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- 1. The Best Selling Ufology Books Collection www.UfologyBooks.com
- 2. Cases That Test Your Skills ‘I’ve been abducted by aliens’ Patricia Kinne, MD, and Venna Bhanot, MD Ms. S is afraid to sleep at night because that’s when How would you the aliens come. Is she psychotic, or do her nocturnal handle this case? Visit CurrentPsychiatry.com experiences have another cause? to input your answers and see how your edia colleagues responded ficulty falling asleep, so h lt I Mmelatonin, 3 Hea Her add pattern CASE ‘I’m not crazy’ Ms. S, age 55, presents for treatment because n wde u still on to 6 mg at bedtime. ly sleeping is improved, but se variable. She also tries she is feeling depressed and anxious. Her o t® Dquetiapine,a25 mg at bedtime, but soon dis- l igh - ersonit due to intolerance. symptoms include decreased concentration, intermittent irritability, hoarding, r y and diffi continues Cop For p As our rapport strengthens, Ms. S reveals culty starting and completing tasks. She also has chronic sleep difficulties that often keep that she has had multiple encounters with her awake until dawn. aliens beginning at age 3. Although she has Fatigue, lack of focus, and poor compre- not had an “alien experience” for about 5 years, hension and motivation have left her un- she does not feel safe sleeping at night and in- employed. She and her teenage daughter stead sleeps during the day. Her efforts to stay live with Ms. S’s elderly mother. Ms. S feels awake at night strain her relationship with her tremendous guilt because she cannot be the mother. mother and daughter she wants to be. Initially, I (PK) diagnose Ms. S with major How would you respond to a patient who depressive disorder and prescribe sertraline, claims she has been abducted by aliens? 100 mg/d, which improves her mood and en- a) explain that there are no such things as aliens ergy. However, her inability to stay organized b) insist that she was dreaming results in her being “let go” from job training. c) issue a mental hygiene warrant and sign a certificate for immediate hospitalization Ms. S reports similar difficulties in school as d) explore the experiences in a supportive, a child. I determine that she meets DSM-IV-TR respectful manner and rule out organic or criteria for attention-deficit/hyperactivity dis- substance-induced etiology order (ADHD). Adding methylphenidate, 10 mg bid, improves her concentration and abil- The authors’ observations To read more about ity to complete tasks. It also reduces the im- Approximately 1% of the U.S. population sleep disorders, see “Sexual behavior pulsivity that has disrupted her relationships. report alien abduction experiences (AAE)— during sleep: Despite a strong desire to normalize her an umbrella term that includes alleged con- Convenient alibi sleep schedule, Ms. S continues to have dif- tact with aliens ranging from sightings to or parasomnia,” abductions.1 Patients rarely report AAE to page 21-30 Dr. Kinne is a fellow, department of child and adolescent mental health professionals. In our soci- psychiatry, University of Louisville, Louisville, KY. Dr. Bhanot is associate professor, department of psychiatry, West Virginia ety, claiming to be an “abductee” implies Current Psychiatry University, Charleston. that one might be insane. A survey of 398 Vol. 7, No. 7 81 For mass reproduction, content licensing and permissions contact Dowden Health Media.
