“Sound Of Silence”. The Underlying Neurobiological Mechanisms Of Auditor Hallucinations In A Deaf And Mute Patient: A Case Report And Narrative Review

INTRODUCTION: Schizophrenia is a psychiatric illness with lifetime prevalence of 1.4%. the prevalence of psychosis in deaf and mute is almost equivalent to the general population. Almost 50% deaf and mute patients diagnosed with psychosis report “hearing of voices which others cannot hear” in the absence of any external stimulus. Similar percentage of patients report visual and tactile hallucinations. The assessment of psychosis in such patients become difficult due to lack of tools and training of medical professionals in communication with such patients. There exists some literature which shows association in the neurobiology of auditory hallucinations and hearing impairment. The following case report illustrates a case of psychosis in a deaf and mute patient CASE REPORT: A 17 years old unmarried female, not formally educated, unemployed, deaf and mute since birth with easy premorbid temperament no history of any comorbid illness and no family history of any psychiatric or neurological illness presented with insidious onset continuous course of total duration since last 1 year characterized by verbal and physical aggression, suspiciousness, muttering to self, hearing of voices that others cannot hear, odd behaviour, poor self care, decreased sleep. Patient was admitted due to unmanageability at home. On mental status examination, patient was agitated, violent towards herself and her family members. She was started on antipsychotic and had a good response on treatment. CONCLUSION: This case illustrates the presense of psychotic symptoms including auditory hallucinations in a congenital deaf and mute patient.