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Am J P sych ia try 138 :9 , Sep tem ber 19 81 LETTER S TO THE ED ITOR 1263

exh ib ited hy pe rac tiv ity , flig h t o f ideas, rap id sp eech , g rand i-

osity , an d an ang ry a ffec t. S he had a h isto ry o fh eav y a lco ho l

co nsum ptio n , bu t h er gene ral p hys ica l h ea lth w as go od .

W hen M s. A w as adm itted , sh e repo rted tha t she h ad no t

been drink in g or tak ing any presc r ibed m ed ica tion . O n

hosp ital day I a t 10 :00 a .m . M s. A w as g iv en 5 m g i.m . o f

halopen id o l to trea t he r lo udn ess , hyp eractiv ity , and hos til-

ity . Sh e w as no t p laced on regu la r dosages o f h alop erid o l. A t

3 :00 p .m . th e sam e day she began to ho ld h er th ro at and gasp

tha t she cou ld no t b rea the o r sw allow . Sh e ind ica ted tha t the

ha lope rido l w as causing th is reac tio n an d w hisp e red tha t she

need ed benz trop in e m esy late im m ed ia te ly . T he nu rse qu ick -

ly adm in is te red benz trop in e m esy la te , 2 m g i.m . A fte r 30

mm M s. A ’s dy spn ea and anx iety d isappea red . I then

prescr ibed I m g of o ral benz tro p in e m esy la te b .i.d . fo r th e

w eekend . M s. A had no fu rth er ep isodes du rin g tho se 2

days.

I a sked M s. A why sh e h ad tho ugh t the h a loper id o l w as

cau sing h er d istre ss . S h e said sh e h ad had tw o s im ila r

ep isodes w hen she w as hosp ita lized in ano th er s tate . O n

bo th occas ions she exp er ienced prob lem s brea th in g an d

sw allow ing w hile receiv ing o n ly h a lo pen ido l. H er p ro b lem s

were re liev ed by in tram u scu la r doses o f benz trop in e m esy-

la te . A t o th er tim es M s. A h ad receiv ed tn if luo pe raz ine and

th io th ix ene . b u t each tim e she had receiv ed eith e r o f these

drugs she w as sta rted co ncom itan tly on an tipa rk in son ism

drugs .

A laryn geal-ph aryn geal dys ton ia is a fr igh ten in g exp eri-

en ce fo r pa tien ts an d physic ians. I ag ree w ith D r. M enuck

th a t th is is a h igh -risk , po ten tially le tha l com p lica tio n . O ne

p reven tiv e m easu re w ou ld b e to tak e a care fu l d rug h isto ry

from the pa tien t reg ard in g p rev io us reac tion s to m ed ica tion s

be fo re star ting drug reg im en s. esp ecia lly low dosages o f

h igh -po ten cy n eu ro lep tics lik e ha lope rido l.

CLA REN CE E . M CD A NA L . JR . . M.D .Birmingham , A Ia .

Hypersex ua lity in M en R ece iv ing F luph en azin e D ecanoa te

S IR : A la rg e num ber o f am bu la to ry ch ro n ic sch izoph ren ic

pa tien ts a re trea ted w ith p e riod ic in jectio ns o f f lup henazin e

decan oa te. M any do w ell un til adve rse sid e e ffec ts . su ch as

ex trapyram ida l and an ticho line rg ic sym ptom s or im pa ired

sex ua l reac tion s, cau se th em to d iscon tinue an o th e rw ise

success fu l th erapy . Th e Physic ian ’s D esk Re fe rence. 1980

ed ition , lis ts im po tence in m en and increased lib ido in

w om en as end oc rin e s ide e ffec ts o fflu ph en az in e decano ate .

T he fo llow ing cases, how eve r , de sc r ibe tw o sch izop hren ic

m en w ho rece ived long -ac ting flu phenaz ine and dev elo pedhyp ersexua lity ra the r than im po ten ce . I t sh ou ld b e n o ted

tha t it w as clo se fam ily m em bers an d no t th e pa tien ts

them se lves w ho com pla ined ab ou t the hyp ersexua lity .

