the international pilot study of schizophrenia estimated that 70% of schizophrenia patients suffered from hallucinations .
25 - 30% of the auditory hallucinations in schizophrenia are refractory to traditional antipsychotic drug treatment .
even with the advent of newer antipsychotics , a significant minority of patients continue to experience persistent hallucinations . apart from pharmacological treatments , other therapies such as transcranial magnetic stimulation , cognitive behavior therapy , and hallucination - focused integrative treatment
tiapride , is a substituted benzamide antipsychotic drug and has a selective d2 and d3 dopamine receptor antagonist activity in limbic brain areas and the locus ceruleus .
the usual indications of tiapride use are the presence of extrapyramidal symptoms or other dyskinesias , hyperkinesias , patients with huntington 's chorea and also geriatric agitation and restlessness .
the common side - effects with tiapride are drowsiness , extrapyramidal symptoms , dizziness , and orthostatic hypotension . here
, we report two cases of schizophrenia with persistent auditory hallucinations that responded favorably to tiapride as an add on drug to their already existing drug treatments .
a 37-year - old right handed female christian graduate was brought to the out - patient department by family members with chief complains of hearing voices inaudible to others , suspiciousness toward others as though they are talking about her and plotting against her since the past 5 years .
she would hear voices of known and unknown people saying sometimes good things and majority of times saying bad things to her .
she would get commanding hallucinations telling her to tear her books , bible , certificates , etc . , she also complained of occasional anger outbursts , decreased sleep , and stopped doing household activities .
she was diagnosed as having paranoid schizophrenia as per diagnostic and statistical manual for the classification of psychiatric disorders  4 edition text revised ( dsm - iv tr ) ( dsm - iv tr ) criteria and was started on olanzapine 10 mg / day , haloperidol 10 mg / day and trihexyphenidyl 4 mg / day all in oral formulations .
gradually , the doses were increased weekly to olanzapine 20 mg / day , haloperidol 20 mg / day , and trihexyphenidyl 6 mg / day .
clozapine 25 mg at night was added , which was gradually increased to 100 mg at night .
her hallucinations persisted , but there was some improvement in that the number of people whose voices she used to get reduced .
the patient and relatives were not willing for electroconvulsive therapy ( ect ) as a treatment option .
hence , tiapride 50 mg / day was added after 6 months of addition of clozapine 100 mg .
after 2 weeks of tiapride therapy , the dose was increased to 100 mg / day in divided doses .
olanzapine was reduced as she complained of excessive sedation with it . currently , the patient is on haloperidol 20 mg / day , olanzapine 10 mg / day , trihexyphenidyl 6 mg / day , clozapine 100 mg at night and tiapride 100 mg / day .
she was assessed for hallucinations using the hallucinations subscale of the psychopathology rating scale ( psyrats ) .
her score on the hallucination subscale improved from 28 to 11 after the addition of tiapride . a 32-year - old married 10 standard educated female
was brought to the out - patient department by her sister with complaints of suspiciousness toward the neighbors that they are talking about her and that they would kill her and her family members since the past 6 months .
she would feel that they are keeping a watch on her by cameras fitted in her house by them .
she would also hear voices inaudible to others commenting on her actions and sometimes giving running commentary also .
she was diagnosed as having paranoid schizophrenia as per dsm - iv tr criteria and was started on risperidone 4 mg / day and trihexyphenidyl 4 mg / day .
gradually risperidone was increased to 8 mg / day in weekly increments and trihexyphenidyl to 6 mg / day .
her symptoms showed no improvements after 1 month and olanzapine 10 mg / day was added , which was increased gradually to 20 mg / day .
she and her family members were not consenting for ect and tiapride 50 mg / day in divided doses was added to her medication .
she started feeling better , her voices began to reduce and the intensity and frequency of hallucinations decreased .
the patient claimed 80% improvement in auditory hallucinations after 2 months of addition of tiapride to her medication .
her total score on the psyrats - hallucination subscale improved from 41 to 25 after addition of tiapride .