- 3. Cases That Test Your Skills Canadian students that assessed attitudes, HISTORY Terrifying experiences beliefs, and experiences regarding alien Ms. S elaborates on her alien experiences, abductions found that 79% of respondents relating a particularly terrifying example believed they would have mostly negative from her teen years. She was lying awake in consequences—such as being laughed at or bed, looking at the ceiling, where she saw a socially isolated—if they claimed to have jeweled spider with a drill. As the spider de- encountered aliens.1 scended from the ceiling and spread its legs, Persons who have AAE may attend sup- she recalled a noise like a dentist’s drill. As port groups of fellow “abductees” to accu- the spider neared her face, it grew larger and mulate behavior-consonant information larger. Terrified, Ms. S was unable to scream (hearing other people’s abduction stories) for help or move anything except her eyes as and reduce dissonance by being surround- the spider clamped its legs around her head Clinical Point ed by others who share a questionable be- and bored into her skull. She reported that al- lief.2 A survey of “abductees” found that though she could feel the drill go in, it wasn’t A survey of 88% report at least some positive aspects painful. ‘abductees’ found of the experience, such as a sense of im- Other experiences included giving birth, that 88% described portance or feeling as though they were undergoing examinations or probes, and at least some chosen to bridge communication between communicating with aliens. Although she is positive aspects extraterrestrials and humans.3 very distressed by most memories, she feels Data collected over 17 years from Min- she benefited from others. For example, as a of the experience nesota Multiphasic Personality Inventory child, Ms. S’s math skills improved dramati- (MMPI) scores of 225 persons who report- cally after an AAE episode; she believes this ed AAE reveal common personality traits, was a gift from the aliens. Ms. S’s AAE mem- including: ories are as vivid to her as memories of her • high levels of psychic energy college graduation. She had been reluctant • self-sufficiency to discuss these events with anyone outside • resourcefulness her family out of fear of being perceived as • a tendency to question authority and “crazy.” to be exposed to situational conflicts.1 Ms. S says she was a shy child who had dif- Other common characteristics include ficulty making friends. She was plagued with above-average intelligence, assertiveness, fatigue and worry about family members. She a tendency to be reserved and absorbed believed that aliens might attack her sisters in thought, and a tendency toward defen- and felt obligated to stay awake at night to siveness, but no overt psychopathology.1 protect them. Aside from alien experiences, After Ms. S reveals her alien experienc- Ms. S reports a happy childhood. es, I reassure her in a nonjudgmental man- She has always been an avid reader. At ner that we will explore her experiences age 8 or 9, after reading a book on alien ab- and determine ways to help her cope with duction, she concluded that she had been them. abducted. Later, she joined a group of pro- fessed alien abductees. She feels accepted and validated by this group and has a forum for discussing her experiences without fear of Want to know more? See these articles at CurrentPsychiatry.com ridicule or rejection. Irrational beliefs: Ms. S remains frightened by things that A ubiquitous human trait remind her of aliens. Although she wrote a FEBRUARY 2007 summary of her alien experiences, she can- Psychosis: Is it a medical problem? not draw a picture of an alien, and thoughts Current Psychiatry 82 July 2008 JANUARY 2007 or images of the prototypical “grey” alien trig- continued on page 85
- 4. Cases That Test Your Skills continued from page 82 Table 1 4 types of sleep paralysis-related hallucinations Intruder Vague sense of a threatening presence accompanied by visual, auditory, and tactile hallucinations—noises, footsteps, gibbering voices, humanoid apparitions, and sensation of being touched or grabbed Incubus Breathing difficulties, feelings of suffocation, bodily pressure (particularly on the chest, as if someone were sitting or standing on it), pain, and thoughts of impending death Vestibular-motor Sensations of floating (levitation), flying, and falling Other Out-of-body experiences, autoscopy (seeing oneself from an external point), and fictive motor movements, ranging from simple arm movements to sitting up to apparent locomotion through the environment Source: References 7,9 Clinical Point