Five rare psychiatric syndromes cooccurring together.

P rare syndromes are interesting subjects found all around the world, and we have no comprehensive model to classify them. This is partially due to the little body of knowledge that exists, and because of their rarity, we know of them mostly via case reports, which include only one or a few cases. In this report, we present a case with symptoms of 5 rare syndromes, including; lycanthropy, Cotard, subjective doubles, Fregoli, and Dorian Gray. Lycanthropy is the ability of human beings to undergo transformation into a wolf (Lykos means wolf in Greek). In psychiatric literature, lycanthropy is defined as an unusual belief or delusion that one has been transformed into an animal or a behavior suggestive of such a belief.1 Cotard’s syndrome was introduced in 1880 by Cotard,2 and the central core of this syndrome is nihilistic delusion. The patient believes that he is dead or may deny his own existence or outer world. The patient may deny the existence of parts of his body or their function. Ideation of immortality is another part of this syndrome.3 In the syndrome of subjective double, the patient believes that other people have transformed into his own self. Experience of double was also named doppelganger.4 In the typical form of Fregoli syndrome, the patient identifies his supposed persecutor in several persons who may be different in shape, age, and gender.5 In Dorian Gray syndrome, the core of symptoms is a wish to remain young. In this syndrome, the patient may think that he remains young but others grow old.6 A 22-year-old, single, unemployed man was admitted to our psychiatric ward in Beheshti Hospital, Kerman, Iran for the first time. His symptoms started 3 weeks prior to his admission. His chief complaints were restlessness, insomnia, and aggression. His general symptoms included accusing his relatives of unfriendly behavior. He believed that his mother adds poison to his food and wants to decay his brain. He claimed that his thoughts were transformed into the engine of automobiles, which were passed around and then broadcasted. He had delusion of reference and attributed external events to himself. He also heard the voice of his thoughts from the working engine of automobiles. He believed that his brother injected his thoughts into his head when he was asleep. His specific symptoms were that he believed that he is a wolf, which was born from a human. To explain how he was born, he said the forehead of his father was opened and tear-shaped material was pulled out and entered his mother’s umbilicus (he could not explain regular sexual intercourse). He described the wolf as the strongest animal in the jungle, and as the boss and master of all the animals. In his view, the wolf always is a male and could never be a female. The wolf can do everything he wants. He has extraordinary power, for example, he can stop a running train. The wolf had a special city for himself. In this city, dead people who were revived by him were living. He believed that he (wolf ) has a pair of glands named hypnophys (he knew hypophys and differentiated it from hypnophys) in his occipital area. These glands were connected to his eyes and so he can see everything behind him. He referred to his extra tooth, which was located between the incisor teeth (Figure 1) and claimed it is a snake’s tooth and he can transform himself into any animal by rotating this tooth in his mouth. He said this ability belongs to a snake, but the wolf as master of jungle also has this power. To remain young forever, he stated that he emptied all his internal organs and saved them in a watermelon that was grown from a cannabis seed. He claimed, he reshaped this watermelon into an ampoule and whenever he wants to generate other wolves, he injects this ampoule and all the organs became replaced in their location. When he was asked more questions, he replied “there is nothing inside me, if you are not sure, you can take an x-ray of me”. He believed that he (wolf ) can marry with any human and animal and claimed that until the time of his psychiatric admission, he married approximately 30-40 thousands girls from different races (Chinese, Japanese, Indians, English, and so on). He believed that many of these girls fell in love with him and others were offered to him as gift by their fathers. He asked the girls at the beginning of the marriage, “what kind of animal do you love”, then he generated that animal. He Clinical Notes