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DR.SRIRAM.R
 DELUSIONAL MISIDENTIFICATION SYNDROMES
(DMS)
 OTHER MONOTHEMATIC DELUSIONS
 ALIEN HAND SYNDROME
 ALICE IN WONDERLAND SYNDROME
 JERUSALEM SYNDROME
 PARIS SYNDROME
 FUGUE STATE
 FOREIGN ACCENT SYNDROME
 STOCKHOLM SYNDROME
 LIMA SYNDROME
 STENDHAL SYNDROME
 DIOGENES SYNDROME
 MUNCHAUSEN SYNDROME
 MUNCHAUSEN SYNDROME BY PROXY
 APOTEMNOPHILIA
 ACROTOMOPHILIA
1.CAPGRAS SYNDROME
 Person holds a delusion that a friend, spouse, parent, or
other close family member has been replaced by an
identical-looking impostor
 Capgras syndrome is named after Joseph Capgras (1873–
1950), a French psychiatrist who described the disorder in
1923 and called it “l’illusion des sosies”
 Occurs in – paranoid schizophrenia, post brain injury,
neurodegenerative conditions and dementia, diabetes,
hypothyroidism, migraine, post-ketamine
 F : M = 3:2
 Reason - ?A disconnection between the amygdala and
inferotemporal cortex (VS Ramachandran)
 Facial recognition involves a conscious (how people
look, sound) vs. unconscious (beliefs, emotions,
preferences, personalities) pathway
 Prosopagnosia (emotional arousal intact) vs. Capgras
syndrome (problem with emotional arousal)
 Treatment – Individual psychotherapy and
antipsychotics
2. SYNDROME OF SUBJECTIVE DOUBLES
 Person experiences the delusion that he or she has a double
or Doppelgänger with the same appearance, but usually with
different character traits, that is leading a life of its own
 First defined in 1978 by Greek psychiatrist George N.
Christodoulou
 Defining features of the delusion:
- The existence of the delusion, by definition, is not a widely
accepted cultural belief.
- The patient insists that the double he/she sees is real even when
presented with contradictory evidence.
- Paranoia and/or spatial visualization ability impairments are
present.
 May be seen associated with paranoid schizophrenia,
bipolar depression, substance dependence, epilepsy,
traumatic brain injury
 Interpersonal counseling and antipsychotics are the
treatments of choice
 Variations of this include “Clonal pluralization of the
self” where the other person is both physically as well
as psychologically the same
 Not defined in both ICD-10 as well as DSM-IV
3.INTERMETAMORPHOSIS
 First described in 1932 by P. Courbon and J. Tusques
(Illusions d'intermétamorphose et de la charme)
 The main symptoms consist of patients believing that
they can see others change into someone else in both
external appearance and internal personality
 The disorder is usually comorbid with neurological
disorders or mental disorders eg. Alzheimer’s
 Misidentification is present even when the person
makes a phone call to the person he believes as
someone else
4.FREGOLI SYNDROME
 Person holds a delusional belief that different people
are in fact a single person who changes appearance or
is in disguise, and is paranoid in nature
 Named after the Italian actor Leopoldo Fregoli, who
was renowned for his ability to make quick changes of
appearance during his stage act
 Causes – Antiparkinsonism treatment, TBI to the right
frontal and left temporo-parietal areas, fusiform gyrus
 Treatment – Antipsychotics (trifluperazine),
anticonvulsants and antidepressants
 ALL OF THE DMS are monothematic, as they are
delusions that concern only one topic
 Others included in this category are
1.COTARD SYNDROME
 a.k.a Walking Corpse Syndrome is a delusional
belief that they are dead (either figuratively or
literally), do not exist, are putrefying, or have lost
their blood or internal organs
 In rare instances, it can include delusions of
immortality
 It is not listed in DSM-IV, DSM-IV-TR, nor ICD-10
 3 distinct stages : In the first stage – Germination – patients
exhibit psychotic
depression and hypochondriacal symptoms. The second
stage – Blooming – is characterized by the full blown
development of the syndrome and the delusions of
negation. The third stage – Chronic – is characterized by
severe delusions and chronic depression
 Causes – TBI to the parietal lobe, fusiform area,
schizophrenia, migraine, valacyclovir (metabolite CMMG)
 Rx – Antidepressants, antipsychotics, mood stabilizers,
also ECT plus pharmacotherapy, hemodialysis (renal failure
secondary to antivirals)
2. MIRRORED SELF-MISIDENTIFICATION
 Delusional belief that one's reflection in a mirror is some
other person (often believed to be someone who is
following one around)
 People may also treat their reflection as a companion or
become indifferent to them
 Many people mask their mirrors in order to evade who they
believe to be a stranger
 Along with masking their mirrors some throw objects at
the mirrors
 CAUSES – Impaired face perception and mirror agnosia
 Seen in dementia, stroke, TBI and neurological illness
3.REDUPLICATIVE PARAMNESIA
 Delusional belief that a place or location has been
duplicated, existing in two or more places simultaneously,
or that it has been 'relocated' to another site
