Auditory Hallucinations in a Deaf Patient: A Case Report

This case report describes the progression of symptoms in a young deaf female. Her initial psychotic symptoms occur at the age of 16, but she did not come into contact with a psychiatric treatment facility before the age of 27, where she felt symptoms were distressing. The case report describes the difficulties in evaluating psychotic symptoms in a deaf patient, as well as the use of specialized scales in combination with the standard psychiatric evaluation. The current evidence, concerning the prevalence of psychotic symptoms, as well as the influence of deafness on the understanding of psychosis, is described. 1. Introduction In a review by Landsberger and Diaz [1], they examined the diagnostic and clinical features of deaf psychiatric inpatients and found studies showing prevalence rates of psychotic disorders from 20% to 54%. Authors of early studies suggested that these prevalence rates could represent diagnostic inaccuracies resulting from cultural and linguistic biases [2]. The deaf and hard of hearing population have a “deaf culture” that needs to be considered in the diagnostic procedure; this is especially important in deaf persons who are not fluent in the spoken/verbal language [3]. Due to suboptimal communication between deaf patients and early caregivers and peers, for example, parents and children of the same age, it is reasonable to suspect that the deaf patients could have difficulties with the normal experience of socialization, problem-solving skills, and emotional regulation [4]. The very early functional skill attainment seen in childhood is lacking in deaf patients, which likely contributes to a high rate of deaf patients displaying symptoms of socially inappropriate behaviour, poor self-care, behavioural impulsivity, aggression and self-injury, leading to diagnosis of impulse control disorders, mental retardation, and pervasive developmental disorders [4]. In a recent review, the prevalence rate of psychotic disorders in a sample of deaf inpatients was 43% in the USA [3]. Similar results were found in a population of deaf inpatients living in the UK, with a prevalence rate of 39% [5]. In contrast, studies from other European countries have reported lower prevalence rates with deaf Dutch inpatients having a prevalence rate of eight percent [6] and deaf Austrian inpatients having a prevalence rate of four percent [7]. In this paper, we wish to describe a patient with symptoms of psychosis and congenital deafness and the difficulties observed in our diagnostic process. 2. Case Presentation A 28-year-old single female with family