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Abstract
The present paper describes a patient who exhibited 'Alice in Wonderland' (AIW) syndrome as well as lilliputian hallucinations. The patient regularly consumed a cough syrup that contained dihydrocodein phosphate and di-methylephedrine hydrochloride over 3 years. At the age of 46, he developed AIW syndrome. The patient ingested a large dose of triazolam and exhibited delirium. Even after the disappearance of symptoms associated with AIW syndrome and delirium, the patient continued to experience lilliputian hallucinations. We believe that these hallucinations were caused by some of the components of the cough syrup.
Introduction
Symptoms including disturbances of body image with hyperschemia, hyposchemia, macropsia, micropsia, illusory feelings of levitation, and depersonalization all fall under what is now described as `Alice in Wonderland' (AIW) syndrome [1]. This syndrome is named for the famous Alice stories authored by Lewis Carroll. Another disorder is termed lilliputian hallucination and is characterized by visual hallucinations of small people, animals or objects [2]. Patients who experience these hallucinations visualize a world such as that described by Swift in Gulliver's Travels.
The present patient exhibited features of both AIW syndrome and lilliputian hallucinations.
Case Report
Mr. A, a 46-year-old hypertensive man with no previous psychiatric history, under vent daily administration of antihypertensive drugs including 15 mg captopril, 1.5 mg prazosin hydrochloride and 120 mg nicardipine hydrochloride. He also consumed approximately 200 ml of Dickinin Cough Syrup for the past 3 years for the purpose of `stimulating his mind'. A normal dose (24 ml) of this syrup contains 8 mg dihydrocodein phosphate, 10 mg dl-methylephedrine hydrochloride, 300 mg acetaminophen, 2.5 mg chlorpheniramine maleate, 50 mg caffeine anhydride and 332 mg licorice extract. He did not regularly drink alcohol.
Mr. A exhibited metamorphopsia (TV pictures and books seemed to be distorted), macropsia (insects were enlarged), distortion of body image (expansion of his own body), feeling of levitation when sitting in bed, depersonalization, as well as feelings of...