 most commonly associated with acquired brain injury,
particularly simultaneous damage to the right cerebral
hemisphere and to both frontal lobes
 first used in 1903 by neurologist Arnold Pick to describe a
condition in a patient with suspected Alzheimer's disease
 Also seen in
stroke,intracerebral hemorrhage, tumor, dementia, encephal
opathy and various psychiatric disorders
4.SOMATOPARAPHRENIA
 Person denies ownership of a limb or an entire side of one's
body
 Even if provided with undeniable proof that the limb
belongs to and is attached to their own body, the patient
produces elaborate confabulations about whose limb it
really is, or how the limb ended up on their body
 occur predominately in the left arm of one's body
 accompanied by left-sided paralysis and anosognosia
 CAUSE – Damage to posterior cerebral temporo-parietal
junctions
 Treatment – Mirror therapy, but condition persists after the
mirror is taken away
 Appeared in a detailed case report published in
German in 1908 by German neuro-psychiatrist, Kurt
Goldstein
 Goldstein described a right-handed woman who had
suffered a stroke affecting her left side from which she
had partially recovered by the time she was seen.
However, her left arm seemed as though it belonged to
another person and performed actions that appeared
to occur independent of her will
 Afflicted people lost the 'sense of agency' associated
with the purposeful movement of the limb while
retaining a sense of 'ownership' of the limb.
 Affected hand is viewed as "wayward" or "disobedient,"
while the unaffected hand is under normal volitional
control
 Damage to the corpus callosum produces “intermanual
conflict” or “ideomotor apraxia”
 Caused by stroke or other brain damage, particularly in the
areas of the corpus callosum, or frontal or parietal lobes,
AD or CJD
 There is no cure for the alien hand syndrome. However, the
symptoms can be reduced and managed to some degree by
keeping the alien hand occupied and involved in a task, for
example by giving it an object to hold in its grasp, warm
water application, biofeedback, soft foam orthosis etc
 In reference to an influential description of the
condition by John Todd (1914-1987) in 1955, a British
psychiatrist who worked in Yorkshire
 The optical system is entirely physically normal. The
AIWS involves a change in perception as opposed to a
malfunction of the eyes themselves
 Patient's sense of body image, space, and/or time are
distorted. Sufferers may experience micropsia or
Lilliputian hallucinations, macropsia, or size distortion
of other sensory modalities, which includes also an
altered sense of velocity, produced by the distorted
sense of size, perspective, and time
 The sufferer will find that he is confused as to the size and
shape of parts of (or all of) his body. These symptoms can
be alarming, causing fear, even panic. Distortions can recur
several times a day and may take some time to abate
 Associated with migraines, brain tumors, or the use of
psychoactive drugs (Muscimol) and can also present as the
initial sign of the Epstein-Barr virus or during high fever
 Rest is the best treatment. If associated with migraines,
treatment is the same as that for other migraine
prophylaxis, including anticonvulsants, antidepressants,
beta blockers, and calcium channel blockers, together with
strict adherence to the migraine diet.
 The Jerusalem syndrome is a group of mental
phenomena involving the presence of either religiously
themed obsessive ideas, delusions or other psychosis-
like experiences that are triggered by a visit to the city
of Jerusalem.
 It is not endemic to one single religion or
denomination but has affected Jews, Christians
and Muslims of many different backgrounds.
 First clinically described in the 1930s by
Jerusalem psychiatrist Heinz Herman, one of the
founders of modern psychiatric research in Israel
 Bar-El et al. classified the syndrome into three major types
Type I - Jerusalem syndrome imposed on a previous psychotic
illness
Type II - Jerusalem syndrome superimposed on and complicated
by idiosyncratic ideas
Type III - Jerusalem syndrome as a discrete form, uncompounded by
previous mental illness. This describes the best-known type,
whereby a previously mentally balanced person becomes
psychotic after arriving in Jerusalem. The psychosis is
characterised by an intense religious character and typically
resolves to full recovery after a few weeks or after being removed
from the locality. It shares some features with the diagnostic
category of a "brief psychotic episode“
 Rx – Antipsychotics , with careful withdrawal after cessation or
psychosis/long term Rx in people with co-existing psychosis
 Professor Hiroaki Ota, a Japanese psychiatrist working
in France, is credited as the first person to diagnose
the condition in 1986
 Japanese visitors are observed to be especially
susceptible. Around twenty Japanese tourists a year are
affected by the syndrome out of the 6 million who
visit.
