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‘Alice in Wonderland’ syndrome: 63-year-old from Pune treated for “one in a million” Lilliputian hallucinations
The patient started having recurrent bouts of hallucinations of being attacked by a hundreds of men. The strangest thing about his episodes, was the size of the imaginary men attacking him, no bigger than the size of his fingers
A 63-year-old man, Pramod Patil, (name changed) started having recurrent bouts of hallucinations of being attacked by a hundreds of men. The strangest thing about his episodes, was the size of the imaginary men attacking him, no bigger than the size of his fingers. He started getting these hallucinations around six months ago. His family ignored the episodes at first, but with increased recurrence he was taken to a city hospital. After months of treatment the hallucinations have stopped and doctors say he has almost recovered.
He was diagnosed with Lilliputian hallucinations, with which people or things seem smaller than their actual size. The rare neuropsychological condition sees the patient experience it often, not knowing that the distorted perception and hallucinations are an illusion.
It is also called the “Alice in Wonderland” syndrome, a condition where visual perception is altered. Named after the famous children’s book “Alice in Wonderland”, where the main character Alice goes through metamorphic changes after eating or drinking particular foods and liquids.
Patil would get at least two episodes a day lasting five minutes each, and was taken for a psychiatric evaluation.
Patil said, “Around 200 people used to attack me. They were very small in size. My family members say that I then used to shout at them in a very loud voice. I am a retired person, and I stay home all the time. In a day, at least twice, I used to get a thought that I am being attacked by tiny people. Now, I can sleep peacefully and I do not get any thoughts that I am being attacked.”
Dr Dharmendra Kendre, a neuropsychiatrist from Noble Hospital who treated the patient, said, “This is a very rare case with one in one million seen with such a disorder. Lilliputian hallucination is nothing but a false perception about things without stimulus. This can happen because of intake of certain drugs like cocaine and cannabis. Metabolic or electrolyte imbalance can also cause this hallucination. We can also see such cases in people with temporal lobe brain tumours, dementia and schizophrenia. Treatment is offered according to the cause behind the hallucination.”
Dr Kendre added, “In Pramod’s case this might have been caused by some post-traumatic stress. He has been taking treatment for the last three months. We have prescribed him antipsychotic medicines and counselling sessions. In the case of senior citizens, even post-traumatic stress or prolonged sleeplessness can cause Lilliputian hallucination. In such cases, patients should immediately visit a psychiatrist for early recovery.”
The doctor mentioned that after several months of medications, counselling, the occurrence of hallucinations slowly reduced with medications and he is no longer experiencing hallucinations now.
Dr Shrikant Pawar, psychiatrist working at the Maharashtra Institute of Mental Health, Sassoon hospital, said, “It is a very rare disorder and because of a stigma attached and discrimination. Cases related to such hallucinations are poorly reported in India. However, people must note that such hallucinations and conditions are a treatable disorder with proper medications and counselling.”
