Introduction: Hallucinations, especially visual hallucination, are Considered to affect about one -quarter of patients with Parkinson's disease. They are viewed as a side - effect of anti Parkinsonian drugs, but other factors such as age, sex, stage of disease and duration of disease onset may be involved. Hallucinations were a risk factor for permanent nursing home placement, with its associated high mortality rate. The aim of this study is to determine the prevalence of hallucinations and type of them in the patients with Parkinson's disease and to determine risk factors may be involved in the creation of them.Materials and Methods: In this study during the 18 months the patients that had the Parkinson's disease clinical diagnostic Criteria studied. During this period for 100 patient especial questionnaires were completed and then after the appointment of prevalence of hallucinations, the patient were divided in two groups of Parkinson Patients with hallucination and without hallucination and they were compared for age, sex, duration of disease onset, stage of disease, types of used drugs and clinical diagnostic criteria that includes bradykinesia, muscular rigidity, rest tremor, Postural instability, history of repeated strokes, history of repeated head trauma, history of definite encephalitis, unilateral onset, Evidence of progression of disease, the presence of asymmetry, excellent response to Levodopa, severe Levodopa – induced chorea, Levodopa response for more than 5 years and clinical course of more than 10 years.Results: The prevalence of hallucinations in the patients of our study was %24. The most common of these were visual hallucinations (%79.2 of the total hallucinations), after them they were visual- Auditory hallucinations (%12.5), proprioceptive hallucinations (%4.2) and Auditory hallucinations (%4.2) of the total hallucinations. Among the clinical diagnostic criteria, hallucinations had relationship with the postural instability (P=0.005) and the evidence of progression of disease. (P=0.022) Hallucinations also were related with the stage of disease. (P=0.000), among the used drugs, hallucinations were related with Levodopa (P=0.000), carbidopa (P=0.000), trihexy phenidyl (P=0.004) and Amantadine (P=0.030). The average dose of daily use in these drugs in the patients with hallucination, from left to right, was 722.5, 75, 6, 266.7 milligram per day.Conclusion: Hallucinations were present in 24% patients with Parkinson's disease that in addition to the drugs include Levodopa, Carbidopa, Trihexyphenidyl and Amantadine, other factors such as the postural instability, the evidence of progression of disease had stage of disease have a role in the appearance of these hallucinations.

Background and Objectives: Coronavirus disease (COVID-19) respiratory manifestations range from mild signs to respiratory failure. Nevertheless, Coronavirus is not limited to the respiratory system and affects other organs, including the central nervous system. In this study, we reported a case of COVID-19 associated with the first episode of psychotic symptoms. Case presentation: The patient was a 39-year man who was brought to the emergency ward with loss of consciousness, following opioid overdose. He was intubated for airway protection. After the naloxone infusion, he became alert. The brain CT scan was normal, but the findings of the chest CT scan were compatible with COVID-19 involvement. In addition, his throat swab sample was positive. On the second day, he stated that he heard strange voices talking to each other, but he could not figure out where those voices were coming from. He did not experience hallucinations in any other sensory modalities. On the third day, three episodes of generalized tonic colonic seizures suddenly emerged. The brain CT scan demonstrated bilateral parieto-occipital hypoattenuation, which extended to the frontal lobes. Cortical hemorrhage was also seen in the right parietal lobe. Implications for Practice: The evidence indicates the neuroinvasive potential of COVID-19. Therefore, psychiatric symptoms are a novel phenomenon related to this disease. Clinicians should consider psychiatric representations in COVID-19 patients in order to decrease the complication of this disease.

Introduction: Many conditions can mimic psychiatric symptoms. Amongst them, intracranial mass and space occupying lesions have a significant importance. Aggression and hallucination are seen in association with a basal frontal lesion, and may mimic psychotic syndromes.Case Presentation: A 37-year-old man with no previous mental illness presented with a month history of headache, blurred vision, diplopia, aggression, loss of interest, fatigue, insomnia, and depressed mood. He was suffering from daily auditory hallucination which described as musical hallucination lasting about an hour per day. The headache was tension-type which appeared swinging, two times per week lasting 30 minutes. After auditory hallucination, the patient disclosed nausea, vomiting, and transient loss of consciousness. He referred from a neurologist, because, conventional therapy for the patient had not response. There were no other neurological symptoms or deficits. The results of neurologic examination including evaluation of the cranial nerves as well as head and neck examination were normal, But, psychiatric symptoms developed. Therefore, he was admitted to the psychiatric ward. The patient was diagnosed with major depressive disorder (MDD) with psychotic feature by Diagnostic and Statistical Manual of Mental Disorders (DSM) IV criteria and received psychiatric treatment. He started on antipsychotic agent (olanzapine 5 mg tablet/bid), antidepressant (sertraline 50 mg tablet/qhs) and valproate sodium 200 mg tablet/bid for treatment of aggression and headaches. After five days of admission, primary symptoms of headache and auditory hallucination were better but diplopia and blurred vision were still present. Ophthalmology examination revealed. The pupils were round, isochoric, and normoreactive to light and accommodation, and there was no sign of a relative afferent pupillary defect. Ophthalmoscopy showed a papilledema in both eyes. In order to rule out the intracranial pressure and their causes, neuroimaging was requested. An emergent noncontrast-enhanced computed tomography (CT) image of the head revealed a hyperdense mass in midfrontal convexity. Magnetic resonance imaging of the brain and orbits with and without intravenous gadolinium enhancement further delineated the CT findings and highlighted a large avidly enhancing midline mass within the frontal region measuring approximately 48×50×42 mm in axial dimension, consistent with a meningioma. The patient discharged from psychiatric ward with necessary advices and was admitted to the neurosurgery ward for further evaluation. A first psychosis episode is a clinical condition with principal indication for cerebral CT-scan.Discussion: Meningioma is a common intracranial tumor with a variety of histomorphologic growth patterns, which are usually easily recognized. The three most common symptoms are headaches, mental status changes, and paresis. Aggression and hallucination are seen in association with a basal frontal lesion and may mimic psychotic syndromes like hypomania and schizophrenia. A first psychosis episode is a clinical condition with principal indication for cerebral CT-scan.

Leukotriene receptor antagonists (montelukast) have been used for many years in the treatment of asthma both acute and chronic stages. They are accepted commonly as safe but mostly possible side effects are ignored. However, montelukast also could lead to important adverse reactions like hallucinations. In literature only 2 reports have been found about hallucinations with it. One is a study which reports 3 patients from 48 children and the other is a 29 year-old case report. In our case, psychiatric adverse reactions of montelukast, especially hallucinations are reported similarly. We are presenting a child who had visual hallucinations after starting to use montekulast and after stopping the medicine these complaints disappeared in 48 hours. Although it is a safe drug, it should not be forgotten that it has psychiatric side effects which may be missed easily especially in children.