 Characterized by a number of psychiatric symptoms
such as acute delusional states, hallucinations, feelings
of persecution, derealization, depersonalization,
anxiety, and also psychosomatic manifestations such
as dizziness, tachycardia, sweating, and others
 Hypotheses why Japanese people are affected include
their apparent suggestibility regarding an idealized
image of Paris, but the confrontation with very
different cultural habits, a strong language barrier, and
physical and mental exhaustion have also been
suspected as triggers
 Psychotherapeutic and supportive approaches should
be used as treatment
 Fugue state, previously also called dissociative fugue or
psychogenic fugue, is a rare psychiatric disorder
characterized by reversible amnesia for one's personal
identity, which includes the memories, personality,
belongings and other identifying characteristics of
one's individuality and life
 Usually, the fugue state lasts hours to days, but it has
lasted for months.
 Precipitated by a strong emotional or physical stressor
or stressful episode. After recovery from the fugue,
there may be amnesia for the precipitating stressor.
 Dissociative fugue usually involves unplanned travel or
wandering around, sometimes accompanied by the
establishment of a new identity
 Previous memories usually return intact, but usually there
remains complete amnesia for the fugue.
 observed in the context of severe psychological or physical
trauma, the ingestion of psychotropic substances, or a
general medical condition. It has also been related to
bipolar disorder, depression, delirium, and dementia
 Psychotherapeutic and supportive approaches should be
used as Rx
 The condition was first described in 1907 by the French
neurologist Pierre Marie
 The foreign accent syndrome is a rare condition whereby
someone speaks their native language as if they had a
foreign accent
 This syndrome usually follows a migraine, head injury,
trauma, or stroke affecting the speech center of the brain
 Cerebellum may be involved in certain cases
 Contrary to popular beliefs that individuals with FAS
exhibit their accent without any effort, these individuals
feel as if they are suffering from a speech disorder
 Named after a bank robbery in Stockholm, Sweden. The
bank robbers held bank employees hostage from August 23
to August 28 in 1973 and the hostages became emotionally
attached to their hostage-takers. They even defended their
captors after they were freed, refusing to testify against
them.
 A psychological response that can be observed seen in a
victim, in which the victim shows signs of sympathy,
loyalty, or even voluntary compliance with the victimizer,
regardless of the risk in which the victim has been placed.
 The syndrome is most often discussed in the context of
hostage abduction, but has also been described in
relationship to rape, spousal and child abuse
 A famous example of Stockholm syndrome is Patty
Hearst. She was a millionaire's daughter who was
kidnapped in 1974 and later took part in a robbery
organized by her and her kidnapper
 Severe form of reaction formation that takes place
under enormous physiologic and emotional stress
 As in all cases of severe trauma, psychotherapeutic and
supportive approaches should be used, and comorbid
conditions should be identified and managed as
appropriate.
 Exact inverse of Stockholm syndrome. In this case,
hostage-takers or victimizers become sympathetic to
the wishes and needs of the hostages or victims
 Named after the Japanese embassy hostage crisis in
Lima, Peru, that lasted from December 17, 1996 until
April 22, 1997
 Within a few days of the hostage crisis, the militants
had released most of the captives, with seeming
disregard for their importance, including the future
president of Peru, and the mother of the current
president
 Named after the famous 19th-century French
author Stendhal (pseudonym of Henri-Marie Beyle), who
described his experience with the phenomenon during his
1817 visit to Florence
 Characterized by physical and emotional anxiety up to the
level of a panic attack, dissociative experiences, confusion,
and even hallucinations when an individual is exposed to
ART
 The syndrome is usually triggered by art that is perceived as
particularly beautiful or when the individual is exposed to
large quantities of art that are concentrated in a single
place
 Stendhal syndrome is self-limited and not followed by
lasting or severe mental sequelae
 Disorder characterized by extreme self-neglect,
domestic squalor, social
withdrawal, apathy, compulsive hoarding of garbage,
and lack of shame and catatonia.
