Rare variant of lycanthropy and ecstasy.

BACKGROUND: Lycanthropy is an unusual belief or delusion in which the patient thinks that he/she has been transformed into an animal. In rare cases, the patient believes that another person has been transformed into an animal. CASE REPORT: We report a patient with an uncommon variant of lycanthropy is introduced. The symptoms appeared after consumption of ecstasy. This shows the occurrences of uncommon and rare psychosis after ecstasy drug use especially in patients susceptible to schizophrenia. Ecstasy drug can induce paranoid psychosis similar to schizophrenia. In the presented case, ecstasy seemed to have a role in patient's underlying susceptibility to schizophrenia.

Introduction

Lycanthropy from Greek words lykoi, “wolf” and anthropos, “human” is an unusual belief or delusion in which the person thinks that he/she is transformed into an animal and his/her behavior and feelings suggest this belief.1, 2

Lycanthropy is more frequently seen in mood disorders or schizophrenia and is a symptom of delusion, which is not specific to a certain disorder. In rare cases, patient believes that other people have changed into animals2–5 and this is called Lycanthropic intermetamorphosis in Moselhy's report6 and Lycanthropy spectrum in Nejad's report.7

Classic amphetamines (methamphetamines, dextroamphetamine, methylphenidate) act via dopaminergic pathway, but substitute amphetamines have neurochemical effects on dopaminergic and serotonergic pathways with behavioral effects showing similar amphetamine and delusional reactions. Some amphetamine substitutes are classified in hallucinogenic drugs.8 Some examples of substitute amphetamines are: 3,4 methyldioxyamphetamine (MDMA) which is also known as Adam or XTC, N-ethyl 3,4 Methyldioxyamphetamine (MMDA) which is also known as Eve, 5-methoxy 3,4 methyl-dioxyamphetamine (MMDA), and 2,5 methoxy 4 methylamphetamine (DOM) also called STP. In this report we present a rare case of lycanthropy in a schizophrenic patient following the consumption of ecstasy.

Case Report

Patient was a 28-year-old, unemployed, married male living in Kerman province, Iran. His education level was 5th grade and was brought to Beheshti Psychiatry Hospital in Kerman for his aggressiveness and restlessness. The patient complained of people who were observing him with an intention to harm.

The patient believed that his father had changed to a boar and frequently attacked him, his brother had changed to a horse and sometimes kicked him, and his mother changed to a donkey and continuously brayed. He said that his soul sometimes left his body and went to various places with these animals and found what others do in their houses. He also stated that there was an angel protecting him and he could hear some people talking to him about his daily activities. He believed that there was a chicken in his head capturing his body and pushing his brain with thoughts that were not his. He believed that his wife was wearing a ring and by moving it puts more stress on his brain and more unpleasant feeling and for this reason had asked his wife to move out.

It was found in his history that following taking many ecstasy pills for opium cessation in an unofficial opium cessation center, he developed some delusional symptoms. He had been under physician's observation for several months and after relative recovery, he stopped his medications and the symptoms aggravated again. There was no history of mental problems before taking ecstasy. He had persecutory delusions, depersonalization, passivity, loss of ego boundary, out of body experience, synesthesia, lycanthropy, thought insertion delusions and auditory and visual hallucinations. His time, place and person orientation and memory were intact. His neurological exam showed no important point. He had normal brain CT scan and MRI. Based on his history and diagnostic criteria of DSM-IV-TR (1), the patient was admitted with schizophrenia diagnosis and received 15 mg olanzapine daily. His lycanthropic symptoms stopped after two weeks of treatment and other symptoms improved gradually after second month of admission.

Discussion

Lycanthropy is a topic of discussion in psychiatry. Some put it in misidentification syndrome category while most others consider it as a rare symptom in several psychiatric disorders (mostly mood disorders and schizophrenia).2, 3, 5

The first report of this rare case was by Moselhy, presenting a patient who believed someone else was transformed to an animal.6 The second report belonged to Nejad presenting a patient who believed his wife and daughter were changed to animals.9 Third report was on a patient who believed his mother was transformed to a dog.7 This report is the fourth one with a patient believing that three of his close relatives have changed to donkey, boar and horse and talk to him in his language and mean to hurt him.

Jaspers (1959) explained rare conditions of lycanthropy in terms of disorders of self-awareness, which he divides into four categories of activities, unity, identity, and boundaries of self. Lycanthropy is in the third category, disorders of identity.10 He also explains ecstasy, thought control and passivity experiences as disorders of ego boundaries.

The patient in the present report had passivity, possession, thought insertion delusions and out of body experience, which all include in disorders of self-awareness and it is interesting that all these symptoms are seen in hallucinogenic drugs.10 Since the patient had no history of psychiatric symptoms before taking ecstasy and developed these symptoms following one occasional consumption of ecstasy without repeated the consumption, we concluded that he had an underlying susceptibility and ecstasy triggered his underlying disorder.

This patient had no diagnostic criteria for psychosis based on DSM-IV and his psychosis was due to schizophrenia, and it shows that taking ecstasy will change the type and appearance of usual symptoms of schizophrenia. In other words, psychosis following consumption of hallucinogenic drugs can present in unusual, complex and rare forms, even in presence of underlying disorders and not due to subsequent psychosis.

Furthermore, there are many disorders reported following consumption of amphetamines and amphetamine. In a study on 36 cases of psychiatric complications of ecstasy in a period of 12 years, the incidence of psychiatric disorders following ecstasy consumption found to be related to susceptibility or continuous consumption and high dose of ecstasy. The study reported a high occurrence of psychosis, panic attacks and depression symptoms following the consumption of ecstasy.11 It is reported that ecstasy can cause schizophrenic-like paranoid psychosis. However, in contrast to schizophrenia which has more negative sings and weak personal relationships, in psychosis pertinent to hallucinogenic drug shows positive signs (hallucination and delusion) while communicating with the physician.8

This report shows that hallucinogenic drugs such as ecstasy can not only aggravate the underlying symptoms of schizophrenia, but can cause these symptoms to appear in unusual and complex forms, in case of psychosis and even in presence of underlying schizophrenia. Because the current knowledge on the subject is limited, further investigations about unusual, rare and complex forms of psychosis following consumption of psychoactive drugs such as ecstasy would be considerable.

Also, according to some reports ecstasy can increase energy, light, sound and touch sensitivity, libido, symptoms of psychosis and depression, generalized anxiety disorder and behavioral and cognitive complications.12–15 This report shows that psychosis following ecstasy consumption might have complex, unusual and rare forms.

The increasing usage of ecstasy among Iranian youth and the existence of unofficial centers which recommend it for opium cessation (to which this case report was related) necessitate educating people especially vulnerable groups in the society about its complications. Also, physicians and especially psychiatrists should consider ecstasy's rare psychotic complications.