Medical Syndromes

Fish Odor Syndrome
Struggling with something called trimethylaminuria literally stinks. As a
result of the body’s inability to break down a certain organic
compound found in numerous foods an afflicted individual tends to
give off an overwhelmingly strong fish-smelling odor. Unfortunately
there is no cure but thus far people have managed to control it by
employing various diets.
Kleine-Levin Syndrome
A strange and little understood disorder that can potentially lead to
people sleeping for weeks on end. Fortunately most children that are
afflicted will see the symptoms gradually disappear by the time they
reach their twenties.
Trichotillomania
A disorder that leads to people compulsively pulling out their hair, the
peak of onset is between the ages of 9 to 13 and in extreme cases the
hair is actually ingested as well.
Progeria
Wrinkles, baldness, missing teeth…stick around long enough and
you’re sure to have your fill. While old age happens eventually, to
children affected by Progeria all of those symptoms we dread
manifest themselves before the age of two. Unfortunately, although
mentally they are still their age, many of these children develop the
illnesses typically associated with the elderly such as cardiovascular
disease and arthritis. Rarely do they live to be older than 12 or 13.

Human Werewolf Syndrome
Sure, you may have some hairy friends, but not like this. Formally
known as hypertrichosis, there are only about 50 people in the world
afflicted with this rare disorder. Unfortunately for them not even laser
hair removal is an effective treatment as the hair will rapidly grow
back.
Alice in Wonderland Syndrome
Probably as a result of something malfunctioning in the brain’s
occipital lobe, this disorder causes people to percieve objects as
being either much larger or smaller than they really are. Moreover, the
individual will also mispercieve the passage of time and possibly have
their sense of hearing and touch affected as well.

Alice in Wonderland Syndrome or Todd Syndrome
Alice in Wonderland syndrome (AIW) or Todd syndrome is a neurologic condition in which a patient's sense of
body image, space, and/or time are distorted. Sufferers may experience micropsia or Lilliputian hallucinations,
macropsia, or size distortion of other sensory modalities, which includes also an altered sense of velocity,
produced by the distorted sense of size, perspective, and time.
AIWS is a result of change in perception as opposed to the eyes themselves malfunctioning. AIWS affects the
sufferer's sense of vision, sensation, touch, and hearing, as well as one's own body image and sense of time.
The most prominent and often most disturbing symptom is that of altered body image: the sufferer will find that he
is confused as to the size and shape of parts of (or all of) his body. These symptoms can be alarming, causing
fear, even panic. Distortions can recur several times a day and may take some time to abate.
It is often associated with migraines, brain tumors, or the use of psychoactive drugs and can also present as the
initial sign of the Epstein-Barr virus or during high fever. Rest is the best treatment. If associated with migraines,
treatment is the same as that for other migraine prophylaxis, including anticonvulsants, antidepressants, beta
blockers, and calcium channel blockers, together with strict adherence to the migraine diet.

Paris Syndrome
Paris syndrome is a strange condition exclusive to Japanese nationals who experience a mental breakdown
while visiting the famous French capital, but it has also been observed in Japanese tourists visiting France or
Spain in general. Paris syndrome appears to be a severe form of culture shock that can express itself in many
different forms, including physical and emotional symptoms of anxiety, derealization, depersonalization, as well
as acute delusional states, persecutory ideas, and hallucinations.
Of an estimated 6 million Japanese tourists who visit the city every year, approximately 1-2 dozen suffer this
illness. Usually, people with Paris syndrome do not have a psychiatric history. Hypotheses why Japanese people
are affected include their apparent suggestibility regarding an idealized image of Paris, but the confrontation with
very different cultural habits, a strong language barrier, and physical and mental exhaustion have also been
suspected as triggers.
Psychotherapeutic and supportive approaches should be used, and comorbid conditions should be identified and
managed as appropriate.
Foreign Accent Syndrome
The foreign accent syndrome is a rare condition whereby someone speaks their native language as if they had a
foreign accent. This syndrome usually follows a head injury, trauma, or stroke affecting the speech center of the
brain.