 The origin of the syndrome is unknown, although the
term “Diogenes” was coined by A. N. G. Clarke et al. in
the mid-1970s and has been commonly used since
then.
 The name derives from Diogenes of Sinope, an ancient
Greek philosopher, a Cynic and an
ultimate minimalist, who allegedly lived in a large jar
in Athens
 These symptoms suggest damages on the prefrontal areas
of the brain, due to its relation to decision making.
 The frontal lobes are of particular interest, because they are
known to be involved in higher order cognitive processes,
such as reasoning, decision-making and conflict
monitoring.
 Diogenes Syndrome tends to occur among the elderly with
dementias.
 Results after hospitalization tend to be poor.
 There are other approaches to improve the patient’s
condition. Day care facilities have often been successful
with maturing the patient’s physical and emotional state,
as well as helping them with socialization.
 Psychiatric factitious disorder wherein those affected
feign disease, illness, or psychological trauma to
draw attention, sympathy, or reassurance to
themselves.
 They also have a history of recurrent hospitalization,
travelling, and dramatic, untrue, and extremely
improbable tales of their past experiences.
 This disorder is distinct from hypochondriasis and
other somatoform disorders in that those with the
latter do not intentionally produce their somatic
symptoms.
 Named after Baron von Munchausen (1720-1797), an 18th-
century German officer who was known for embellishing
the stories of his life and experiences.
 Some will secretively injure themselves to cause signs like
blood in the urine or cyanosis of a limb, ingest bacteria, etc
 Patients may have multiple scars on abdomen due to
repeated "emergency" operations
 Risk factors for developing Münchausen syndrome include
childhood traumas, growing up with parents/caretakers
who were emotionally unavailable due to illness or
emotional problems, a serious illness as a child, failed
aspirations to work in the medical field, personality
disorders, and a low self-esteem
 Rx is CBT and/or pharmacotherapy and is based on cause.
 Type of factitious disorder in which a person acts as if an
individual he or she is caring for has a physical or mental illness
when the person is not really sick.
 Victim is usually a child <6yrs of age, and the parent may suffer
from Munchausen syndrome, CHILD ABUSE present.
 Common characteristics in a person with Munchausen syndrome
by proxy include:
 Often a parent, usually a mother, but can be the adult child of an
elderly patient;
 Might be a healthcare professional;
 Is very friendly and cooperative with the healthcare providers;
 Appears quite concerned (some might seem overly concerned)
about the child or designated patient; and
 Might also suffer from Munchausen syndrome
 Other possible warning signs of Munchausen syndrome by proxy in
children or cared-for adults include:
• The child has a history of many hospitalizations, often with strange
symptoms;
• The child's reported condition and symptoms do not agree with the
results of diagnostic tests;
• Worsening of the child's symptoms generally is reported by the mother
and is not witnessed by the hospital staff;
• There might be more than 1 unusual illness or death of children in the
family;
• The child's condition improves in the hospital, but symptoms recur
when the child returns home;
• Blood in lab samples might not match the blood of the child; and
• There might be signs of chemicals in the child's blood, stool, or urine.
 People who perpetrate this type of abuse are often
affected by concomitant psychiatric problems, like
depression, spouse abuse, psychopathy, or psychosis.
 Etiologic and treatment considerations are identical to
those in Munchhausen syndrome. The major
difference lies in the fact that the first concern is to
ensure the safety and protection of any real or
potential victims.
 Erotic interest in being or looking like an amputee.
 First described in a 1977 article by psychologists Gregg
Furth and John Money.
 Associated with Body integrity identity disorder (BIID) in
which otherwise sane and rational individuals express a
strong and specific desire for the amputation of a healthy
limb or limbs.
 Has features in common with somatoparaphrenia.
 Inadequate activation of the right superior parietal lobe
(SPL) leads to the unnatural situation in which the
sufferers can feel the limb in question being touched
without it actually incorporating into their body image,
with a resulting desire for amputation
 After amputation most report to being happy with their
decision and often state, paradoxically, that they are
‘complete’ at last.
 An individual with true apotemnophilia may be chronically
unsatisfied with their sexual relationships, or even
completely sexually dysfunctional until their desire for
amputation is realized and it is a paraphilia.
 Apotemnophilia (sexual arousal present) vs. BIID (sexual
arousal absent)
 Apotemnophiles may have associated depression, isolation
and confusion.
 Rx is CBT, aversion therapy and/or pharmacotherapy.