ger panic. She also feels somewhat “different,” Myers-Briggs Type Indicator (MBTI), and Ms. S’s symptoms nervous, and distant from others. Wechsler Adult Intelligence Scale (WAIS suggested a III)—revealed no evidence of psychosis or diagnosis of What diagnosis do Ms. S’s symptoms and personality disorder, and intelligence was psychosis, seizures, history suggest? within the average range. Mental status false memory, or a a) seizure activity exam was normal. Aside from the alien b) sexual abuse/trauma sleep disorder experiences, Ms. S denied any memory of c) schizoaffective disorder childhood trauma. Interviews did not reveal d) schizotypal personality disorder symptoms compatible with narcolepsy. e) sleep disorder Diagnostic testing ruled out hallucino- sis related to seizures. I also ruled out false The authors’ observations memory related to sexual abuse or trauma, Reviewing AAE literature led me to con- which is commonly found in patients who sider several diagnoses, including: present with AAE. • psychosis Collaborative information from relatives • seizures did not uncover a history of psychosis. She • false memory (sexual abuse, trauma) and family members reported, however, • narcolepsy that Ms. S’s father and 1 sister had periodic • sleep paralysis. sleep disturbances with associated halluci- A medical workup ruled out common nations. I began to suspect sleep paralysis. organic causes of psychosis. Results were normal for brain MRI, ECG, comprehensive What is the prevalence of sleep paralysis? metabolic panel, thyroid function tests, com- a) 5% plete blood count with differential, serum b) 17% alcohol, urinalysis, and urine drug screen. c) 20% Electroencephalography (during drows- d) 30% e) 60% iness) revealed abnormal activity (oc- currences of widely scattered bursts of nonspecific, round, sharply contoured The authors’ observations slow waves in the left frontal region) only Full-body paralysis normally accompanies in the F7 electrode. In the absence of clini- rapid eye movement (REM) sleep, which cal symptoms and when found in a single occurs several times a night.4 Sleep paraly- lead, this is considered a normal variant. sis is a transient state that occurs when an Current Psychiatry Psychological testing—including MMPI, individual becomes conscious of this im- Vol. 7, No. 7 85 continued on page 90
- 5. Adverse Events with an Incidence ≥1% in Intramuscular Trials—The following treatment-emergent Cases That Test Your Skills adverse events were reported at an incidence of ≥1% with intramuscular olanzapine for injection (2.5-10 mg/injection) and at incidence greater than placebo in short-term, placebo-controlled trials in agitated patients with schizophrenia or bipolar mania: Body as a Whole—asthenia; Cardiovascular— hypotension, postural hypotension; Nervous System—somnolence, dizziness, tremor. Dose Dependency of Adverse Events in Short-Term, Placebo-Controlled Trials—Extrapyramidal Symptoms—In an acute-phase controlled clinical trial in schizophrenia, there was no significant difference in ratings scales incidence between any dose of oral olanzapine (5±2.5, 10±2.5, or 15±2.5 mg/d) and placebo for parkinsonism (Simpson-Angus Scale total score >3) or akathisia (Barnes Akathisia continued from page 85 global score ≥2). In the same trial, only akathisia events (spontaneously reported COSTART terms akathisia and hyperkinesia) showed a statistically significantly greater adverse events incidence with the 2 higher doses of olanzapine than with placebo. The incidence of patients reporting any extrapyramidal event was significantly greater than placebo only with the highest dose of oral olanzapine (15±2.5 mg/d). mobility, typically while falling asleep or In controlled clinical trials of intramuscular olanzapine for injection, there were no statistically significant differences from placebo in occurrence of any treatment-emergent extrapyramidal awakening.5 These experiences can be ac- symptoms, assessed by either rating scales incidence or spontaneously reported adverse events. Dystonia, Class Effect—Dystonia symptoms (prolonged abnormal contractions of muscle companied by hypnagogic (while falling groups) may occur in susceptible individuals during the first few days of treatment. While these symptoms can occur at low doses, the frequency and severity are greater with high potency and at higher doses of first-generation antipsychotics. In general, an elevated risk of acute dystonia asleep) or hypnopompic (while awaken- may be observed in males and younger age groups receiving antipsychotics; however, dystonic events have been reported infrequently (<1%) with