Am J Psychiatry 138:9, September 1981 LETTERS TO THE EDITOR 1263

exhibited hyperactivity, flight of ideas, rapid speech, grandi- illegitimate children were a 14-year-old boy and two girls, 12
osity, and an angry affect. She had a history ofheavy alcohol and 13 years of age. Six weeks after the reduction of the
consumption, but her general physical health was good. medication, Mr. A’s sister came to the clinic to report that
When Ms. A was admitted, she reported that she had not although Mr. A was much improved, he was ‘horny’ ‘ all the ‘

been drinking or taking any prescribed medication. On time, a condition that was unusual for him. He masturbated
hospital day I at 10:00 a.m. Ms. A was given 5 mg i.m. of and frequently propositioned neighborhood girls. On one
halopenidol to treat her loudness, hyperactivity, and hostil- occasion his sister had found Mr. A rubbing himself against
ity. She was not placed on regular dosages of haloperidol. At one of her daughters. Mr. A confirmed his sister’s com-
3:00 p.m. the same day she began to hold her throat and gasp plaints and admitted to wet dreams and to masturbatory
that she could not breathe or swallow. She indicated that the activities as often as three times a day. He was not receiving
haloperidol was causing this reaction and whispered that she any other medication. We gave Mr. A complete physical and
needed benztropine mesylate immediately. The nurse quick- neurological examinations . Laboratory studies included tox-
ly administered benztropine mesylate, 2 mg i.m. After 30 ic drug screen, VDRL, and serum levels of FSH, LH,
mm Ms. A’s dyspnea and anxiety disappeared. I then prolactin, and testosterone. The results were all negative
prescribed I mg of oral benztropine mesylate b.i.d. for the except for the prolactin (16.5 ng/ml) and LH (62.5 mIU/ml)
weekend. Ms. A had no further episodes during those 2 serum levels. We discontinued fluphenazine because Mr. A
days. had been in remission for about 2 years. Four weeks later
I asked Ms. A why she had thought the haloperidol was Mr. A became disorganized, delusional, and belligerent and
causing her distress. She said she had had two similar had to be hospitalized.
episodes when she was hospitalized in another state. On
Case 2. Mr. B was a 28-year-old man who was married and
both occasions she experienced problems breathing and
the father of three children. He had a 4-year history of
swallowing while receiving only halopenidol. Her problems
chronic schizophrenia, with three previous hospitalizations.
were relieved by intramuscular doses of benztropine mesy-
He had been in satisfactory remission for about I year after
late. At other times Ms. A had received tnifluoperazine and
receiving fluphenazine decanoate 12.5 mg i.m. every 3
thiothixene. but each time she had received either of these
weeks. Mr. B was in good physical health and was not taking
drugs she was started concomitantly on antiparkinsonism
any other medication. He worked as a janitor and had no
drugs.
complaints about himself or his work. The only complaint
A laryngeal-pharyngeal dystonia is a frightening experi- came from his wife, who had noticed that for the first time in
ence for patients and physicians. I agree with Dr. Menuck their marriage Mr. B was demanding sex every day. She also
that this is a high-risk, potentially lethal complication. One discovered that when she refused him, he would go to
preventive measure would be to take a careful drug history pornographic movies and engage in sexual activities with
from the patient regarding previous reactions to medications prostitutes. The results of physical and neurological exami-
before starting drug regimens. especially low dosages of nations were within normal limits. Laboratory work-up
high-potency neuroleptics like haloperidol. included EEGs, chest X rays, CBC. toxic screen. thyroid
studies, VDRL, serum levels ofprolactin. testosterone, LH,
CLARENCE E. MCDANAL. JR. M.D. and FSH. All the results were within normal limits except for
,
.

Birmingham A Ia. elevated prolactin (16.7 ng/ml) and LH (40.5 mIU/ml). Mr. B
was switched to a dihydroindolone compound, after which
he showed a moderate decrease of his hypersexuality.
