaudible to others, suspiciousness toward others as though they are talking about her and plotting against her since the past 5 years. She would hear voices of known and unknown people saying sometimes good things and majority of times saying bad things to her. She would get commanding hallucinations telling her to tear her books, bible, certificates, etc., She also complained of occasional anger outbursts, decreased sleep, and stopped doing household activities. She was diagnosed as having Paranoid Schizophrenia as per Diagnostic and Statistical Manual for the Classification of Psychiatric Disorders – 4th edition text revised (DSM-IV TR) (DSM-IV TR) criteria and was started on olanzapine 10 mg/day, haloperidol 10 mg/day and trihexyphenidyl 4 mg/day all in oral formulations. Gradually, the doses were increased weekly to olanzapine 20 mg/day, haloperidol 20 mg/day, and trihexyphenidyl 6 mg/day. Her suspiciousness and other behavioral disturbances started decreasing. However, her auditory hallucinations persisted even after 6 months of regular treatment. Clozapine 25 mg at night was added, which was gradually increased to 100 mg at night. Her hallucinations persisted, but there was some improvement in that the number of people whose voices she used to get reduced. She continued having auditory hallucinations lasting whole day. The patient and relatives were not willing for electroconvulsive therapy (ECT) as a treatment option. Hence, tiapride 50 mg/day was added after 6 months of addition of clozapine 100 mg. Her hallucinations started reducing in frequency and duration. After 2 weeks of tiapride therapy, the dose was increased to 100 mg/day in divided doses. The patient was completely relieved of her hallucinations in 4 weeks of starting tiapride. Olanzapine was reduced as she complained of excessive sedation with it. Currently, the patient is on haloperidol 20 mg/day, olanzapine 10 mg/day, trihexyphenidyl 6 mg/day, clozapine 100 mg at night and tiapride 100 mg/day. She was assessed for hallucinations using the hallucinations subscale of the psychopathology rating scale (PSYRATS). Her score on the hallucination subscale improved from 28 to 11 after the addition of tiapride.