Stockholm Syndrome
Stockholm syndrome characterizes a psychological response that can be observed seen in a victim, in which the
victim shows signs of sympathy, loyalty, or even voluntary compliance with the victimizer, regardless of the risk in
which the victim has been placed. The syndrome is most often discussed in the context of hostage abduction, but
has also been described in relationship to rape, and spousal and child abuse. It can be understood as a severe
form of reaction formation that takes place under enormous physiologic and emotional stress.
Stockholm syndrome is named after a bank robbery in Stockholm, Sweden. The bank robbers held bank
employees hostage from August 23 to August 28 in 1973 and the hostages became emotionally attached to their
hostage-takers. They even defended their captors after they were freed, refusing to testify against them.
A famous example of Stockholm syndrome is Patty Hearst. She was a millionaire's daughter who was kidnapped
in 1974 and later took part in a robbery organized by her and her kidnapper.
As in all cases of severe trauma, psychotherapeutic and supportive approaches should be used, and comorbid
conditions should be identified and managed as appropriate.

Lima Syndrome
Lima syndrome is the exact inverse of Stockholm syndrome. In this case, hostage-takers or victimizers become
sympathetic to the wishes and needs of the hostages or victims.
Lima syndrome is named after the Japanese embassy hostage crisis in Lima, Peru, that lasted from December
17, 1996 until April 22, 1997. Fourteen members of the Tupac Amaru Revolutionary Movement took several
hundred diplomats, government and military officials, and business executives of many countries hostage at a
party that took place at the official residence of Japan's ambassador to Peru. Curiously, within a few days of the
hostage crisis, the militants had released most of the captives, with seeming disregard for their importance,
including the future president of Peru, and the mother of the current president.
After months of unsuccessful negotiations, all remaining hostages were freed by a raid by Peruvian commandos,
although 1 hostage was killed.
It is unclear if Lima syndrome can be explained by feelings of guilt, moral indecisiveness, second guessing of
one's actions, or obliviousness.


Stendhal Syndrome
Stendhal syndrome is characterized by physical and emotional anxiety up to the level of a panic attack,
dissociative experiences, confusion, and even hallucinations when an individual is exposed to art. The syndrome
is usually triggered by art that is perceived as particularly beautiful or when the individual is exposed to large
quantities of art that are concentrated in a single place. The term can also be applied to a similar reaction to an
overwhelming experience, for example when confronted with immense beauty in the natural world.
Stendhal syndrome is named after the famous 19th century French author Stendhal who described his
experience with the phenomenon during his visit to Florence, Italy, in 1817, when he was 34 years old. It has also
been called hyperculturemia or Florence syndrome.
Usually, Stendhal syndrome is self-limited and not followed by lasting or severe mental sequelae, and no
interventions beyond supportive measures are needed.

Diogenes Syndrome
Diogenes syndrome is a condition characterized by extreme self-neglect, social withdrawal, lack of shame,
apathy, and compulsive hoarding of rubbish. It is found mainly in old people and is associated with progressive
dementia.
Diogenes syndrome is named after the Greek philosopher Diogenes of Sinope (412 or 404 BCE until 323 BCE),
who was a Cynic and Minimalist. The philosophy of Cynicism is based on the belief that the purpose of life is to
live a life of virtue in agreement with Nature. To achieve this goal, one had to reject all conventional desires for
wealth, power, health, and fame, and live a simple life free from all possessions.
Diogenes took Cynicism to its logical extreme. He is said to have lived in a wine barrel on the streets of Athens,
promoting ideas of nihilism and animalism. Famously, when asked by Alexander the Great, the most powerful
person of that time, what he wanted most in the world, he replied, "For you to get out of my sunlight!"
The syndrome is actually a misnomer because Diogenes was not known to hoard or neglect his own hygiene and
he sought discussions with other people in the Agora.

