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conferenceseries.com
April 24-25, 2017 Las Vegas, USA
16th World Congress on
Psychiatry and Psychological Syndromes
Volume 20, Issue 2 (Suppl) J Psychiatry 2017
ISSN: 2378-5756 Psychiatry, an open access journal Psychiatry 2017
April 24-25, 2017
J Psychiatry 2017, 20:2 (Suppl)
A case of Alice inWonderland Syndrome presenting as generalized anxiety disorder with panic attacks
Rishi Kakar and Myriam Thiele
1Segal Institute for Clinical Research, USA
2Larkin Community Hospital, USA
Alice in Wonderland Syndrome is mostly a neurological condition. It is known for a set of several symptoms, the most famous
being alteration of body image, where the sizes of parts of the body are perceived incorrectly. There is also an alteration of visual
perception where the sizes of external objects are also perceived incorrectly. Majority of people suffering from this condition are
children that grew out of the symptoms around their teens. Nevertheless although not frequently reported, there are many adults
still suffering from the condition. The most common time to experience AIWS symptoms is at night. Our client was a 29-year-old
single, Hispanic female with a past psychiatric history of anxiety and panic disorder, presented to the psychiatric consult service with
symptoms of anxiety, depression and frequent panic attacks. Patient complained also of frequent headaches and abdominal migraines
and reported to have perceptual disturbances that appeared shortly before the pain in the form of headache or abdominal migraines.
The perceptual disturbances were described as vague kinesthetic sensations under her skin as if skin was growing or changing shapes
as well as the impression that the room where she was became smaller and her own body was going through a process of expansion.
Patient also reported that the majority of the symptoms occurred at night. Patient consulted many different doctors of different
specialties before coming to see us. Patient was seen by neurologist, ENT doctors and GI doctors and was given different diagnosis
like irritable bowel syndrome, atypical migraines, underwent many different medical studies, from MRI to testing for food allergies
and sensitivities and treated with different medications from different modalities. At some point patient was tested for gluten and
other food sensitivities, including endoscopy of the GI tract. By the time we saw the patient, she was already very disappointed and
frustrated with the medical profession and still looking for answers. We treated her for the symptoms of anxiety and panic attacks,
revised her MRI, sleep studies that were all unremarkable and continued medication like Topamax for the headaches. She was already
on Amitriptyline give to her by her GI doctor for the abdominal migraines and she was also on Alprazolam PRN for the panics that
we changed to Diazepam. Patient has tried other psychotropic medications in the past like ability. We believe that at some point
she could have been diagnosed with major depressive disorder with psychotic features, although her psychotic features were part
of the perceptual disturbances of AIWS. After 2 months, patient started to have less panic attacks and less migraines, still reported
perceptual disturbances before her abdominal migraines. She also was recommended to start psychotherapy that she started shortly
afterwards. We appreciated the importance of recognizing this syndrome and not confusing it with perceptual disturbances related to
delusional ideations or hallucinations. We believe that if the symptoms were recognized earlier, our client would have been spared of
suffering some costly and invasive testing. We recognize the importance for psychiatrists to work in collaboration with our neurologist
colleagues and not to forget our neurology training when we face these not so frequent situations. We understood the importance of
having more research in this type neurological condition with psychiatric features and continue to investigate the treatments options.