olanzapine. ing) hallucinations. An estimated 30% of Other Adverse Events—Dose-relatedness of adverse events was assessed using data from this same clinical trial involving 3 fixed oral dosage ranges (5±2.5, 10±2.5, or 15±2.5 mg/d) compared the population has had at least one sleep with placebo. The following treatment-emergent events showed a statistically significant trend: asthenia, dry mouth, nausea, somnolence, tremor. paralysis episode.6 In one study, 5% of In an 8-week, randomized, double-blind study in patients with schizophrenia, schizophreniform disorder, or schizoaffective disorder comparing fixed doses of 10, 20, and 40 mg/d, statistically significant differences were seen between doses for the following: baseline to endpoint weight gain, sleep paralysis patients had episodes that 10 vs 40 mg/d; incidence of treatment-emergent prolactin elevations >24.2 ng/mL (female) or were accompanied by hallucinations.7 >18.77 ng/mL (male), 10 vs 40 mg/d and 20 vs 40 mg/d; fatigue, 10 vs 40 mg/d and 20 vs 40 mg/d; and dizziness, 20 vs 40 mg/d. Vital Sign Changes—Oral olanzapine was associated with orthostatic hypotension and tachycardia Although individuals cannot make in clinical trials. Intramuscular olanzapine for injection was associated with bradycardia, hypotension, and tachycardia in clinical trials (see PRECAUTIONS). gross body movements during sleep pa- Laboratory Changes—Olanzapine is associated with asymptomatic increases in SGPT, SGOT, and GGT and with increases in serum prolactin and CPK (see PRECAUTIONS). Asymptomatic elevation of ralysis, they can open their eyes and are eosinophils was reported in 0.3% of olanzapine patients in premarketing trials. There was no indication of a risk of clinically significant neutropenia associated with olanzapine in the premarketing database. able to report events that occurred around ECG Changes—Analyses of pooled placebo-controlled trials revealed no statistically significant olanzapine/placebo differences in incidence of potentially important changes in ECG parameters, including QT, QTc, and PR intervals. Olanzapine was associated with a mean increase in heart rate of them during the episode.8 Patients inter- 2.4 BPM compared to no change among placebo patients. Other Adverse Events Observed During Clinical Trials—The following treatment-emergent events pret sleep paralysis experiences in subjec- were reported with oral olanzapine at multiple doses ≥1 mg/d in clinical trials (8661 patients, 4165 patient-years of exposure). This list may not include events previously listed elsewhere in tive terms. Common descriptions include labeling, those events for which a drug cause was remote, those terms which were so general as to be uninformative, and those events reported only once or twice which did not have a substantial probability of being acutely life-threatening. Frequent events occurred in ≥1/100 patients; infrequent intense fear, breathing difficulties, feel- events occurred in 1/100 to 1/1000 patients; rare events occurred in <1/1000 patients. Body as a Whole—Frequent: dental pain, flu syndrome; Infrequent: abdomen enlarged, chills, face edema, ing of bodily pressure—especially on the intentional injury, malaise, moniliasis, neck pain, neck rigidity, pelvic pain, photosensitivity reaction, suicide attempt; Rare: chills and fever, hangover effect, sudden death. Cardiovascular—Frequent: chest—and sensations of floating, flying, hypotension; Infrequent: atrial fibrillation, bradycardia, cerebrovascular accident, congestive heart failure, heart arrest, hemorrhage, migraine, pallor, palpitation, vasodilatation, ventricular extrasystoles; or falling (Table 1, page 85).7,9 Rare: arteritis, heart failure, pulmonary embolus. Digestive—Frequent: flatulence, increased salivation, thirst; Infrequent: dysphagia, esophagitis, fecal impaction, fecal incontinence, gastritis, gastroenteritis, gingivitis, hepatitis, melena, mouth ulceration, nausea and vomiting, oral moniliasis, periodontal abscess, During sleep paralysis episodes, indi- rectal hemorrhage, stomatitis, tongue edema, tooth caries; Rare: aphthous stomatitis, enteritis, viduals typically sense a threatening pres- eructation, esophageal ulcer, glossitis, ileus, intestinal obstruction, liver fatty deposit, tongue discoloration. Endocrine—Infrequent: diabetes mellitus; Rare: diabetic acidosis, goiter. Hemic and Lymphatic—Infrequent: anemia, cyanosis, leukocytosis, leukopenia, lymphadenopathy, thrombocytopenia; ence.6 Patients have reported beastly and Rare: normocytic anemia, thrombocythemia. Metabolic and Nutritional—Infrequent: acidosis, alkaline phosphatase