Lilliputian Hallucinations in Schizophrenia: Case Report Review of Literature

Abstract

A patient with chronic schizophrenia who had visual hallucinations of lilliputian nature is described. The authors review the studies on prevalence of visual hallucinations in schizophrenic patients and suggest that visual hallucinations may be more common in schizophrenia than previously acknowledged. The authors suggest a routine enquiry about visual hallucination in clinical practice and emphasize the need for further research under controlled conditions.

Neuropsychiatry of Complex Visual Hallucinations

“…PH frequently presents with LHs, defined by Leroy as a visual phenomenon in which a patient views detailed miniature people in lines or groups, often undertaking unusual postures or actions, usually accompanied by wonder rather than terror [45, 46]. LHs can occur in a range of neuropsychiatric syndromes including schizophrenia [47], dementia [48], encephalomyelitis [49], traumatic brain injury [50], AIDS-related dementia [50], multiple sclerosis [51], side-effects of dopaminergic and anticholinergic anti-Parkinsonian medication [52] and abuse of over-the-counter substances such as cough syrup [53]. Generally, LHs have been felt to have no localizing significance [54], although they have been reported in basilar conditions such as basilar migraine [39] and are a common presentation in PH [22].…”

Neuropsychiatry of complex visual hallucinations

“…PH frequently presents with LHs, defined by Leroy as a visual phenomenon in which a patient views detailed miniature people in lines or groups, often undertaking unusual postures or actions, usually accompanied by wonder rather than terror [45,46]. LHs can occur in a range of neuropsychiatric syndromes including schizophrenia [47], dementia [48], encephalomyelitis [49], traumatic brain injury [50], AIDS‐related dementia [50], multiple sclerosis [51], side‐effects of dopaminergic and anticholinergic anti‐Parkinsonian medication [52] and abuse of over‐the‐counter substances such as cough syrup [53]. Generally, LHs have been felt to have no localizing significance [54], although they have been reported in basilar conditions such as basilar migraine [39] and are a common presentation in PH [22].…”

Lilliputian hallucinations in Schizophrenia: A case report

“…2 Lilliputian hallucinations have been described in a variety of clinical conditions such as delirium, dementia, alcohol withdrawal states, following intake of dihydrocodein phosphate and dl-methylephedrine hydrochloride (a cough syrup), and medical conditions like toxoplasmosis, basilar migraine, mesencephalic lesions, cerebral tumors, epilepsy, Charles Bonnet Syndrome, and trichloroethylene poisoning. 1,[3][4][5][6][7] Lilliputian hallucinations were first described in schizophrenia by Lewis 8 , but have been reported as a rare phenomenon.…”

“…9 There are three other case reports which have described Lilliputian hallucinations in patients with schizophrenia. 6,8,9 Another case report described the co-existence of Ekbom's syndrome (i.e. delusions of parasitosis) and Lilliputian hallucinations in a patient with dementia.…”