Ca se 1 . M r. A was a 25 -y ea r-o ld m an w ith a 6 -yea r h isto ry

of sch izo ph ren ic d iso rd er. H e h ad b een ho sp ita liz ed fou r

tim es an d unsuccessfu lly trea ted w ith a lliph a tic ph eno th i-

azines , b u ty roph enones , an d th ioxan thenes un til he w as

sw itched to long -ac ting flu phenaz ine decan oa te , 25 m g i.m .

ev ery 3 w eek s. W hen M r. A im prov ed no ticeab ly the d osage

w as dec reased to 1 2 .5 m g . M r. A lived w ith h is m othe r , w ho

w as phy sically d is ab led , and a 3 0-year-o ld sis te r , w hose

illeg itim a te ch ild ren w ere a 14 -y ea r-o ld b oy and tw o g ir ls , 12

and 13 yea rs o f age . S ix w eeks a fte r th e reduc tion o f the

m ed ica tion , M r. A ’s s iste r cam e to the c lin ic to repor t th at

alth ough M r. A w as m uch im pro ved , he w as ‘ ‘ho rny ’ ‘ a ll th e

tim e , a con d ition tha t w as u nusu a l fo r h im . H e m astu rba ted

an d frequen tly p rop osition ed ne ighb orhood g irls . O n one

occasion h is s is ter had fou nd M r. A rubb in g h im se lf aga ins t

one o f he r d au gh te rs . M r. A confirm ed h is s is ter’s com -p lain ts and adm itted to w et d ream s and to m astu rb ato ry

ac tiv itie s as o ften as th ree tim es a d ay . H e w as n o t rece iv ing

an y o th e r m ed ica tion . W e gave M r. A com p lete p hysica l an d

ne uro log ica l e xa min atio ns . Labo ra to ry stud ies inc lud ed tox -

ic d rug sc reen , V D RL , an d serum lev els o f FSH , LH ,

pro lac tin , and tes toste ron e . T he resu lts w ere a ll nega tiv e

ex cep t fo r th e p ro lactin (1 6 .5 ng /m l) and LH (62 .5 m IU /m l)

se rum leve ls . W e d iscon tinued f lu phenaz ine because M r. A

h ad been in rem iss io n fo r abo u t 2 yea rs . F our w eek s late r

M r. A becam e d iso rgan ized , d e lu sion al, and b ellig eren t and

h ad to b e h osp italized .

Case 2 . M r. B w as a 28 -y ea r-o ld m an w ho w as m arried and

the fa the r o f th ree ch ild ren . H e had a 4-y ear h is to ry of

chro n ic sch izop hren ia , w ith th ree prev ious hosp ita liza tions .

He had been in sa tisfac to ry rem iss ion fo r ab ou t I yea r a fte r

rece iv ing fluph en az ine d ecanoa te 1 2 .5 m g i.m . eve ry 3

w eek s. M r. B w as in g ood physica l health and w as no t tak ing

any o ther m ed ica tion . H e w orked as a jan ito r and had no

com p la in ts abo u t h im se lf o r h is w o rk . T he o n ly com pla in t

cam e from his w ife , w ho had no ticed tha t fo r the firs t tim e in

the ir m arriage M r. B w as d em and ing sex every day . Sh e a lso

d iscovered tha t w hen she refused h im , he w ou ld g o to

pornograph ic m ovies an d eng age in sex ua l ac tiv ities w ith

pro stitu tes . T he resu lts o f p hys ica l and neuro lo g ica l exam i-

na tions w ere w ith in norm al lim its . Lab ora to ry w ork-up

inc luded EEG s, chest X rays, CBC . to x ic sc reen . thy ro id

stud ies , V D RL , se rum leve ls ofp ro lactin . te sto ste rone , LH ,

and FSH . A ll the re su lts w ere w ith in n orm a l lim its excep t fo r

e leva ted p ro lac tin (16 .7 n g /m l) and LH (40 .5 m IU /m l) . M r. B

w as sw itched to a d ihydro indo lon e com pound , a fte r w hich

he show ed a m od erate decrease of h is h ypersex ua lity .

A rev iew ofthe lite ra tu re revea ls a pauc ity o f m eth odo log -

ic stu d ies abou t the ro le o f endo cr in e an d nonendocn ine

m echan ism s in n eu ro lep tic- in duced sex ua l dysfun ctions : I

fou nd on ly one p ape r (1 ) tha t q u a lif ie s a s such . W e a lso n eed

m o re re search o n the in flu en ces o f p sycho tic d iso rd e r o r its

res id ua l sym p tom ato lo gy in the pro duc tio n of sex ua l dys-

func t ions .

REFERENCE

1 . E rd os M A , Po lga r M : Endoc rino lo g ical chan ges in pa tien ts w ithsexua l dy sfun ction under long-te rm neuro lep tic treatm en t. P har-

m akopsych ia tr 12 :426-431 , 1 979

EFRA IN A . GOME z , M.D .

H ous ton , Tex .

P seu doh a lluc in a tion s: R ad io R ecep tion T hrough Shrap ne l

Fr a gmen t s

S IR : W e recen tly tre ated a p atien t w ho su ffe red from w hat

w as in itia lly th ough t to be m usica l ha lluc ina tions b u t ac tua lly

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1264 LETTERS TO TH E ED ITOR Am J P sych ia tr y 138 :9 , Sep tem ber 1 98!

ap pea red to be recep tio n of rad io sign als th ro ugh sh rapn el

fragm en ts im p lan ted in h is sku ll.