Munchausen Syndrome
Munchausen syndrome, also sometimes called hospital addiction syndrome, is named after Baron von
Munchausen (1720-1797), an 18th-century German officer who was known for embellishing the stories of his life
and experiences.
Munchausen syndrome is currently classified as a type of factitious disorder characterized by a person's
repeatedly acting as if he or she has a physical or mental disorder when, in truth, he or she has caused the
symptoms. People with factitious disorders act this way because of an inner need to be seen as ill or injured, not
to achieve a concrete benefit, such as financial gain. They are even willing to undergo painful or risky tests and
operations to get the sympathy and special attention given to people who are truly ill. Some will secretively injure
themselves to cause signs like blood in the urine or cyanosis of a limb.
However, there is discussion to reclassify Munchausen syndrome as a somatoform disorder in DSM V because it
is unclear whether people are conscious of drawing attention to themselves. While the "patient" role is familiar
and comforting, filling a psychological need in people with Munchausen syndrome, the condition is different from
hypochondriasis in that patients with Munchausen syndrome are aware that they are exaggerating, whereas
sufferers of hypochondriasis believe they actually have a disease
People affected by Munchausen syndrome deliberately produce or exaggerate symptoms in several ways. They
might lie about or fake symptoms, hurt themselves, or change diagnostic tests. Possible warning signs of
Munchausen syndrome include the following:
• Dramatic but inconsistent medical history;
• History of seeking treatment at numerous hospitals, clinics, and doctors' offices, possibly even in different cities;
• Extensive knowledge of hospitals and/or medical terminology, as well as the textbook descriptions of illnesses;
• Willingness or eagerness to have medical tests, operations, or other procedures;
• Presence of multiple surgical scars;
• Unclear symptoms that are not controllable and that become more severe or change once treatment has begun;
• Appearance of new or additional symptoms following negative test results;
• Predictable relapses following improvement in the condition;
• Presence of symptoms only when the patient is not alone or not being observed;
• Reluctance by the patient to allow healthcare professionals to meet with or talk to family, friends, or prior
healthcare providers; and
• Problems with identity and self-esteem.
The exact cause of Munchausen syndrome is unknown, but a history of abuse or neglect as a child, or a history
of frequent illnesses requiring hospitalization, might be factors associated with the development of this syndrome.
Also, personality disorders are common in individuals with Munchausen syndrome.
Medical professionals or doctors suspecting Munchausen syndrome should first rule out the possibility that the
patient does indeed have a disease but in an early stage and not yet clinically detectable. Although a person with
Munchausen syndrome actively seeks treatment for the various disorders he or she invents, the person usually is
unwilling to admit to and seek treatment for the syndrome itself. When treatment is initiated, the first goal is to
modify the person's behavior and reduce his or her misuse or overuse of medical resources. Any underlying
psychiatric disorder, such as a mood disorder, anxiety disorder, or personality disorder, should be identified and
treated. As with other factitious disorders, the primary treatment for Munchausen syndrome is psychotherapy,
including cognitive-behavioral therapy and family therapy.

Munchausen Syndrome by Proxy
Munchausen syndrome by proxy (ie, through a substitute) is a type of factitious disorder in which a person acts
as if an individual he or she is caring for has a physical or mental illness when the person is not really sick. The
adult perpetrator has Munchausen syndrome by proxy and directly produces or lies about illness in another
person under his or her care, usually a child under 6 years of age, but cases of adult victims have also been
reported. Munchausen syndrome by proxy is considered a form of abuse by the American Professional Society
on the Abuse of Children and occurs in about 2 out of 100,000 children.
People with Munchausen syndrome by proxy might create or exaggerate the child's symptoms in several ways.
They might simply lie about symptoms, alter diagnostic tests (such as contaminating a urine sample), falsify
medical records, or induce symptoms through various means, such as poisoning, suffocating, starving, and
causing infection. The presenting problem may also be psychiatric or behavioral.
Common characteristics in a person with Munchausen syndrome by proxy include:
• Often a parent, usually a mother, but can be the adult child of an elderly patient;
• Might be a healthcare professional;
• Is very friendly and cooperative with the healthcare providers;
• Appears quite concerned (some might seem overly concerned) about the child or designated patient; and
• Might also suffer from Munchausen syndrome.
Other possible warning signs of Munchausen syndrome by proxy in children or cared-for adults include:
• The child has a history of many hospitalizations, often with strange symptoms;
• The child's reported condition and symptoms do not agree with the results of diagnostic tests;
• Worsening of the child's symptoms generally is reported by the mother and is not witnessed by the hospital
staff;
• There might be more than 1 unusual illness or death of children in the family;
• The child's condition improves in the hospital, but symptoms recur when the child returns home;
• Blood in lab samples might not match the blood of the child; and
• There might be signs of chemicals in the child's blood, stool, or urine.
People with Munchausen syndrome by proxy have an inner need for the person they care for to be seen as ill or
injured. The lying, fabrication of symptoms or harm is not done to achieve a concrete benefit, such as financial
gain. People with Munchausen syndrome by proxy are willing to have the person under their care undergo painful
or risky tests and operations to get the sympathy and attention given to people whose family member is truly ill.
People who perpetrate this type of abuse are often affected by concomitant psychiatric problems, like depression,
spouse abuse, psychopathy, or psychosis.
Etiologic and treatment considerations are identical to those in Munchhausen syndrome. The major difference
lies in the fact that the first concern is to ensure the safety and protection of any real or potential victims. This
might require that the child or elderly be placed in the care of others. Management often requires a team that
includes social workers, foster care organizations, and law enforcement in addition to the healthcare providers.
Successful treatment of people with Munchausen syndrome by proxy is difficult because those with the disorder
often deny there is a problem.