 Acrotomophilia is a form of sexual fetishism whereby
the person without amputation or the wish to be
amputated has a strong erotic interest in other people
who are missing limbs.
 In the body integrity identity disorder community,
these people are referred to as “devotees”.
 However, there might be some relationship between
APOTEMNOPHILIA and this, with some individuals
exhibiting both conditions.
 Rx is essentially the same as that of apotemnophiles.
uncommon psychiatric disorders

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uncommon psychiatric disorders

  • 2.  DELUSIONAL MISIDENTIFICATION SYNDROMES (DMS)  OTHER MONOTHEMATIC DELUSIONS  ALIEN HAND SYNDROME  ALICE IN WONDERLAND SYNDROME  JERUSALEM SYNDROME  PARIS SYNDROME  FUGUE STATE  FOREIGN ACCENT SYNDROME  STOCKHOLM SYNDROME
  • 3.  LIMA SYNDROME  STENDHAL SYNDROME  DIOGENES SYNDROME  MUNCHAUSEN SYNDROME  MUNCHAUSEN SYNDROME BY PROXY  APOTEMNOPHILIA  ACROTOMOPHILIA
  • 4. 1.CAPGRAS SYNDROME  Person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor  Capgras syndrome is named after Joseph Capgras (1873– 1950), a French psychiatrist who described the disorder in 1923 and called it “l’illusion des sosies”  Occurs in – paranoid schizophrenia, post brain injury, neurodegenerative conditions and dementia, diabetes, hypothyroidism, migraine, post-ketamine  F : M = 3:2
  • 5.  Reason - ?A disconnection between the amygdala and inferotemporal cortex (VS Ramachandran)  Facial recognition involves a conscious (how people look, sound) vs. unconscious (beliefs, emotions, preferences, personalities) pathway  Prosopagnosia (emotional arousal intact) vs. Capgras syndrome (problem with emotional arousal)  Treatment – Individual psychotherapy and antipsychotics
  • 6. 2. SYNDROME OF SUBJECTIVE DOUBLES  Person experiences the delusion that he or she has a double or Doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own  First defined in 1978 by Greek psychiatrist George N. Christodoulou  Defining features of the delusion: - The existence of the delusion, by definition, is not a widely accepted cultural belief. - The patient insists that the double he/she sees is real even when presented with contradictory evidence. - Paranoia and/or spatial visualization ability impairments are present.
  • 7.  May be seen associated with paranoid schizophrenia, bipolar depression, substance dependence, epilepsy, traumatic brain injury  Interpersonal counseling and antipsychotics are the treatments of choice  Variations of this include “Clonal pluralization of the self” where the other person is both physically as well as psychologically the same  Not defined in both ICD-10 as well as DSM-IV
  • 8. 3.INTERMETAMORPHOSIS  First described in 1932 by P. Courbon and J. Tusques (Illusions d'intermétamorphose et de la charme)  The main symptoms consist of patients believing that they can see others change into someone else in both external appearance and internal personality  The disorder is usually comorbid with neurological disorders or mental disorders eg. Alzheimer’s  Misidentification is present even when the person makes a phone call to the person he believes as someone else
  • 9. 4.FREGOLI SYNDROME  Person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise, and is paranoid in nature  Named after the Italian actor Leopoldo Fregoli, who was renowned for his ability to make quick changes of appearance during his stage act  Causes – Antiparkinsonism treatment, TBI to the right frontal and left temporo-parietal areas, fusiform gyrus  Treatment – Antipsychotics (trifluperazine), anticonvulsants and antidepressants
  • 10.  ALL OF THE DMS are monothematic, as they are delusions that concern only one topic  Others included in this category are 1.COTARD SYNDROME  a.k.a Walking Corpse Syndrome is a delusional belief that they are dead (either figuratively or literally), do not exist, are putrefying, or have lost their blood or internal organs  In rare instances, it can include delusions of immortality  It is not listed in DSM-IV, DSM-IV-TR, nor ICD-10
