Sir: Palinopsia is an unusual phenomenon characterized by the recurrence of visual images after the stimulus object has been removed. 1,2 In most cases of palinopsia, neuropathology has been identified.1,2 Infrequently, palinopsia has also been described in association with schizophrenia. 3 We present the case of a man who suffered from psychosis and anxiety disorder, whose palinopsia responded to carbamazepine.Case report. Mr. A, a 40-year-old man, was hospitalized complaining of combat-related "flashbacks" and insomnia that he had begun experiencing at age 21. These had diminished since his initial exposure to combat. By age 26, he suddenly began to experience visual abnormalities unrelated to his combat experiences, describing them as perseverations of images of objects he had previously visualized. He stated that, for about 10 seconds after seeing an object, he would continue to see its colored image, then the image would enlarge, lose shape, and disappear. Concurrently, he also began to experience paranoid delusions and tangential thinking. Results of Mr. A's physical examination, including a visual examination, were normal. Blood chemistry, CBC, urinalysis, head CT scan, and EEG findings were normal.He met DSM-IV diagnostic criteria for psychosis not otherwise specified. He also qualified for anxiety disorder not otherwise specified because, although he experienced some posttraumatic stress disorder (PTSD) symptoms, he did not meet full criteria for PTSD. He was treated with imipramine 200 mg and trifluoperazine 10 mg daily. After 3 weeks, his flashbacks of war content, delusions, and insomnia diminished considerably; however, he continued to experience perseveration of visual images.Disorders of an episodic or paroxysmal nature have been successfully treated with carbamazepine. 4 Because palinopsia presents as a repetitive, paroxysmal phenomenon reminiscent of an epileptic process, we added the antiepileptic agent carbamazepine to Mr. A's medication regimen. Forty-eight hours after carbamazepine treatment was initiated at 400 mg/day, Mr. A experienced a decrease of image perseveration. After 6 days of treatment, on 800 mg/day of carbamazepine, his palinoptic experiences disappeared. No carbamazepine level measurements were made because the patient refused them. He left the hospital soon thereafter.