PSYCHIATRICANNALS•Vol.47,No.4,2017 163 case challenge A 61-Year-Old Inpatient with Visual Hallucinations and Agitation Qaiser S. Khan, MD, MPH; Akshay Lokhande MD, MHA; Charles H. Dukes, MD; and Britta Ostermeyer, MD, MBA, FAPA T he psychiatry team was consulted to see a 61-year- old woman for the chief complaint of visual hallucinations and agitation for more than 1 week since her hospital admission. These hallucinations were episodic and lasted from a few minutes to hours a day. The patient was unable to identify any specific factors that triggered the onset or resolution of these hallucinations, such as agita- tion or mood changes. The hallucinations were clear and vivid, consisting of people’s faces in her doorway or in the cor- ner of her room. The patient report- ed that she felt that she was seeing those faces as in a “warehouse.” The patient could not understand this unusual phenomenon, which caused her to become frightened, frustrated, and agitated. While ex- periencing these hallucinations, the patient had no mental status changes and maintained full in- sight and awareness. She reported left homonymous hemianopia, with her vision improving from light perception to hand motion. She stated she had no auditory or other hallucinations. Her medical history included significant cerebrovascular disease, Takotsubo cardiomyopathy, sei- zures, hypothyroidism, hyperten- sion, renal artery clot, and stage III sacral ulcer. Takotsubo cardio- myopathy is a stress-induced, non- ischemic cardiomyopathy in which there is a sudden temporary weak- ening of the muscular portion of the heart. This is often triggered by severe emotional distress or signifi- cant anxiety. Of note, her history was relevant for cortical blindness and the de- velopment of Anton syndrome after an ischemic cerebrovascular event. She reported vision improvement during the hospital course. She re- ported no past psychiatric history. Upon examination, the patient was oriented to place, person, and time but had some fluctuation in attention. She was distressed, anx- ious, and agitated during the inter- view. She also had affect lability but did not report any visual hal- lucinations during the psychiatric assessment. Her blood pressure was 149/80 mm Hg, pulse rate was 91 beats per minute, respira- tion was 16 breaths per minutes, temperature was 35.9°C, and oxy- Qaiser S. Khan, MD, MPH, is a Psychiatry Resident. Akshay Lokhande, MD, MHA, is a Psychiatry Resident. Charles H. Dukes, MD, is a Clinical Assistant Professor, the Direc- tor of Psychiatry Residency Training Program, and the Director of Consultation Liaison Service. Britta Ostermeyer, MD, MBA, FAPA, is the Paul and Ruth Jonas Chair in Mental Health and a Professor and the Chairman. All authors are afliated with the Depart- ment of Psychiatry and Behavioral Sciences, College of Medicine, University of Okla- homa Health Sciences Center. Address correspondence to Britta Ostermeyer, MD, MBA, FAPA, Department of Psy- chiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, Oklahoma City, OK 73104; email: Britta-Ostermeyer@ ouhsc.edu. Disclosure: The authors have no relevant financial relationships to disclose. doi: 10.3928/00485713-20170301-01