  • 11.  3 distinct stages : In the first stage – Germination – patients exhibit psychotic depression and hypochondriacal symptoms. The second stage – Blooming – is characterized by the full blown development of the syndrome and the delusions of negation. The third stage – Chronic – is characterized by severe delusions and chronic depression  Causes – TBI to the parietal lobe, fusiform area, schizophrenia, migraine, valacyclovir (metabolite CMMG)  Rx – Antidepressants, antipsychotics, mood stabilizers, also ECT plus pharmacotherapy, hemodialysis (renal failure secondary to antivirals)
  • 12. 2. MIRRORED SELF-MISIDENTIFICATION  Delusional belief that one's reflection in a mirror is some other person (often believed to be someone who is following one around)  People may also treat their reflection as a companion or become indifferent to them  Many people mask their mirrors in order to evade who they believe to be a stranger  Along with masking their mirrors some throw objects at the mirrors  CAUSES – Impaired face perception and mirror agnosia  Seen in dementia, stroke, TBI and neurological illness
  • 13. 3.REDUPLICATIVE PARAMNESIA  Delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been 'relocated' to another site  most commonly associated with acquired brain injury, particularly simultaneous damage to the right cerebral hemisphere and to both frontal lobes  first used in 1903 by neurologist Arnold Pick to describe a condition in a patient with suspected Alzheimer's disease  Also seen in stroke,intracerebral hemorrhage, tumor, dementia, encephal opathy and various psychiatric disorders
  • 14. 4.SOMATOPARAPHRENIA  Person denies ownership of a limb or an entire side of one's body  Even if provided with undeniable proof that the limb belongs to and is attached to their own body, the patient produces elaborate confabulations about whose limb it really is, or how the limb ended up on their body  occur predominately in the left arm of one's body  accompanied by left-sided paralysis and anosognosia  CAUSE – Damage to posterior cerebral temporo-parietal junctions  Treatment – Mirror therapy, but condition persists after the mirror is taken away
  • 15.  Appeared in a detailed case report published in German in 1908 by German neuro-psychiatrist, Kurt Goldstein  Goldstein described a right-handed woman who had suffered a stroke affecting her left side from which she had partially recovered by the time she was seen. However, her left arm seemed as though it belonged to another person and performed actions that appeared to occur independent of her will  Afflicted people lost the 'sense of agency' associated with the purposeful movement of the limb while retaining a sense of 'ownership' of the limb.
  • 16.  Affected hand is viewed as "wayward" or "disobedient," while the unaffected hand is under normal volitional control  Damage to the corpus callosum produces “intermanual conflict” or “ideomotor apraxia”  Caused by stroke or other brain damage, particularly in the areas of the corpus callosum, or frontal or parietal lobes, AD or CJD  There is no cure for the alien hand syndrome. However, the symptoms can be reduced and managed to some degree by keeping the alien hand occupied and involved in a task, for example by giving it an object to hold in its grasp, warm water application, biofeedback, soft foam orthosis etc
  • 17.  In reference to an influential description of the condition by John Todd (1914-1987) in 1955, a British psychiatrist who worked in Yorkshire  The optical system is entirely physically normal. The AIWS involves a change in perception as opposed to a malfunction of the eyes themselves  Patient's sense of body image, space, and/or time are distorted. Sufferers may experience micropsia or Lilliputian hallucinations, macropsia, or size distortion of other sensory modalities, which includes also an altered sense of velocity, produced by the distorted sense of size, perspective, and time
  • 18.  The sufferer will find that he is confused as to the size and shape of parts of (or all of) his body. These symptoms can be alarming, causing fear, even panic. Distortions can recur several times a day and may take some time to abate  Associated with migraines, brain tumors, or the use of psychoactive drugs (Muscimol) and can also present as the initial sign of the Epstein-Barr virus or during high fever  Rest is the best treatment. If associated with migraines, treatment is the same as that for other migraine prophylaxis, including anticonvulsants, antidepressants, beta blockers, and calcium channel blockers, together with strict adherence to the migraine diet.