increased, bilirubinemia, dehydration, hypercholesteremia, hyperglycemia, hyperlipemia, demonic figures of doom: devils, demons, hyperuricemia, hypoglycemia, hypokalemia, hyponatremia, lower extremity edema, upper extremity edema; Rare: gout, hyperkalemia, hypernatremia, hypoproteinemia, ketosis, water intoxication. witches, aliens, and even cinematic villains Musculoskeletal—Frequent: joint stiffness, twitching; Infrequent: arthritis, arthrosis, leg cramps, myasthenia; Rare: bone pain, bursitis, myopathy, osteoporosis, rheumatoid arthritis. Nervous System—Frequent: abnormal dreams, amnesia, delusions, emotional lability, euphoria, manic reaction, such as Darth Vader and Freddy Kruger.6 paresthesia, schizophrenic reaction; Infrequent: akinesia, alcohol misuse, antisocial reaction, ataxia, CNS stimulation, cogwheel rigidity, delirium, dementia, depersonalization, dysarthria, facial paralysis, Others have described this presence in hypesthesia, hypokinesia, hypotonia, incoordination, libido decreased, libido increased, obsessive compulsive symptoms, phobias, somatization, stimulant misuse, stupor, stuttering, tardive dyskinesia, terms of alien visitations or abductions. vertigo, withdrawal syndrome; Rare: circumoral paresthesia, coma, encephalopathy, neuralgia, neuropathy, nystagmus, paralysis, subarachnoid hemorrhage, tobacco misuse. Respiratory— Internationally, most alien experience Frequent: dyspnea; Infrequent: apnea, asthma, epistaxis, hemoptysis, hyperventilation, hypoxia, laryngitis, voice alteration; Rare: atelectasis, hiccup, hypoventilation, lung edema, stridor. Skin and Appendages—Frequent: sweating; Infrequent: alopecia, contact dermatitis, dry skin, eczema, reports come from countries dominated by maculopapular rash, pruritus, seborrhea, skin discoloration, skin ulcer, urticaria, vesiculobullous rash; Rare: hirsutism, pustular rash. Special Senses—Frequent: conjunctivitis; Infrequent: abnormality of Western culture and values. This suggests accommodation, blepharitis, cataract, deafness, diplopia, dry eyes, ear pain, eye hemorrhage, eye inflammation, eye pain, ocular muscle abnormality, taste perversion, tinnitus; Rare: corneal lesion, that a belief in aliens serves as a template glaucoma, keratoconjunctivitis, macular hypopigmentation, miosis, mydriasis, pigment deposits lens. Urogenital—Frequent: vaginitis∗; Infrequent: abnormal ejaculation∗, amenorrhea∗, breast pain, against which people share ambiguous in- cystitis, decreased menstruation∗, dysuria, female lactation∗, glycosuria, gynecomastia, hematuria, impotence∗, increased menstruation∗, menorrhagia∗, metrorrhagia∗, polyuria, premenstrual syndrome∗, formation, diffuse physical sensations, and pyuria, urinary frequency, urinary retention, urinary urgency, urination impaired, uterine fibroids enlarged∗, vaginal hemorrhage∗; Rare: albuminuria, breast enlargement, mastitis, oliguria. (∗Adjusted vivid hallucinations of alien encounters for gender.) The following treatment-emergent events were reported with intramuscular olanzapine for injection at one or more doses ≥2.5 mg/injection in clinical trials (722 patients). This list may not include events that they experience as real events.10 previously listed elsewhere in labeling, those events for which a drug cause was remote, those terms which were so general as to be uninformative, and those events reported only once or twice which did A Harvard University study of 11 in- not have a substantial probability of being acutely life-threatening. Body as a Whole—Frequent: injection site pain; Infrequent: abdominal pain, fever. Cardiovascular—Infrequent: AV block, heart dividuals who reported alien abductions block, syncope. Digestive—Infrequent: diarrhea, nausea. Hemic and Lymphatic—Infrequent: anemia. Metabolic and Nutritional—Infrequent: creatine phosphokinase increased, dehydration, hyperkalemia. found that all participants experienced a Musculoskeletal—Infrequent: twitching. Nervous System—Infrequent: abnormal gait, akathisia, articulation impairment, confusion, emotional lability. Skin and Appendages—Infrequent: sweating. Postintroduction Reports—Reported since market introduction and temporally (not necessarily similar sequence of events: causally) related to olanzapine therapy: allergic reaction (e.g., anaphylactoid reaction, angioedema, pruritus or urticaria), diabetic coma, jaundice, neutropenia, pancreatitis, priapism, rhabdomyolysis, and • They suspected abduction after sleep venous thromboembolic events (including pulmonary embolism and deep venous thrombosis). Random cholesterol levels of ≥240 mg/dL and random triglyceride levels of ≥1000 mg/dL have been reported. episodes