Family history is positive for anxiety and Graves’ disease in mother and depression in uncle and cousin, but no family history of bipolar disorder or schizophrenia. Although she did excellent in school and the first part of university, her grades began to drop and she switched universities, changing her original plan from studying medicine to nursing, and then kinesiology.Īt age of 12 years, she had removal of a facial mole with no complications, and at age of 18 years, she was diagnosed with Graves’ disease, received radioiodine and was currently on eltroxin.

She reported difficulty with memory and “my brain is going dead”.Īs a child, she was described as outgoing and social, but at age of 15 years, social anxiety presented, and at age of 18 years, she was seen by a psychologist to work on repetitive checking behavior, which she and her family reported resolved with brief treatment with venlafaxine. She started checking her face in the mirror four to five times, and asking her mother for reassurance. No other delusions were reported at the time.Ībout 2 - 3 months later, she reported feeling like her facial expressions were displaying emotions that she had no control over, “my expressions are showing anger”, and would hide her face in her hands or with her hair. She denied auditory, tactile, olfactory or other visual hallucinations at the time. She also reported seeing things as “fake” and “detached”, like through a veil, and that she could not concentrate and had poor memory. On presentation, she reported that she saw people around her having distorted faces, “noses moving around”, not attached to people’s faces, and she covered her eyes in distress at one point, stating that the interviewer’s eyes had changed to cat’s eyes, and then that they were moving from side to side on the interviewer’s face. The family noticed a sudden, marked deterioration where she refused to leave the hotel, and had picked up a knife to harm herself. AB, a 22-year-old university student, was on holiday with her family at the time of presentation.

Thus, it may present diagnostic delays and management challenges, with distress and high-risk behavior for the patient, sometimes taking years before resolving as in the case of Ms. Prosopometamorphosia, as the presenting feature, is rarely attributed to a diagnosis of schizophrenia, although identified as a feature of schizophrenia. Treatment approaches were variable and specific to those conditions. A search of PubMed, using the term prosopometamorphosia, lists 15 cases all linked to organic causes, with diagnoses of epilepsy, migraine, eye diseases, CT and MRI abnormalities, none of which were attributed to schizophrenia. Prosopometamorphosia is even rarer, and is usually attributed to a neurological cause. Psychiatrists are trained to ask about hallucinations however, visual illusions and hallucinations are usually taken as an indication of organic conditions given the commonality of auditory hallucinations. Hallucinations and delusions are core diagnostic criteria for schizophrenia however, visual hallucinations and illusions are less common as the presenting symptom. Illusions of distorted faces relate to activity on the lateral convexity of the occipital lobe 39, a region specialized for face features (the occipital face area), and the same region is likely to account for hallucinations of distorted faces. hallucinations would be caused by a deficit in the metacognitive capacity of assessment/discrimination of reality. Slade and Bentall (1988) suggested that hallucinations occur as a result of the inability of the subject to distinguish if an object is real or if it is a product of the imagination, i.e. Metamorphosias are typically associated with eye or brain diseases.

The term prosopometamorphopsia was introduced by the British neurologist Macdonald Crichley, to denote a type of metamorphopsia in which people’s faces or specific parts of faces are perceived in a distorted manner. Keywords: Prosopometamorphosia Schizophrenia Psychosis Visual hallucinations Face Introduction This case illustrates the presentation of a young female with prosopometamorphasia and discusses the diagnostic and medication challenges over the years before it resolved with clozapine.

It is of unknown cause, but is usually attributed to organic diseases of neurological origin such as migraine, epilepsy and abnormal findings on CT scans and MRIs of the head. Prosopometamorphosia is a rare visual perceptual distortion resulting in altered perception of faces.

Warped reality disorder