  • 19.  The Jerusalem syndrome is a group of mental phenomena involving the presence of either religiously themed obsessive ideas, delusions or other psychosis- like experiences that are triggered by a visit to the city of Jerusalem.  It is not endemic to one single religion or denomination but has affected Jews, Christians and Muslims of many different backgrounds.  First clinically described in the 1930s by Jerusalem psychiatrist Heinz Herman, one of the founders of modern psychiatric research in Israel
  • 20.  Bar-El et al. classified the syndrome into three major types Type I - Jerusalem syndrome imposed on a previous psychotic illness Type II - Jerusalem syndrome superimposed on and complicated by idiosyncratic ideas Type III - Jerusalem syndrome as a discrete form, uncompounded by previous mental illness. This describes the best-known type, whereby a previously mentally balanced person becomes psychotic after arriving in Jerusalem. The psychosis is characterised by an intense religious character and typically resolves to full recovery after a few weeks or after being removed from the locality. It shares some features with the diagnostic category of a "brief psychotic episode“  Rx – Antipsychotics , with careful withdrawal after cessation or psychosis/long term Rx in people with co-existing psychosis
  • 21.  Professor Hiroaki Ota, a Japanese psychiatrist working in France, is credited as the first person to diagnose the condition in 1986  Japanese visitors are observed to be especially susceptible. Around twenty Japanese tourists a year are affected by the syndrome out of the 6 million who visit.  Characterized by a number of psychiatric symptoms such as acute delusional states, hallucinations, feelings of persecution, derealization, depersonalization, anxiety, and also psychosomatic manifestations such as dizziness, tachycardia, sweating, and others
  • 22.  Hypotheses why Japanese people are affected include their apparent suggestibility regarding an idealized image of Paris, but the confrontation with very different cultural habits, a strong language barrier, and physical and mental exhaustion have also been suspected as triggers  Psychotherapeutic and supportive approaches should be used as treatment
  • 23.  Fugue state, previously also called dissociative fugue or psychogenic fugue, is a rare psychiatric disorder characterized by reversible amnesia for one's personal identity, which includes the memories, personality, belongings and other identifying characteristics of one's individuality and life  Usually, the fugue state lasts hours to days, but it has lasted for months.  Precipitated by a strong emotional or physical stressor or stressful episode. After recovery from the fugue, there may be amnesia for the precipitating stressor.
  • 24.  Dissociative fugue usually involves unplanned travel or wandering around, sometimes accompanied by the establishment of a new identity  Previous memories usually return intact, but usually there remains complete amnesia for the fugue.  observed in the context of severe psychological or physical trauma, the ingestion of psychotropic substances, or a general medical condition. It has also been related to bipolar disorder, depression, delirium, and dementia  Psychotherapeutic and supportive approaches should be used as Rx
  • 25.  The condition was first described in 1907 by the French neurologist Pierre Marie  The foreign accent syndrome is a rare condition whereby someone speaks their native language as if they had a foreign accent  This syndrome usually follows a migraine, head injury, trauma, or stroke affecting the speech center of the brain  Cerebellum may be involved in certain cases  Contrary to popular beliefs that individuals with FAS exhibit their accent without any effort, these individuals feel as if they are suffering from a speech disorder
  • 26.  Named after a bank robbery in Stockholm, Sweden. The bank robbers held bank employees hostage from August 23 to August 28 in 1973 and the hostages became emotionally attached to their hostage-takers. They even defended their captors after they were freed, refusing to testify against them.  A psychological response that can be observed seen in a victim, in which the victim shows signs of sympathy, loyalty, or even voluntary compliance with the victimizer, regardless of the risk in which the victim has been placed.  The syndrome is most often discussed in the context of hostage abduction, but has also been described in relationship to rape, spousal and child abuse
  • 27.  A famous example of Stockholm syndrome is Patty Hearst. She was a millionaire's daughter who was kidnapped in 1974 and later took part in a robbery organized by her and her kidnapper  Severe form of reaction formation that takes place under enormous physiologic and emotional stress  As in all cases of severe trauma, psychotherapeutic and supportive approaches should be used, and comorbid conditions should be identified and managed as appropriate.
  • 28.  Exact inverse of Stockholm syndrome. In this case, hostage-takers or victimizers become sympathetic to the wishes and needs of the hostages or victims  Named after the Japanese embassy hostage crisis in Lima, Peru, that lasted from December 17, 1996 until April 22, 1997  Within a few days of the hostage crisis, the militants had released most of the captives, with seeming disregard for their importance, including the future president of Peru, and the mother of the current president
  • 29.  Named after the famous 19th-century French author Stendhal (pseudonym of Henri-Marie Beyle), who described his experience with the phenomenon during his 1817 visit to Florence  Characterized by physical and emotional anxiety up to the level of a panic attack, dissociative experiences, confusion, and even hallucinations when an individual is exposed to ART  The syndrome is usually triggered by art that is perceived as particularly beautiful or when the individual is exposed to large quantities of art that are concentrated in a single place  Stendhal syndrome is self-limited and not followed by lasting or severe mental sequelae
  • 30.  Disorder characterized by extreme self-neglect, domestic squalor, social withdrawal, apathy, compulsive hoarding of garbage, and lack of shame and catatonia.  The origin of the syndrome is unknown, although the term “Diogenes” was coined by A. N. G. Clarke et al. in the mid-1970s and has been commonly used since then.  The name derives from Diogenes of Sinope, an ancient Greek philosopher, a Cynic and an ultimate minimalist, who allegedly lived in a large jar in Athens
  • 31.  These symptoms suggest damages on the prefrontal areas of the brain, due to its relation to decision making.  The frontal lobes are of particular interest, because they are known to be involved in higher order cognitive processes, such as reasoning, decision-making and conflict monitoring.  Diogenes Syndrome tends to occur among the elderly with dementias.  Results after hospitalization tend to be poor.  There are other approaches to improve the patient’s condition. Day care facilities have often been successful with maturing the patient’s physical and emotional state, as well as helping them with socialization.