characterized by awakening, full- DRUG ABUSE AND DEPENDENCE: Olanzapine is not a controlled substance. ZYPREXA is a registered trademark of Eli Lilly and Company. ZYDIS is a registered trademark of body paralysis, intense fear, and a feeling Catalent Pharma Solutions. Literature revised March 10, 2008 of a presence. Several reported tactile or PV 6240 AMP PRINTED IN USA Eli Lilly and Company visual sensations strikingly similar to de- Indianapolis, IN 46285, USA www.ZYPREXA.com scriptions of sleep paralysis, such as levi- Copyright © 1997, 2008, Eli Lilly and Company. All rights reserved. tating, being touched, and seeing shadowy ZYPREXA (Olanzapine Tablets) figures. ZYPREXA ZYDIS (Olanzapine Orally Disintegrating Tablets) ZYPREXA IntraMuscular (Olanzapine for Injection) PV 6240 AMP
- 6. Cases That Test Your Skills Table 2 • They sought explanations for what they perceived as anomalous experiences. Diagnostic criteria • They “recovered” abduction memo- for sleep paralysis ries in therapy (with the help of techniques A. Patient complains of inability to move such as hypnosis) or spontaneously (after the trunk or limbs at sleep onset or upon reading books or seeing movies or televi- awakening sion shows depicting similar episodes).4 B. Brief episodes of partial or complete Ms. S reported no daytime sleep attacks, skeletal muscle paralysis cataplexy, or rapid onset of dreaming. Be- C. Episodes can be associated with cause her reported AAEs were spread out hypnagogic (preceding sleep) and the last occurred approximately 5 years hallucinations or dreamlike mentation ago, I decided against conducting a sleep D. Polysomnographic monitoring study because it likely would be low yield demonstrates at least 1 of the following: Clinical Point and costly. I reached a diagnosis of sleep pa- 1. Suppression of skeletal muscle tone ralysis-familial type, chronic based on: 2. A sleep-onset REM period During sleep • an absence of organic or psychiatric 3. Dissociated REM sleep paralysis episodes, dysfunction E. Symptoms are not associated with individuals often • a familial pattern of sleep disturbances other medical or mental disorders, such sense a threatening • the temporal pattern and description as hysteria or hypokalemic paralysis presence that some of her symptoms (Table 2).11 Minimal criteria are A plus B plus E describe as alien All of Ms. S’s episodes occurred at night Note: If symptoms are associated with a or times of quiet restfulness. She usually familial history, the diagnosis is sleep visitations slept on her back, which may be a risk fac- paralysis-familial type. If symptoms are not associated with a familial history, the tor for sleep paralysis.12 diagnosis is sleep paralysis-isolated type Severity criteria Mild: <1 episode per month TREATMENT Reassurance, therapy Moderate: >1 episode per month Effective treatment for Ms. S required helping but <1 per week her to understand that an organic condition Severe: ≥1 episode per week was the foundation of her experiences. I be- Duration criteria gan by conveying the sleep paralysis diagno- Acute: ≤1 month sis and my understanding of the occupational Subacute: >1 month but <6 months and personal consequences that this condition Chronic: ≥6 months had had for her. I explained the physiology of REM: rapid eye movement Source: Reference 11 sleep paralysis and that memories or halluci- nations (dreamlike mentation) are preserved in an extremely vivid fashion because her eyes treatment, Ms. S cites multiple improvements, are open. I acknowledged the realistic charac- with no recurrence of sleep paralysis episodes. ter of her experiences and the resulting symp- She continues to take sertraline, which relieves toms of posttraumatic stress disorder (PTSD). her depression and anxiety, and methylpheni- I refer Ms. S to a therapist for psychother- date to improve her attention and concentra- apy. The therapist begins by using trauma tion. She has taken on more responsibility at informed techniques to address Ms. S’s PTSD. home, cleaning, preparing meals, helping her As she improves, her therapy evolves into a daughter choose a college, and attending to combination of narrative and supportive psy- her mother’s health issues. Ms. S still has dif- chotherapy, and then family systems therapy to ficulties with her sleep patterns, and her new address issues with her daughter and mother. psychiatrist is exploring the possibility of a bi- Current Psychiatry In a follow-up visit 1 year after beginning polar component to her mood disorder. Vol. 7, No. 7 91 continued