M r. A , a 35-yea r-o ld ve teran . had a 9-yea r h isto ry o f

recu rren t d epre ssion and headache s. Tw e lve y ears ag o he

susta ined sh rapn el w ounds in h is sku ll an d sh ou ld e r d u ring

com ba t. W hen M r. A w as adm itted to our se rv ice, he

com pla ined of hav ing headaches and dyspho ria and ofh ea ring vo ice s an d m usic . T he aud ito ry ph en om ena w ere

ch a rac ter ized b y a pe rcep tio n o f rad io -like m usic and vo ices

tha t o ften chang ed in rhy thm . T hese ceased o n ly w h en M r.

A was su p in e on th e con cre te floor o f h is m eta l-w alle d

garage . W e found no s igns or sym ptom s o f p sycho sis.

Physica l ex am ina tion w as un rem arkab le ex cep t fo r w e ll-

hea led sca rs in M r. A ’s neck and le ft shou lder. W e disco v-

e red no tin n itus o r hearing im pa irm en t. N europ sycho lo g ical

tes ting show ed m ild ly im pa ired long- te rm m em ory . M r. A ’s

CT scan and EEG w ere no rm a l. P lain sku ll f ilm s revealed

sm a ll m e ta llic densitie s in th e so ft tissues and c ran ial bon es

o f the le ft p ar ie to -o cc ip ita l reg ion .

W e trea ted M r. A w ith am itr ip ty lin e , 150 m g h .s. , an d

th io th ixene , 10 m g /day . H is m ood and head ach es im pro ved .

bu t th e au d ito ry p henom en a co n tinu ed . M r. A sta ted tha t h e

heard the m usic m ain ly w ith h is lef t ea r and th at it had a

defin ite rad io -like q ua lity . O ne o f us (S .L .) te sted h im by

ask ing h im to m atch h is pe rcep tions w ith v ariou s sta tio ns on

the AM bro ad cast band . H e consis ten tly iden tif ied the sam e

station (5 60 kH z) w h ile the rad io w as tuned to v ariou s

sta tions o n the b and regard less o f th e tim e of d ay or type of

prog ramm ing . W hen on ly the exam ine r lis tened to th is

sta tion w ith an ea rpho ne , M r. A w as ab le to h um th e m usic

he w as hea rin g . co rrec tly iden tify p au ses an d chang es in the

p rog ramm ing . and cou ld p rec isely tap ou t th e beat o f the

so ngs be ing broadcas t. W e in fo rm ed h im tha t w e fe lt tha t he

w as receiv ing rad io signa ls th rou gh h is sh rap ne l im p lan ts .

H e fe lt q u ite re lieved by th is find ing and fe lt tha t h e co u ld

cop e w ith th is p rob lem .

A udito ry ha lluc ina tio ns, such as sp oken w ord s. o ften

accom pany m ajo r fu nc tiona l p sycho ses , to x ic de lirium , and

organ ic d em en tias . M usica l ha lluc ina tion s have been de-

scn ib ed le ss o ften , b u t h av e been assoc ia ted w ith v ascu lar

and tum ora l les io ns (I) and senso rineu ra l d efic its (2 . 3 ).

There have b een few reports in the lite ra tu re co ncern ing

rad io recep tion th ro ugh den ta l w ork (4 ). W e propose th at a

m echan ism for M r. A ’s recep tion of rad io broad cas ts in -

vo lv es th e m eta l im plan ts ’ p rov is io n ofd iode rec tifica tion o f

th e sign al. T h us de tec tion an d dem odu la tion a re accom -

p lished by these m e ta ls im p lan ted in b one (m uch th e sam e

w ay as a crys tal rad io se t op era tes ). The aud io is then

transm itted by bone conduc tio n to the aud ito ry ap para tus.

The pe rcep tion of th e rece iv ed sig na ls m ay no t b e p erfec tly

c lea r, a s w as th e case w ith M r. A , w ho cou ld n o t con vey to

th e ex am ine r the spec ific con ten t o f new s b ro ad casts .

T he report o f th is phenom enon m ay a id th e d iffe ren tial

d iag nos is o f p a tien ts w ho suffe r from aud ito ry ‘ ‘ ha l luc ina -

tion s” bu t ex h ib it no o th er s igns of psychos is .

