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First reported case of clinical lycanthropy in a 12‐year‐old adolescent: From culture‐bound syndromes to Internet‐mediated delusions?

2020; Wiley; Volume: 75; Issue: 2 Linguagem: Inglês

10.1111/pcn.13177

1440-1819

Sélim Benjamin Guessoum, Jasmina Mallet, Fumie Todo, Jean‐Pierre Benoît, Marie Rose Moro,

Mental Health and Psychiatry

Clinical lycanthropy is a syndrome in which the patient has the delusional belief of turning into a wolf.1 To our knowledge, it has never been reported as occurring during early adolescence. Clinical lycanthropy is a psychiatric syndrome, whereas ‘werewolf syndrome’ sometimes refers to some rare somatic conditions, such as severe hypertrichosis.2 The patient was a 12-year-old pubescent adolescent born in France. He had allegedly refused to take part in a school field trip because of the occurrence of a full moon. Two months prior, he had been admitted to the emergency department because he had scratched and bit other pupils. No family nor personal psychiatric history was found. The medical history reported supernumerary finger removal and febrile convulsions during infancy. The patient had distant and inhibited contact, hypomimia, and thought blocking. He exhibited delusional ideas of wolf metamorphosis. He often heard werewolves telling him to ‘join the pack.’ He often looked at himself in the mirror, believing that his eyes had changed color and his teeth had lengthened. We excluded the hypothesis of a factitious disorder due to the anxiety we observed concerning these delusions, and the associated mild negative and depressive symptoms. His mother had discovered deliberately torn trousers. Biological and neurological exams were normal. Antipsychotic treatment (1 mg risperidone) allowed progressive recovery within 2 weeks. Ethics and parental consent complied with the Declaration of Helsinki. From a neuroscientific perspective, we conducted a review on PubMed of cases of lycanthropy and cyanthropy (dog transformation) of adolescents aged younger than 20 years (Table 1). Diagnoses reported were: schizophrenia, psychotic depression, and mania. For patients with follow-up, treatments were antipsychotic medications (for one patient, a mood regulator was added). Clinical lycanthropy is one of the delusional misidentification syndromes, which are characterized by patients misidentifying a person, place, or object, and also include Capgras syndrome, Fregoli syndrome, reduplicative paramnesia, and intermetamorphosis.5 Lesions localized in the right hemisphere and frontal lobe are reported in lesion-related delusional misidentification syndromes, but wider networks may be involved.1 Clinical lycanthropy can also be conceptualized as a cenesthopathy.2, 6 There are no neuroscientific studies on zoanthropic syndromes (animal transformation). Low-dose risperidone has shown efficacy in psychotic disorders in adolescents.7 We initiated low-dose risperidone, and no dose increase was discussed due to its efficacy on the symptoms plus the occurrence of extrapyramidal secondary effects. From a transcultural psychiatry perspective, zoanthropy has been observed on several continents. Wolf transformation has been reported throughout history in Western countries. The oldest known Western writings mentioning lycanthropy are found in the Greek myth of Lycaon. Some Byzantine physicians described lycanthropy as a form of melancholy or mania. In medieval and Renaissance times, lycanthropy was often attributed to satanic forces.2 In Japan, cases of belief of possession by foxes have been reported.8 As a transcultural example, the belief of possession by foxes (kitsune-tsuki) and the belief of possession by dog-like mythological beings (inugami) have been described in Japanese culture since the 12th century in Konjaku Monogatarishū (今昔物語集 [Anthology of Tales from the Past]). The delusion of possession by a fox was described as the most common animal possession in some populations of patients in Japan.9 These examples show that the content of psychiatric symptoms, such as the type of animal-related delusion, could be influenced by the cultural background. Today, people build their own cultures throughout the Internet. Digital culture allowed our patient to immerse himself in this mythical imagination via series and the Internet, as in two other recent clinical lycanthropy case reports.2, 5 Surprisingly, research on the link between delusions and the Internet remains sporadic.10 Studying the implication of digital technology on adolescents' psychiatric disorders and assessing their use in daily clinical practice seems highly relevant. In adolescents' popular culture, werewolves are still represented in novels (the character Remus Lupin in J. K. Rowling's Harry Potter), manga (Kazumasa Hirai's Urufu Gai [Wolf Guy]), movies (Mamoru Osada's Ōkami Kodomo no Ame to Yuki [Wolf Children]), and series (Jeff Davis's Teen Wolf). Psychiatric transtheoretical reflections are needed. Neurobiological and cultural approaches are complementaristic. This case report also highlights the need for research on the influence of digital technology on adolescents' psychiatric disorders, especially psychotic disorders. Antipsychotic medications may be an efficient psychopharmacological treatment for this rare transnosographic delusional syndrome. The authors report no biomedical financial interests or potential conflicts of interest.