Rare and Unusual Psychiatric Syndromes: A Primer and Culture-Specific Psychiatric Syndromes: A Review are articles from Medscape Internal Medicine which is an online compendium of useful information dedicated to practitioners of the specialty. You can read both articles by clicking the above links. The syndromes these articles describe are taken from from the Diagnostic and Statistical Manual of Mental Disorders 5 – the psychiatry profession’s handbook of diseases. The manual is highly recommended, both for casual reading and intensive study. Here are a few the interesting syndromes abstracted by Medscape from the DSM V.
Alice in Wonderland syndrome (AIWS) or Todd syndrome is a neurologic condition in which a patient’s sense of body image, space, and/or time are distorted. Patients may experience micropsia, Lilliputian hallucinations, or other sensorial distortions, including altered sense of velocity.
AIWS is a result of change in perception as opposed to the eyes themselves malfunctioning. The most prominent and often most disturbing symptom is that of altered body image, in which the person is confused as to the size and shape of some parts of (or all of) his or her body. These symptoms can be alarming, causing fear or even panic. Distortions can recur several times a day and may take some time to abate.
AIWS is often associated with migraines, brain tumors, or use of psychoactive drugs, and can also present as the initial sign of the Epstein-Barr virus or other infections.
Paris syndrome is an unusual state exclusive to Japanese nationals who experience a mental breakdown while visiting the famous French capital, but it has also been observed in Japanese tourists visiting France or Spain in general. Paris syndrome appears to be a severe form of culture shock that can express itself in many different forms, including physical and emotional symptoms of anxiety, derealization, and depersonalization, as well as acute delusional states, persecutory ideas, and hallucinations.
Lima syndrome is the exact inverse of Stockholm syndrome. In this case, hostage-takers or victimizers become sympathetic to the wishes and needs of the hostages or victims. The name comes from a 1996 Japanese embassy hostage crisis in Lima, Peru. Fourteen members of the Túpac Amaru Revolutionary Movement took several hundred diplomats, government and military officials, and business executives of many countries hostage at a party that took place at the official residence of Japan’s ambassador to Peru. Curiously, 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. After months of unsuccessful negotiations, all remaining hostages were freed by a raid by Peruvian commandos, although one hostage was killed. It is unclear whether Lima syndrome can be explained by feelings of guilt, moral indecisiveness, second-guessing of one’s actions, or obliviousness.
Stendhal syndrome is 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. The term can also be applied to a similar reaction to other overwhelming experiences, for example when confronted with immense beauty in the natural world.
Stendhal syndrome is named after the 19th-century French author Stendhal who described his experience with the phenomenon during his visit to Florence, Italy, in 1817, when he was 34 years old. It has also been called “hyperculturemia” or “Florence syndrome.”
Usually, Stendhal syndrome is self-limited and not followed by lasting or severe mental sequelae, and no interventions beyond supportive measures are
Diogenes syndrome is a condition characterized by extreme self-neglect, social withdrawal, lack of shame, apathy, and compulsive hoarding of rubbish. It is found mainly in elderly persons and is associated with progressive dementia.
The syndrome is named after the Greek philosopher Diogenes of Sinope (412 or 404 BCE-323 BCE), who was a Cynic and Minimalist. The philosophy of cynicism is based on the belief that life should be lived virtuously in agreement with nature by rejecting all conventional desire for wealth, power, and fame, and to live simply and free of all possessions. Diogenes took cynicism to its extreme. He is said to have lived in a wine barrel on the streets of Athens, promoting ideas of nihilism and animalism. Famously, when asked by Alexander the Great, the most powerful person of that time, what he wanted most in the world, he replied, “For you to get out of my sunlight!” The syndrome is actually a misnomer because Diogenes was not known to hoard or neglect his own hygiene, and he sought discussions with other people in the agora.
Amok (‘Running Amok’)/Berserker Loosely translated as “rampage” in Malay, amok is a dissociative condition characterized by an unpremeditated violent, disorderly, or homicidal rage directed against other objects or persons. This diagnosis is found in Southeast Asia and Scandinavia. The condition, which is often accompanied by amnesia and exhaustion, is typically incited by a perceived or actual insult and can occur as part of a brief psychotic episode or as an exacerbation of a chronic psychotic illness. A similar term, “berserker,” is used in Old Norse literature to describe a frenzied rage in Viking warriors.
Latah/Jumping Frenchmen of Maine Latah describes an exaggerated startle response to frightening stimuli, diagnosed in Southeast Asia and Japan. Patients can experience a trance-like dissociation as well as echolalia and echopraxia. A similar condition, termed “jumping Frenchmen of Maine” syndrome, has been described in Franco-Canadian lumberjack communities. This condition has features of dissociative or conversion disorders or catatonia, and it could also be a severe form of shock in response to a sudden or severe traumatic event.
Clinical Lycanthropy Lycanthropy is a rare condition in which sufferers experience the delusion of transforming into an animal. Affected people may also behave like the animal they believe they have turned into. “Lycanthropy” derives from the Greek myth in which King Lycaon is transformed into a wolf as punishment for serving human flesh to Zeus at dinner, and perhaps the folk belief in werewolves has its origin in the condition. Wolf and dog transformations are most commonly described, but transformations into other animals, including birds and insects, have also been reported. In that sense, the syndrome may be shaped by personal, cultural, and regional influences. Effectively a specific form of a delusional misidentification syndrome, it is not surprising that lycanthropy typically occurs in the context of schizophrenia, psychotic mood disorders, or substance-induced psychoses.
Koro is intense anxiety related to the belief that one’s own genitalia are shrinking or receding, resulting in possible death. This diagnosis is found in Asia, specifically Southeast Asia. Rooted in Chinese metaphysics and cultural practices, Koro is included in the Chinese Classification of Mental Disorders, Second Edition. The disorder has also been associated with the belief that perceived inappropriate sexual acts (eg, extramarital sex, sex with prostitutes, or masturbation) disrupt the yin/yang equilibrium, thought to be achieved during marital sex. Koro has also been thought to be transmitted through food. One could also hypothesize that excessive guilt and shame about fantasized or executed sexual acts might play a role in the delusional belief.
Gururumba is a diagnosis from New Guinea that describes an episode in which the afflicted person (usually a married man) begins burglarizing neighboring homes, taking objects that he considers valuable but which seldom are. He then runs away, often for days, returning without the objects and amnestic about the episode. Sufferers have been described as hyperactive, clumsy, and with slurred speech. This syndrome has features of a dissociative or conversion disorder but also could be a substance intoxication-related condition.
There’s more, read the two articles or additional syndrome or better yet buy a copy of the DSM 5.