REFERENCES

1 . P en field W , Jasp er H : E p ilepsy and the F unc tio na l A n atom y of

the H um an B ra in . B o ston , L ittle , B row n and Co . 195 4 . p p 452-

46 7

2 . C o lem an W S: H allu cina tions in the sane asso cia ted w ith loca l

o rgan ic d isease o fthe sensory o rgans, e tc . B r M ed J 1 :10 15-10 17 ,

1894

3 . Ro ss ED . Jo ssm an PB , B ell B , et a t: M u sic al ha llu cin atio ns in

deafn ess. JAM A 231:620-6 21, 197 5

4 . A nonym ous : R ad io transm ission th roug h fillin gs ( ltr to ed).

J AMA 169:1271, 1959

A pr il F oo ls ’ C orresp on den ce

RAMON A . BO ZA , M .D .

STEPHEN B . L IGGETT

M iam i, F /a .

SIR : I h ave b een try in g very h ard to ge t to lik e DSM-IJJ by

us ing it. B elieve m e, I have been try ing , bu t L ady D eese M .

I II is co ld to m y over tu res ! C ogn itive ly /theore tica lly I

loo ked fo rw ard to m eetin g D eese M . III . and the re she w as :

log ica l, de ta iled , b litz in g m e w ith a ll he r firew orks o f ph e-

nom ena . S he is a n am e dropp er , bu t sh e is a lso v ery hum ble

an d dem u re ly says, ‘ ‘I do n’t kn ow w hy . ‘ ‘ Even tua lly I go t

s ick of a ll th is a theore tica l, phenom en al d illyda lly ing . I

w an ted to have a real af fa ir w ith L ady D eese M . III and g et

to know her from the ins id e ou t. I w an ted to tru ly . a ffec tive ly

ow n her, u se her, g e t u nder h er fan fa re facade of a theo reti-

ca l fo lde ro l. S udd en ly Lady D eese M . III ba lked and sh ow ed

m e her co ld shou ld er. I cou ld no t ge t c lo se to her : coo l sh e

w as an d nea rly fr ig id . and so u nhe lp fu l! H er d eta iled ,

fragm en ted ob session s cau sed m e to fee l the sam e w ay . In

the sh ifting sta te s o f passio n sh e ca lled he rself som e th ing

e lse a ll the tim e . Som etim es her depress ion w as d ig ited as .3 ,

s ome t ime s .5 , som etim es she rem itted and ca lled tha t .3 o r .5

or .6 . W hen she b ecam e ve ry c razy sh e called it eith er .2 o r

.4 . O n ly w hen she w as du ll an d un spec ified w as she consis -

ten tly ze ro . B y th at tim e I lay p ro stra te -to tally fragm en ted

and hop e less ly frustrated ! W hen I thou gh t I kn ew her she

slipped aw ay aga in . W ho m irro rs m e?

A nd th en the re is th a t little m on ster o f he rs , p rob ab ly bo rn

as an afte rthou gh t, no t use fu l to foes o r fr iend s alike . It is

sm all eno ugh , th ank goodness. so tha t I can h ide it an d do

no t h av e to be rem ind ed d aily o f m y n ine do llars-w asted

ado p tio n fees !

I fo un d ou t D eese M . II I’ s log ica l fir ew ork s w ere ra ther

spu rio us, ed gy , and no t ha rm on io us o r p lea sing . H ow I

adm ired h er a t first. I tho ugh t she w ould be a fan tastic ob jec t

truly to be lov ed and che rished , and w e cou ld have a

m ean in g fu l rela tion sh ip . B u t lik e a ll bo rd erline pe rson alitie s

she behaved a long the porcu p ine in dex : w hen I w an ted her

to b e c lose she s lip ped aw ay from m e, an d w hen I w an ted to

push her fa r aw ay-because she su ffoca ted and dra ined

m e-a sin is te r b u reauc ratic fo rce pushed h er rig h t back upon

m e. I nev er go t h er num ber righ t!

In th e p as t I u su a lly w ou ld h ur t from com p lica ted re la tion -

sh ips lik e th is an d su ffe r in silen ce , te lling m y se lf I am no t

sm art and brigh t eno ugh to com prehen d sop h istica ted lad ie s

lik e D eese M . III . A fte r a succes sfu l an aly sis . h ow ev er , I do

no t feel th at w ay an y m ore. Tho se fee lings w ere caused by a

dys th ym ic (neuro tic ) con flic t, now w ell reso lved . T here fo re

I am now add ressin g m y gr ievan ces to D eese M . II I’s

creato rs .

W hy do I th ink tha t D eese M . III is fem ale ? H ave I b een

sligh tly b ra inw ashed by D eese M . III’s paren ts w ho are

m ak ing m e b elieve tha t every th in g capric io us, illog ica l,

‘ ‘ov er-reactin g . ir ratio na l, egocen tr ic , v a in an d dem and ing