Alice in Wonderland Syndrome (AIWS), a neuropsychological disorder, has been reported in less than 200 cases. It was described as a perceptional distortion, especially with visual and sthetic integration. The patient is experiencing size distortions, such as macropsia, micropsia, teleopsia, or pelopsia. This also includes the experience time and body schema. (b). There have been few reports in the past that linked AIWS to depression, although there was no evidence. It is therefore crucial to highlight the linkage between AIWS-psychotic depression in order to increase the understanding of its etiology.
Chinese 65-year old woman has never had a medical or psychiatric history. According to her husband she was outgoing and sociable. She has had a steady job for the past half-year. One month prior her first admission, she complained of AIWS symptoms. Her eyes saw everything, cars included. She was amazed at how large all of the objects she could see. She also felt thinner than usual. She felt that she could sometimes walk between her home in Shenzhen and Shanghai in 30 minutes. However, this is impossible in real life. After being diagnosed with severe depression and AIWS, she was admitted to hospital for the first-ever time. Perphenazine was administered to her and she was fully recovered.
She suffered a recurrence of depression and severe AIWS symptoms after 2 years. She was unable to appreciate the value and importance of money, and she couldn’t express her emotions or sense the significance of the news. She also couldn’t feel the urge or need to urinate. Even though she was given amitriptyline intravenously and aripiprazole, her condition worsens. The condition worsened even after a thorough check-up. There was no evidence of dementia or other organ abnormalities. After receiving mirtazapine and duloxetine twice weekly, and ECT, she was able to recover completely from AIWS. She also recovered almost immediately from her depressive episode.
While the exact cause of AIWS remains a mystery, some cases have shown that there are possible conditions and factors. AIWS can be caused by migraines, infections and brain injuries. Epilepsy, drugs and brain injuries are all possible causes. (d)There is not much research on the relationship between AIWS and mental disorders. There is a possibility of a link between them. Understanding AIWS better would enable us to develop a more effective treatment.
The patient had two episodes of major depression. In this case, symptoms and characteristics typical of AIWS were also observed. While there are some reports that show a relationship between AIWS (psychotic depression) and AIWS, these reports did not clearly demonstrate AIWS. A 74-year old man thought his stool was contaminated and suffered severe depressive symptoms. He also had somatic delusions. He also believed that his feet and hands were shorter than normal, which was indicative of AIWS. A 54-year-old male complained of depressive symptoms including body image distortion and metamorphopsia. The most important thing is that the former had somatic and culpability delusions. This is in line to the patient’s delusions that she was poor. It was clear that the patient with psychotic depression has several symptoms.
Apart from that, psychotic depression’s pathophysiology is similar to AIWS. Delusions and hallucinations can be common symptoms of psychotic depression. Sometimes the patient might hear or see things they don’t know exist. The patient may also feel depressed and worthless. The patient was tired and reluctant to participate in social activities. Incapacity could also be interpreted by her inability to see the scale of objects. Indifference could also be a result of her inability to feel the need or excretion.
This indicated that the patient’s body, time, and space were constrained. This is the same principle as AIWS symptoms. There is no doubt that AIWS and psychotic depression are closely linked in the cases discussed above.