  • 32.  Psychiatric factitious disorder wherein those affected feign disease, illness, or psychological trauma to draw attention, sympathy, or reassurance to themselves.  They also have a history of recurrent hospitalization, travelling, and dramatic, untrue, and extremely improbable tales of their past experiences.  This disorder is distinct from hypochondriasis and other somatoform disorders in that those with the latter do not intentionally produce their somatic symptoms.
  • 33.  Named after Baron von Munchausen (1720-1797), an 18th- century German officer who was known for embellishing the stories of his life and experiences.  Some will secretively injure themselves to cause signs like blood in the urine or cyanosis of a limb, ingest bacteria, etc  Patients may have multiple scars on abdomen due to repeated "emergency" operations  Risk factors for developing Münchausen syndrome include childhood traumas, growing up with parents/caretakers who were emotionally unavailable due to illness or emotional problems, a serious illness as a child, failed aspirations to work in the medical field, personality disorders, and a low self-esteem  Rx is CBT and/or pharmacotherapy and is based on cause.
  • 34.  Type of factitious disorder in which a person acts as if an individual he or she is caring for has a physical or mental illness when the person is not really sick.  Victim is usually a child <6yrs of age, and the parent may suffer from Munchausen syndrome, CHILD ABUSE present.  Common characteristics in a person with Munchausen syndrome by proxy include:  Often a parent, usually a mother, but can be the adult child of an elderly patient;  Might be a healthcare professional;  Is very friendly and cooperative with the healthcare providers;  Appears quite concerned (some might seem overly concerned) about the child or designated patient; and  Might also suffer from Munchausen syndrome
  • 35.  Other possible warning signs of Munchausen syndrome by proxy in children or cared-for adults include: • The child has a history of many hospitalizations, often with strange symptoms; • The child's reported condition and symptoms do not agree with the results of diagnostic tests; • Worsening of the child's symptoms generally is reported by the mother and is not witnessed by the hospital staff; • There might be more than 1 unusual illness or death of children in the family; • The child's condition improves in the hospital, but symptoms recur when the child returns home; • Blood in lab samples might not match the blood of the child; and • There might be signs of chemicals in the child's blood, stool, or urine.
  • 36.  People who perpetrate this type of abuse are often affected by concomitant psychiatric problems, like depression, spouse abuse, psychopathy, or psychosis.  Etiologic and treatment considerations are identical to those in Munchhausen syndrome. The major difference lies in the fact that the first concern is to ensure the safety and protection of any real or potential victims.
  • 37.  Erotic interest in being or looking like an amputee.  First described in a 1977 article by psychologists Gregg Furth and John Money.  Associated with Body integrity identity disorder (BIID) in which otherwise sane and rational individuals express a strong and specific desire for the amputation of a healthy limb or limbs.  Has features in common with somatoparaphrenia.  Inadequate activation of the right superior parietal lobe (SPL) leads to the unnatural situation in which the sufferers can feel the limb in question being touched without it actually incorporating into their body image, with a resulting desire for amputation
  • 38.  After amputation most report to being happy with their decision and often state, paradoxically, that they are ‘complete’ at last.  An individual with true apotemnophilia may be chronically unsatisfied with their sexual relationships, or even completely sexually dysfunctional until their desire for amputation is realized and it is a paraphilia.  Apotemnophilia (sexual arousal present) vs. BIID (sexual arousal absent)  Apotemnophiles may have associated depression, isolation and confusion.  Rx is CBT, aversion therapy and/or pharmacotherapy.
  • 39.  Acrotomophilia is a form of sexual fetishism whereby the person without amputation or the wish to be amputated has a strong erotic interest in other people who are missing limbs.  In the body integrity identity disorder community, these people are referred to as “devotees”.  However, there might be some relationship between APOTEMNOPHILIA and this, with some individuals exhibiting both conditions.  Rx is essentially the same as that of apotemnophiles.