Out-of-body experience and auditory and visual hallucinations in a patient with cardiogenic syncope: Crucial role of cardiac event recorder in establishing the diagnosis.

Out-of-body experience (OBE) and visual and auditory hallucinations can occur in a variety of medical conditions. We describe a 48-year-old male patient who experienced several paroxysmal events with different combinations of the aforementioned symptoms that could finally be attributed to cardiogenic syncope after subcutaneous implantation of an event recorder and that ceased after implantation of a cardiac pacemaker. Hallucinations and OBE are well-known phenomena in syncope. The special purpose of this report is to highlight the crucial role of implantation of the event recorder in establishing the diagnosis and the additional support of the diagnosis by the cessation after implanting the cardiac pacemaker.

Development of psychosis in patients with epilepsy treated with lamotrigine: report of six cases and review of the literature.

Lamotrigine (LTG) is a generally well-tolerated antiepileptic drug (AED) with broad-spectrum efficacy in several forms of partial and generalized epilepsy and is also licensed for use in bipolar disorder in several countries. We describe six patients who developed a psychotic disorder--in most, but not all, cases schizophrenia-like in character--under treatment with LTG, within a group of about 1400 patients treated with this drug in our center. This indicates that psychosis is a rare adverse event under LTG treatment. On the background of available drug serum levels, we suggest, in particular, an intrinsic or toxic psychotogenic effect of LTG. Possible risk factors seem to be psychiatric comorbidity and temporal lobe pathology. The described phenomenon is discussed within the context of possible psychotogenic effects of other AEDs.