Hypersexuality in Men Receiving Fluphenazine Decanoate
A review ofthe literature reveals a paucity of methodolog-
SIR: A large number of ambulatory chronic schizophrenic ic studies about the role of endocrine and nonendocnine
patients are treated with periodic injections of fluphenazine mechanisms in neuroleptic-induced sexual dysfunctions: I
decanoate. Many do well until adverse side effects. such as found only one paper (1) that qualifies as such. We also need
extrapyramidal and anticholinergic symptoms or impaired more research on the influences of psychotic disorder or its
sexual reactions, cause them to discontinue an otherwise residual symptomatology in the production of sexual dys-
successful therapy. The Physician’s Desk Reference. 1980 functions.
edition, lists impotence in men and increased libido in
women as endocrine side effects offluphenazine decanoate.
REFERENCE
The following cases, however, describe two schizophrenic
men who received long-acting fluphenazine and developed 1. Erdos MA, Polgar M: Endocrinological changes in patients with
hypersexuality rather than impotence. It should be noted sexual dysfunction under long-term neuroleptic treatment. Phar-
that it was close family members and not the patients makopsychiatr 12:426-431, 1979
themselves who complained about the hypersexuality.
EFRAIN A. GOMEz, M.D.
Case 1. Mr. A was a 25-year-old man with a 6-year history Houston, Tex.
of schizophrenic disorder. He had been hospitalized four
times and unsuccessfully treated with alliphatic phenothi-
azines, butyrophenones, and thioxanthenes until he was Pseudohallucinations: Radio Reception Through Shrapnel
switched to long-acting fluphenazine decanoate, 25 mg i.m. Fragments
every 3 weeks. When Mr. A improved noticeably the dosage
was decreased to 12.5 mg. Mr. A lived with his mother, who SIR: We recently treated a patient who suffered from what
was physically disabled, and a 30-year-old sister, whose was initially thought to be musical hallucinations but actually
 1264 LETTERS TO THE EDITOR Am J Psychiatry 138:9, September 198!

appeared to be reception of radio signals through shrapnel organic disease ofthe sensory organs, etc. Br Med J 1:1015-1017,
fragments implanted in his skull. 1894
3. Ross ED. Jossman PB, Bell B, et at: Musical hallucinations in
deafness. JAMA 231:620-621, 1975
Mr. A, a 35-year-old veteran. had a 9-year history of
4. Anonymous: Radio transmission through fillings (ltr to ed).
recurrent depression and headaches. Twelve years ago he
JAMA 169:1271, 1959
sustained shrapnel wounds in his skull and shoulder during
combat. When Mr. A was admitted to our service, he
RAMON A. BOZA, M.D.
complained of having headaches and dysphoria and of
STEPHEN B. LIGGETT
hearing voices and music. The auditory phenomena were
Miami, F/a.
characterized by a perception of radio-like music and voices
that often changed in rhythm. These ceased only when Mr.
A was supine on the concrete floor of his metal-walled
garage. We found no signs or symptoms of psychosis. April Fools’ Correspondence
Physical examination was unremarkable except for well-
healed scars in Mr. A’s neck and left shoulder. We discov- SIR: I have been trying very hard to get to like DSM-IJJ by
ered no tinnitus or hearing impairment. Neuropsychological using it. Believe me, I have been trying, but Lady Deese M.
