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INCUBUS IN SCHIZOPHRENIA

  • April 2019
Authors:
Sinha Deoraj
Sinha Deoraj
Sinha Deoraj
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Avinash Priyaranjan
Avinash Priyaranjan
Avinash Priyaranjan
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Charles Pinto at Topiwala National Medical College & B. Y. L. Nair Charitable Hospital
Charles Pinto
Henal Shah at B.Y.L. Nair Charitable Hospital and T.N. Medical College
Henal Shah
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Abstract

Incubus is a rare syndrome of delusional sexual contact. It can occur alone or as a co-morbidity with other psychotic disorders. It may also be presenting symptoms of Schizophrenia. ECT can be considered as a treatment option along with antipsychotics.
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INCUBUS IN SCHIZOPHRENIA
SINHA DEORAJ1, AVINASH PRIYARANJAN2, PINTO CHARLES3 & SHAH HENAL4
1Lecturer, Department of Psychiatry, B. Y. L. Nair Hospital & T. N .M. C Mumbai, Maharasthra, India
2Registrar, Department of Psychiatry, B. Y. L. Nair Hospital & T. N. M. C Mumbai, Maharasthra, India
3Professor, Department of Psychiatry, B. Y. L. Nair Hospital & T. N. M. C Mumbai, Maharasthra, India
4Associate Professor, Department of Psychiatry, B. Y. L. Nair Hospital & T. N. M. C Mumbai, Maharasthra, India
ABSTRACT
Incubus is a rare syndrome of delusional sexual contact. It can occur alone or as a co-morbidity with other
psychotic disorders. It may also be presenting symptoms of Schizophrenia. ECT can be considered as a treatment option
along with antipsychotics.
KEYWORDS: Incubus, Co-Morbidity, Psychotic, Symptoms of Schizophrenia
INTRODUCTION
Incubus is an uncommon syndrome characterized by the delusion that a person has been sexually approached at
night by an unseen individual.
Very few reports exist and it is also reported as a variant or a comorbidity.
Raschka (1979) reported two cases of Incubus syndrome as a variant of Erotomania.(1)) The co-existance of
Incubus and Capgras syndrome has been reported by Atul C.Pande (1981).(2) There is no report of Incubus as a symptom of
Schizophrenia, or of electro convulsive therapy used as a successful treatment modality. .The present case will highlight
these two aspects of the incubus syndrome.
CASE HISTORY
A 40 year old uneducated housewife Mrs. G was brought by her husband with chief complaints of aggressive and
abusive behavior associated with muttering to self; decreased sleep, appetite and self care, ongoing since one and half
years.
The first symptoms could perhaps be traced back nearly 25 years ago, when on one occasion when her husband
was out of the city, and she felt that someone had entered her room and laid down in bed besides her. This was despite the
fact that the door was locked firmly from inside. She believed this to be the devil. She stated that she would get frightened
and shout, and then “the devil” used to vanish in the ground. Gradually the frequency of the same devil coming to her room
increased and he would touch her and started having sexual intercourse with her several times at night, disturbing her sleep.
Usually the devil would take the form of her husband but occasionally would also be in the form of close relatives.
Initially he would visit when she was alone, but later he would have sexual intercourse with her even when her
husband was in the same bed. Over the last few years, the frequency of visits increased, and many a times he had
threatened to harm her son and family. Despite all this, she still continued to have a good interpersonal and sexual
relationship with her husband who was aware of her symptoms.
International Journal of General
Medicine and Pharmacy (IJGMP)
ISSN(P): 2319-3999; ISSN(E): 2319-4006
Vol. 2, Issue 5, Nov 2013, 5-6
© IASET
6 Sinha Deoraj, Avinash Priyaranjan, Pinto Charles & Shah Henal
There was no other significant past medical and surgical history. One of her brothers’ developed abnormal
behavior after head injury. No other details were available.
On the Mental Status Examination patient was sitting comfortably, muttering continuously, attention was ill-
sustained and mood was fearful. Along with the bizarre delusion of the incubus, there were delusions of reference, auditory
and tactile hallucination. Insight was absent.
C.T scan brain revealed subtle ischemic foci in bilateral frontal sub-cortical white matter and MRI brain revealed
few punctuate hyper intense foci in the fronto-parietal white matter bilaterally.
She was admitted and diagnosed as Schizophrenia and treated with Olanzapine (10mg.). After one week it was
increased to 15 mg and ECTs were also started. Her PANSS decreased from 98 to 43 after 12 ECTs over the period of 40
days.
She was discharged on olanzepine and this improvement is maintained for more than five months.
