Visual hallucinations in people with PTSD can be indistinguishable from those in schizophrenia. A study comparing three groups who hear voices—schizophrenia without trauma history (19 participants), PTSD with dissociation (17 participants), and comorbid schizophrenia and PTSD (20 participants)—found remarkable similarity in visual experiences, including rates of complex visual hallucinations, across all groups. No significant differences emerged in the severity or components of distress surrounding these experiences. Dissociation predicted visual hallucination severity only for the comorbid group, not for PTSD or schizophrenia alone. Multimodal hallucinations were frequent in both schizophrenia and PTSD. The authors suggest a model for visual hallucinations in PTSD following two separate neurobiological pathways based on distinct trauma responses.
Ketamine shows promise for treatment-resistant depression, but its use requires careful management through evidence-based guidelines. The editorial emphasizes the need for comprehensive protocols to oversee both licensed and off-licence ketamine formulations, referencing recent efforts to develop such guidelines in New Zealand. It advocates for national registries to monitor ketamine therapy, ensuring responsible and effective treatment for depression.
In a small real-world study of 20 adults with treatment-resistant depression who received at least 100 sessions of intranasal esketamine alongside oral antidepressants over an average of 2.5 years, depression and anxiety scores significantly decreased. 85% of patients showed improvement in depressive severity, with 25% achieving remission; 65% improved in anxiety severity, and 20% reached remission. Esketamine was generally well tolerated with mild, transient side effects and no serious adverse events, though 20% of patients developed urinary symptoms suggestive of cystitis, indicating a need for ongoing monitoring. The findings support the long-term effectiveness and acceptable safety profile of esketamine in complex clinical populations.