Medical students from the universities of Liverpool and Lancaster, under the guidance of Dr Jane Wilcock and Mr Nick Mullin, provide an A-Z of unusual psychiatric conditions that GPs might encounter. Illustrations by Grace Mutton.
Fetishism is an example one of the 8 paraphilia’s listed in the DSM-5. Paraphilia is defined as abnormal sexual desire. In order for a diagnosis to be given the patient must exhibit recurrent, intense sexually arousing fantasies, sexual urges and behaviours that involve either the use of non-living objects and/or a non-genital body part for at least a period of 6 months.1 Sexual interests in fetishist can lead them to perform criminal activities. An example of this might be when an underwear fetishist breaks into a female hall of residence to steal underwear.2
1. Kafta, MP. Arch Sex Behav. 2009. 39(2):357-62
2. Seto, MC, Kingston DA, Bourget, D. The Psychiatric Clinics of North America. 2014. 37(2):149-161.
17 Fregoli delusion or the delusion of doubles/h3>
Fregoli syndrome is a subtype of delusional misidentification.1 In this condition, a person believes that a familiar person, usually someone he believes to be his persecutor, is impersonating multiple familiar people.1 It is usually associated with schizophrenia.2
Fregoli syndrome is named after a famous Italian actor, Leopold Fregoli, who had a remarkable skill in changing appearance during his stage act.3 In 1927, a report written by P. Courbon and G. Fail first reported the syndrome.4 According to the report, a young woman had a strong belief that two actresses whom she often went to see at the theatre were persecuting her. The woman believed that these two actresses were disguising themselves as people she knew.
The causes of Fregoli delusion include traumatic brain injury, lesions on the brain and long-term treatment with levodopa.3 The syndrome can be treated with antipsychotics, anticonvulsants or antidepressants.3
1. Andrew B, Nina H, Charlotte G, Gil M. Oxford Handbook of Clinical Specialties. Oxford, UK: ‘Oxford University Press’
2. Fregoli Syndrome [cited 2017 28 February ]; Available from: http://www.gpnotebook.co.uk/simplepage.cfm?ID=1067057154
3. contributors W. Fregoli delusion Wikipedia, The Free Encyclopedia. ; [cited 2017 20 February ]; Available from: https://en.wikipedia.org/w/index.php?title=Fregoli_delusion&oldid=766485843
4. Ellis HD, Whitley J, Luauté J-P. History of Psychiatry. 1994.
Frotteurism is described as recurrent, intense sexually arousing fantasies, sexual urges or behaviours which involve touching and rubbing against a non-consenting person and in which the condition lasts over a period of at least 6 months.1 This type of paraphilia tends to occur in crowded public places such as on buses or trains and it is sometimes difficult to identify the perpetrator because of the crowded circumstances.2
1. Diagnostic and Statistical Manual of Mental Disorders. Am Psychiatr. Assoc. 2013. DC: Psychiatr. Assoc. 5th ed
2. Beech AR, Miner MH, Thornton D. Annu.Rev. Clin. Psychol. 2016. 12:386-496.
19 Fugue state
Fugue state is a rare dissociative disorder.1 The fugue is a condition in which involves a sudden loss of all autobiographical memories and knowledge of personal identity2. This is associated with unexpected, purposeful wanders away from home or the person’s place of work.2
In order to diagnose a person with fugue, the following criteria should be fulfilled:3
- Features of dissociative amnesia
- Purposeful travel beyond the usual everyday range
- Maintenance of basic self-care and simple social interaction with strangers.
The fugue state may last from hours to months, with a subsequent amnesia gap on recovery and usually precipitated by stressful events.1,4
1. contributors W. Fugue state Wikipedia, The Free Encyclopedia. ; [cited 1 March 2017]; Available from: https://en.wikipedia.org/w/index.php?title=Fugue_state&oldid=767180734
2. Andrew B, Nina H, Charlotte G, Gil M. Oxford Handbook of Clinical Specialties. Oxford, UK: ‘Oxford University Press’
3. The ICD-10 Classification of Mental and Behavioural Disorders. [cited 2017 28 February]; Available from: http://www.who.int/classifications/icd/en/bluebook.pdf
4. David S, Roger S. Oxford Handbook of Psychiatry. Oxford, UK: ‘Oxford University Press’.
20 Ganser’s syndrome
Ganser’s syndrome, also known as “prison psychosis”, was first described by a German psychiatrist, Sigbert Ganser, in 1898, while working inside a prison.1 He discovered three inmates who when asked simple questions would give approximate answers in response. He studied their behaviour and discovered the syndrome was characterised by four aspects:1
- Giving approximate answers to questions
- Visual/auditory hallucinations
- Developing somatic symptoms
- “Clouding of consciousness”, which often fluctuated.
The most striking feature of this syndrome is giving approximate answers to questions. Patients may give answers which are nearly, but not quite, correct, e.g. saying there are five legs on a horse or recalling the month as September instead of August. They can comprehend the question, but they give incorrect responses. An example was a South African man1 who when asked to recall the words “honesty, window and lace”, gave the response of “modesty, house and shoe”.
The aetiology behind Ganser’s syndrome was initially suggested to be a form of malingering1 in prisoners. This has evolved over time and is now classified as a dissociative disorder in ICD-10.3 It is thought to be due to a severe stress reaction rather than a factious disorder, with some suggesting that there could be underlying brain injury.2 Due to its rarity, there is little literature on the syndrome, with Ganser himself stating: “I must openly admit that after observing many details there is a great deal that is obscure to me.”1
1. Dwyer J, Reid S. Lancet 2004. 364:471-473
2. Ouyang D, Duggal H, Jacob NJ. Indian Journal of Psychiatry 2003. 45(4): 255-256
3. World Health Organisation. The ICD-10 Classification of Mental and Behavioural Disorders, 1992.