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Case 1A 18-year-old male, from middle socioeconomic status, who had no family history of any mental illness presented with an insidious onset and continuous illness of 3 years' duration, characterized by delusion of persecution, delusion of reference, delusion of grandiosity, delusion of control, auditory hallucination of commanding and discussing type, thought broadcast, apathy, poor self-care, and marked sociooccupational dysfunction. In addition to the symptoms listed, he elaborated about someone having sexual intercourse with him, against his will. On mental status examination, the patient appeared to be very much distressed with his psychopathology. He described the phenomenon of auditory hallucination (commanding and discussing type) and thought broadcast. In addition, the patient explained that at night, when he would go to his bed, he could feel the sensation of being touched by a female, whom he would describe as a good-looking woman.
He would be able to feel his private parts being touched, leading to erection and ejaculation. As per patient, he did not want this experience, this would happen against his will, would feel guilty about having such an experience and having sexual contact with an unknown female, and he was fully convinced about having such an experience. Very occasionally, he would get up from the sleep, after this experience and remain distressed and fearful. In his explanation, he had a strong belief that a “witch” was doing so, but would not be able to point out the exact figure of “witch.” His cognitive functions were intact and he had poor insight.There was no history suggestive of narcolepsy, insomnia, hypersomnia, sleep terrors, nightmares, sleep-related movement disorders, and sleep paralysis; symptoms suggestive of Dhat syndrome, panic attacks, posttraumatic stress disorder, cognitive deficits, and recent change in medications. Based on the available information, a diagnosis of schizophrenia was considered. His investigations in the form of haemogram, renal function test, liver function test, serum electrolytes, thyroid function test, electroencephalogram, and magnetic resonance imaging of brain did not reveal any abnormality. He was started on aripiprazole which was increased up to 15 mg/day, with which all his symptoms including the phenomenon of succubus improved completely.
He would now report lack of any such experience but was not sure about the previous experience being real or part of the illness. Case 2A 24-year-old male, who has been using cannabis in dependent pattern presented with an insidious onset and continuous illness of 2 years' duration, characterized by the delusion of reference, delusional percept, delusion of love, auditory (commenting, commanding, and discussing), and tactile hallucinations. At presentation, on mental status examination, he was untidy and ill-kempt, had blunt affect; however, there was no formal thought disorder.
When asked about his psychopathology, he ascribed the voices heard to one of his female teacher, who would express her love toward him in the conversations heard as part of the auditory hallucinations. He also ascribed the tactile hallucinations to the same teacher.
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It is imperative to invite and surrender our will to the Holy Spirit each day to prevent Satan's demons from exercising control over us. Also, I help spot demonic possession. How a scientist learned to work with exorcists.
He described this as a sensation of vibration, which he would feel all over his body, more so in his thighs, and genital region. This would occur mainly at night, when he would be fully awake or asleep and alone, would feel aroused, and simultaneously hear the voice of his teacher claiming to be responsible for these sensations. As per him, he would hear that she is in deep love with him and wanted to have sexual intercourse with him, would feel his penis to be touched, and in the process would have erection and occasional ejaculation. He would be unable to describe exactly how she would be doing this but was convinced that it was she who was doing so. He also believed that his body is under the control of his teacher, who forces him to indulge in sexual activities, against his will.
He would deny drawing any pleasure out of these activities and would say that he was not able to avoid this experience. This experience was not associated with any active cannabis use or abstinence from cannabis. At the time of mental status examination, his cognitive functions were preserved, and he had poor insight.Due to all these symptoms, he had to discontinue his education and became homebound. Based on the available information, a diagnosis of schizophrenia and cannabis dependence syndrome was considered, and he was sequentially treated with olanzapine, risperidone, Trifluoperazine, and the combination of olanzapine and fluphenazine decanoate, in adequate doses for adequate duration. He showed 40%–50% improvement in auditory hallucinations but no significant change in tactile hallucinations with these medications. Finally, he responded to clozapine in the dose of 200 mg/day. After being treated with clozapine, his insight improved, he would acknowledge that all his previous symptoms were unreal and part of the illness.
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