[Hallucinations attributed to djinns].

Individuals with an Islamic background who suffer from hallucinations often attribute these to djinns, invisible beings. The treatment of these hallucinations is complicated by the patients' reluctance to discuss them, and by their doubts concerning the usefulness of a biomedical treatment for a problem which they experience as metaphysical in nature. In this clinical lesson, we present case studies of three Moroccan patients who attributed their hallucinations to djinns. The first was a 30-year-old factory worker whose compulsive complaints had started when he saw a white figure in the basement who asked him 'What are you doing here?' The psychiatric diagnosis was obsessive-compulsive disorder. The patient was prescribed cognitive behavioural therapy, an SSRI and a consultation by the imam, but he refused. The second patient was a 25-year-old unemployed man, who had auditory hallucinations, delusions, behavioural problems, and alcohol and cannabis abuse. He heard voices which he attributed to maleficent djinns. He was diagnosed with schizophrenia, but his compliance with antipsychotics was insufficient. The imam who was consulted reassured him that his complaints were not caused by djinns. After prolonged treatment with clozapine and cutting down on cannabis use the patient recovered sufficiently to be discharged. The third patient was a 26-year-old unemployed woman who was hearing voices that her imam thought were caused by a djinn. She was examined because of serious self-mutilation and was diagnosed with a schizoaffective disorder. Treatment with an antipsychotic, lithium and valproic acid and a consultation by a second imam, who found no signs of evidence of djinns, was successful. We recommend to ask individuals with an Islamic background specifically whether djinns might be involved, especially in cases of mental problems and unexplained symptoms, and to seek the cooperation of a qualified imam or traditional healer for treatment purposes.