A 25-year-old woman with hallucinations, hypersexuality, nightmares, and a rash [clinical conference]

A 25.year-old Asian-American single woman, diagnosed with chronic paranoid schizophrenia since age 19, was referred from the inpatient psychiatric unit for evaluation of atypical hallucinations. She had been admitted 3 days earlier after an intentional overdose of 32 over-the.counter sleeping pills. In the emergency room the patient suffered a witnessed grand mal selzure without incontinence, which was followed by a brief period of confusion and combativeness. A computerized tomogra phy (CT) scan of the brain and an EEG at the referring hospital were reportedly normal. A repeat EEC at our hospital demonstrated intermittent asymmetry with posterior right-hemisphere background slowing, which was considered artifact. The patient expressed a delusional belief that she was controlled by an attractive, popular male former high school teacher who had put a curse on her family before her birth and was now sexually obsessed with her. When her eyes were closed, the patient experienced auditory hallucinations and a single visual hallucination consisting of the man’s face in a black spot that wandered throughout her field of vision. She constantly experienced vivid tactile hallucinations of this man molesting her genitally but not having intercourse with her, and she believed that he videotaped her showering and masturbating in order to show these