- 7. Cases That Test Your Skills The authors’ observations Related Resources Like other traumas, AAE can induce symp- • American Academy of Sleep Medicine. International classification of sleep disorders, revised: diagnostic and coding toms of acute or chronic PTSD. The various manual. Chicago, IL: American Academy of Sleep Medicine; psychoses, personality disorders, and dis- 2001:166-9. sociative disorders that could account for • Cheyne JA. Sleep paralysis and associated hypnagogic and hypnopompic experiences. http://watarts.uwaterloo. abduction experiences are characterized ca/~acheyne/S_P.html. by delusions, so conduct ongoing assess- Drug Brand Names ment for these conditions in patients who Methylphenidate • Ritalin Sertraline • Zoloft Quetiapine • Seroquel report AAE. However, evidence suggests Disclosure that serious psychopathology is no more The authors report no financial relationship with any common among “abductees” than among company whose products are mentioned in this article or the general population.12 with manufacturers of competing products. Clinical Point Persons reporting AAE exhibit physi- the UFO abduction phenomenon: hypnotic elaboration, ologic reactivity as profound as that of extraterrestrial sadomasochism, and spurious memories. No drugs are survivors of combat or sexual assault.13 Psychol Inq 1996;7(2):99-126. FDA-approved This reactivity confirms that the emotional 3. Bader CD. Supernatural support groups: who are the UFO abductees and ritual-abuse survivors? J Sci Study Relig for treating sleep power of the memory is as evocative and 2003;42(4):669-78. 4. Clancy SA, McNally RJ, Schacter DL, et al. Memory distortion paralysis, but use problematic as the physiologic reactions in people reporting abduction by aliens. J Abnorm Psychol 2002;111(3):455-61. pharmacotherapy attributable to genuine (documented) 5. Girard TA, Cheyne JA. Individual differences in lateralization traumatic events. Because patients have of hallucinations associated with sleep paralysis. Laterality to address anxiety 2004;9(1):93-111. difficulty differentiating these hallucina- 6. Cheyne JA. The ominous numinous: sensed presence and and depression tions from actual events, they experience “other” hallucinations. Journal of Consciousness Studies 2001;8(5-7):133-50. emotional pain and suffering. Fifty-seven 7. Cheyne JA, Newby-Clark IR, Rueffer SD. Relations among hypnagogic and hypnopompic experiences associated with percent of sleep paralysis patients who re- sleep paralysis. J Sleep Res 1999;8:313-7. port AAE attempt suicide.14 8. Cheyne JA, Rueffer SD, Newby-Clark IR. Hypnagogic and hypnopompic hallucinations during sleep paralysis: Offer patients with AAE psychotherapy neurological and cultural construction of the night-mare. Conscious Cogn 1999;8(3):319-37. to deal with long-term effects of trauma 9. Cheyne JA. Sleep paralysis and the structure of waking- and problems with mood, sleep, daily nightmare hallucinations. Dreaming 2003;13(3):163-79. 10. Spanos NP, Cross PA, Dickson K, et al. Close encounters: functioning, and/or relationships. an examination of UFO experiences. J Abnorm Psychol 1993;102(4):624-32. There are no FDA-approved medica- 11. American Academy of Sleep Medicine. International tions for treating sleep paralysis. Phar- classification of sleep disorders, revised: diagnostic and coding manual. Chicago, IL: American Academy of Sleep Medicine; macotherapy can be used to address 2001:166-9. psychiatric symptoms such as the depres- 12. Holden KJ, French CC. Alien abduction experiences: some clues from neuropsychology and neuropsychiatry. Cognit sion and anxiety Ms. S exhibited. Neuropsychiatry 2002;7(3):163-78. 13. McNally RJ. Applying biological data in forensic and policy arenas. Ann N Y Acad Sci 2006;1071:267-76. References 14. Stone-Carmen J. A descriptive study of people reporting 1. Patry AL, Pelletier LG. Extraterrestrial beliefs and experiences: abduction by unidentified flying objects (UFOs). In: Pritchard an application of the theory of reasoned action. J Soc Psychol A, Pritchard DE, Mack JE, et al, eds. Alien discussions: proceedings 2001;141(2):199-217. of the abduction study conference held at MIT. Cambridge, MA: 2. Newman LS, Baumeister RF. Toward an explanation of North Cambridge Press; 1994:309-15. Bottom Line Assess patients who report alien abductions for psychosis, seizures, false memory, narcolepsy, and sleep paralysis. During sleep paralysis, patients may sense a threatening presence they interpret as intruders or aliens—and experience visual, tactile, and auditory hallucinations—that they perceive as real. Psychotherapy and Current Psychiatry 92 July 2008 pharmacotherapy can help patients manage the impact of these episodes.