testing showed mildly impaired long-term memory. Mr. A’s III is cold to my overtures! Cognitively/theoretically I
CT scan and EEG were normal. Plain skull films revealed looked forward to meeting Deese M. III. and there she was:
small metallic densities in the soft tissues and cranial bones logical, detailed, blitzing me with all her fireworks of phe-
of the left parieto-occipital region. nomena. She is a name dropper, but she is also very humble
We treated Mr. A with amitriptyline, 150 mg h.s. , and and demurely says, ‘I don’t know why. ‘Eventually ‘ ‘ I got
thiothixene, 10 mg/day. His mood and headaches improved. sick of all this atheoretical, phenomenal dillydallying. I
but the auditory phenomena continued. Mr. A stated that he wanted to have a real affair with Lady Deese M. III and get
heard the music mainly with his left ear and that it had a to know her from the inside out. I wanted to truly. affectively
definite radio-like quality. One of us (S.L.) tested him by own her, use her, get under her fanfare facade of a theoreti-
asking him to match his perceptions with various stations on cal folderol. Suddenly Lady Deese M. III balked and showed
the AM broadcast band. He consistently identified the same me her cold shoulder. I could not get close to her: cool she
station (560 kHz) while the radio was tuned to various was and nearly frigid. and so unhelpful! Her detailed,
stations on the band regardless of the time of day or type of fragmented obsessions caused me to feel the same way. In
programming. When only the examiner listened to this the shifting states of passion she called herself something
station with an earphone, Mr. A was able to hum the music else all the time. Sometimes her depression was digited as .3,
he was hearing. correctly identify pauses and changes in the sometimes .5, sometimes she remitted and called that .3 or .5
programming. and could precisely tap out the beat of the or .6. When she became very crazy she called it either .2 or
songs being broadcast. We informed him that we felt that he .4. Only when she was dull and unspecified was she consis-
was receiving radio signals through his shrapnel implants. tently zero. By that time I lay prostrate-totally fragmented
He felt quite relieved by this finding and felt that he could and hopelessly frustrated! When I thought I knew her she
cope with this problem. slipped away again. Who mirrors me?
And then there is that little monster of hers, probably born
Auditory hallucinations, such as spoken words. often as an afterthought, not useful to foes or friends alike. It is
accompany major functional psychoses, toxic delirium, and small enough, thank goodness. so that I can hide it and do
organic dementias. Musical hallucinations have been de- not have to be reminded daily of my nine dollars-wasted
scnibed less often, but have been associated with vascular adoption fees!
and tumoral lesions (I) and sensorineural deficits (2. 3). I found out Deese M. III’s logical fireworks were rather
There have been few reports in the literature concerning spurious, edgy, and not harmonious or pleasing. How I
radio reception through dental work (4). We propose that a admired her at first. I thought she would be a fantastic object
mechanism for Mr. A’s reception of radio broadcasts in- truly to be loved and cherished, and we could have a
volves the metal implants’ provision ofdiode rectification of meaningful relationship. But like all borderline personalities
the signal. Thus detection and demodulation are accom- she behaved along the porcupine index: when I wanted her
plished by these metals implanted in bone (much the same to be close she slipped away from me, and when I wanted to
way as a crystal radio set operates). The audio is then push her far away-because she suffocated and drained
transmitted by bone conduction to the auditory apparatus. me-a sinister bureaucratic force pushed her right back upon
The perception of the received signals may not be perfectly me. I never got her number right!
clear, as was the case with Mr. A, who could not convey to In the past I usually would hurt from complicated relation-
the examiner the specific content of news broadcasts. ships like this and suffer in silence, telling myself I am not
The report of this phenomenon may aid the differential smart and bright enough to comprehend sophisticated ladies
diagnosis of patients who suffer from auditory ‘ ‘ hallucina- like Deese M. III. After a successful analysis. however, I do
tions” but exhibit no other signs of psychosis. not feel that way any more. Those feelings were caused by a
dysthymic (neurotic) conflict, now well resolved. Therefore
I am now addressing my grievances to Deese M. III’s
REFERENCES
creators.
1. Penfield W, Jasper H: Epilepsy and the Functional Anatomy of
Why do I think that Deese M. III is female? Have I been
the Human Brain. Boston, Little, Brown and Co. 1954. pp 452- slightly brainwashed by Deese M. III’s parents who are
467 making me believe that everything capricious, illogical,
2. Coleman WS: Hallucinations in the sane associated with local ‘ ‘over-reacting. irrational, egocentric, vain and demanding