a 37-year - old right handed female christian graduate was brought to the out - patient department by family members with chief complains of hearing voices inaudible to others , suspiciousness toward others as though they are talking about her and plotting against her since the past 5 years .
she would hear voices of known and unknown people saying sometimes good things and majority of times saying bad things to her .
she would get commanding hallucinations telling her to tear her books , bible , certificates , etc . , she also complained of occasional anger outbursts , decreased sleep , and stopped doing household activities .
she was diagnosed as having paranoid schizophrenia as per diagnostic and statistical manual for the classification of psychiatric disorders  4 edition text revised ( dsm - iv tr ) ( dsm - iv tr ) criteria and was started on olanzapine 10 mg / day , haloperidol 10 mg / day and trihexyphenidyl 4 mg / day all in oral formulations .
gradually , the doses were increased weekly to olanzapine 20 mg / day , haloperidol 20 mg / day , and trihexyphenidyl 6 mg / day .
clozapine 25 mg at night was added , which was gradually increased to 100 mg at night .
her hallucinations persisted , but there was some improvement in that the number of people whose voices she used to get reduced .
the patient and relatives were not willing for electroconvulsive therapy ( ect ) as a treatment option .
hence , tiapride 50 mg / day was added after 6 months of addition of clozapine 100 mg .
after 2 weeks of tiapride therapy , the dose was increased to 100 mg / day in divided doses .
olanzapine was reduced as she complained of excessive sedation with it . currently , the patient is on haloperidol 20 mg / day , olanzapine 10 mg / day , trihexyphenidyl 6 mg / day , clozapine 100 mg at night and tiapride 100 mg / day .
she was assessed for hallucinations using the hallucinations subscale of the psychopathology rating scale ( psyrats ) .
her score on the hallucination subscale improved from 28 to 11 after the addition of tiapride .
a 32-year - old married 10 standard educated female was brought to the out - patient department by her sister with complaints of suspiciousness toward the neighbors that they are talking about her and that they would kill her and her family members since the past 6 months .
she would feel that they are keeping a watch on her by cameras fitted in her house by them .
she would also hear voices inaudible to others commenting on her actions and sometimes giving running commentary also .
she was diagnosed as having paranoid schizophrenia as per dsm - iv tr criteria and was started on risperidone 4 mg / day and trihexyphenidyl 4 mg / day . gradually risperidone was increased to 8 mg / day in weekly increments and trihexyphenidyl to 6 mg / day .
her symptoms showed no improvements after 1 month and olanzapine 10 mg / day was added , which was increased gradually to 20 mg / day .
she and her family members were not consenting for ect and tiapride 50 mg / day in divided doses was added to her medication .
she started feeling better , her voices began to reduce and the intensity and frequency of hallucinations decreased .
the patient claimed 80% improvement in auditory hallucinations after 2 months of addition of tiapride to her medication .
her total score on the psyrats - hallucination subscale improved from 41 to 25 after addition of tiapride .
tiapride offers good results in patients whose main complains are auditory hallucinations , which have not responded to other antipsychotics .
tiapride does not cause sedation ; hence , it can be added easily with other antispychotics and no worries of cumulative sedation effects .
to best of our knowledge , there are no literature on use of tiapride for auditory hallucinations , but there is one report on the treatment of visual release hallucinations with tiapride .
 hallucinations are considered as core symptoms of psychosis by both international classification of diseases10 ( icd-10 ) and diagnostic and statistical manual for the classification of psychiatric disorders  
 4th edition text revised ( dsm - iv tr ) . 
 the most common types of hallucinations in patients with schizophrenia are auditory in nature followed by visual hallucinations . 
 few patients with schizophrenia have persisting auditory hallucinations despite all other features of schizophrenia having being improved . here , we report two cases where tiapride was useful as an add - on drug for treating persistent auditory hallucinations . 
INTRODUCTION
CASE REPORTS
Case 1
Case 2
DISCUSSION