DISCUSSIONS
This case appears to be the 1st of its kind to be reported. From various literature sources we gather that this
syndrome was found in Western society, but in India there is no documentation found even after our extensive search. In
this case Mrs. G has encounters with the aforesaid devil on quite a regular basis since last twenty years and the memories
of those encounters are quite vivid and no amount of reasoning makes her doubt the existence of such a devil. In spite of all
this her functioning was well maintained for a long period of time. However, in the last one and half years there has been a
change in behavior with excessive irritability and aggression especially towards husband; and decreased sleep, appetite and
self care with muttering to self.
Currently this points towards a diagnosis of schizophrenia. The interesting fact was the incidental finding of subtle
ischemic foci in bilateral frontal sub-cortical white matter.
The patient improved substantially with antipsychotics and ECTs which lends support to the conclusion that
incubus phenomenon was an extension of an underlying basic schizophrenia in the form of a delusion.
The current clinical picture and the prompt response to antipsychotic drugs and ECTs confirm the diagnosis of
Schizophrenia. However the confounding variables are an exceptionally slow rate of progression of the illness in the initial
period, and the findings on neuro imaging.
This case thus represents an unusual variation in the clinical presentation of Schizophrenia.
REFERENCE
1. Atul C Pande. Co-Existence of Incubus and Capgras Syndromes. Brit. J. Psychiatry. 1981;139:469-470
... [6] A PubMed search with key word of "incubus syndrome," yielded only three case reports [1,7] and one article discussing the phenomenon in relation to sleep. [6] We could additionally locate two case reports in Google search [8,9] and one possible case described as having erotomanic delusions with somatic sexual hallucinations. [10] In one of the reports, authors described two cases in which patients had delusions of been sexually approached at night by an unseen lover. ...
... In a case report from India, authors described the phenomenology of incubus in a patient with schizophrenia who required the use of electroconvulsive therapy. [9] Another case report from Iran documented the phenomenon of incubus during the prodromal phase or as a precursor of schizophrenia in a 23-year-old female with schizophrenia. ...
... Most of the reported cases in literature have also been diagnosed with schizophrenia. [7][8][9][10][11] Similar to the earlier reported cases, our patients also responded well to treatment. However, the unique manifestation in the first case was recurrence of phenomenon in both the episodes of illness. ...
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Incubus syndrome, characterized by delusional belief in female patients of being sexually approached by an unforeseen person, is rarely described in literature and description has been limited to isolated case reports. We describe four patients with schizophrenia, who reported the phenomenon of incubus and responded well to treatment with antipsychotics. A review of literature yielded five reports (describing six cases), most of which were described in the context of schizophrenia. © 2018 Indian Psychiatric Society - South Zonal Branch | Published by Wolters Kluwer - Medknow.
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... Over the years, few case reports have accumulated which have described this phenomenon in women of various age groups. [4][5][6][7][8][9] However, only one of these cases was described in an elderly. In a recent review of literature, the authors reported the existence of five case reports of incubus phenomenon in the literature and additionally reported four cases of incubus. ...
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  • Jan 2019
The term “incubus syndrome” is proposed to describe patients suffering from the delusion that they have been sexually approached at night by an unseen lover. This phenomenon has been rarely described in patients with schizophrenia. However, it is rarely been described in elderly patients with late-onset schizophrenia. In this report, we present a patient with late-onset schizophrenia, who had a phenomenon of incubus syndrome, in addition to other psychopathology.
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... Yakshini Sadhana can be done by following specific tantras. [17][18][19] In our literature search, we could not find any description of succubus in psychiatric literature, although there are few case reports [20][21][22][23] documenting the phenomenon of incubus, which have also being described in relation to erotomania. [20] In both the cases described in this report, both the patients believed that a young beautiful female was having sexual relationship with them, which was distressing to them and was happening against their will. ...
Unusual cases of succubus: A cultural phenomenon manifesting as part of psychopathology
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Succubus is also known as demon female lover who approaches males in their dreams to have sex. This is the phenomenon which is rarely described in psychiatric literature. It is more identified as a cultural belief in different religions. We report the two cases diagnosed with schizophrenia, who reported this rare phenomenon of succubus as part of their psychopathology and discuss the phenomenon of succubus.
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Co-Existence of Incubus and Capgras Syndromes
Article
  • Dec 1981
The Capgras syndrome is an uncommon condition characterized by the delusion that a person, usually closely related to the patient, has been replaced by an exact double. Though erotomania has been reported to co-exist with the Capgras syndrome and folie a deux, there does not seem to be any report of the co-existence of the Capgras phenomenon with delusions of imposed intercourse. The present report focuses on such a case, in which a feature of additional interest was that the patient's father was cast in the role of the incubus.
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