Cotard Delusion
Cotard syndrome is a specific nihilistic delusion named after Jules Cotard, a French neurologist, who first
described the condition, which he called "le délire de négation" (negation delirium), in 1880. The affected person
holds the delusional belief that he or she is already dead, does not exist, is putrefying or has lost his or her blood
or internal organs.
It is most frequently observed in patients with psychotic depression or schizophrenias and is managed by
focusing on the treatment of the underlying disorder.

Reduplicative Paramnesia
Reduplicative paramnesia consists of the delusional belief that a place or location has been duplicated, in that it
exists in 2 or more places simultaneously, or that it has been 'relocated' to another site. It is basically the delusion
of doubles of the Capgras syndrome, only that is does not refer to a person but to a place.
"Reduplicative paramnesia" was first used by neurologist Arnold Pick in 1903 to describe a condition in a patient
with suspected Alzheimer disease.

Walking Corpse Syndrome (Cotard's Syndrome)

People who suffer from Cotard's Syndrome have the delusional belief that
they are dead, do not exist, are putrefying, or have lost their blood or
internal organs. There may also be sensory hallucinations, for instance,
they might think that they smell of rotting flesh. The disordertends to occur
intermittently rather than being chronic and may be a feature of
mooddisorder, schizophrenia or organic disorders.

Moebius Syndrome

Moebius syndrome is a rare neurological disorder that is present at birth.
People with the condition are unable to move their faces (they can't smile,
frown, suck, grimace or blink their eyes) and are unable to move their eyes
from side to side. There may be skeletal problems as well, causing
hand/feet anomalies such as club feet. Respiratory problems, speech and
swallowing disorders, visual impairments, sensory processing disorder,
sleep disorders, and weak upper body strength may also be present.
Approximately 30% of children with Moebius syndrome are on the autism
spectrum.

Asperger's syndrome is one of many conditions that come under the umbrella
term ‘autistic spectrum’.
Children with Asperger's syndrome usually experience difficulty in three main areas: social interaction, social
communication and imagination, and cognitive flexibility. Each of these diagnostic features can be present in
different forms and varying degrees.

This might mean that difficulties with social interaction can include not understanding the subtleties of social
situations, recognising and interpreting other people’s feelings, managing emotions or making and maintaining
friendships.


blue baby syndrome
Methaemoglobinaemia caused by the decreased ability of blood to carry vital oxygen around the
body. One of the most common causes is nitrate in drinking water. It is most important in bottle fed
infants and water from wells in rural areas is of special concern. Controlling nitrate levels in drinking
water sources to below around 50mg/litre is an effective preventive measure.
Methaemoglobinemia is characterized by reduced ability of the blood to carry oxygen because of
reduced levels of normal haemoglobin. It is uncommon. Infants are most often affected, and may
seem healthy, but show signs of blueness around the mouth, hands, and feet, hence the common
name “blue baby syndrome”. These children may also have trouble breathing as well as vomiting and
diarrhoea. In extreme cases, there is marked lethargy, an increase in the production of saliva, loss of
consciousness and seizures. Some cases may be fatal.
Asperger’s Syndrome
As soon as we meet a person we make judgements about them. From their facial expression,
tone of voice and body language we can usually tell whether they are happy, angry or sad and
respond accordingly.
People with Asperger syndrome can find it harder to read the signals that most of us take for
granted. This means they find it more difficult to communicate and interact with others which can
lead to high levels of anxiety and confusion.
About Asperger syndrome
Asperger syndrome is a form of autism, which is a lifelong disability that affects how a person
makes sense of the world, processes information and relates to other people. Autism is often
described as a 'spectrum disorder' because the condition affects people in many different ways
and to varying degrees. (For more information about autism, please read our leaflet What is
autism?)
Asperger syndrome is mostly a 'hidden disability'. This means that you can't tell that someone
has the condition from their outward appearance. People with the condition have difficulties in
three main areas. They are:
 social communication
 social interaction
 social imagination.

They are often referred to as 'the triad of impairments' and are explained in more detail on page
3.
While there are similarities with autism, people with Asperger syndrome have fewer problems
with speaking and are often of average, or above average, intelligence. They do not usually have
the accompanying learning disabilities associated with autism, but they may have specific
learning difficulties. These may include dyslexia and dyspraxia or other conditions such
as attention deficit hyperactivity disorder (ADHD) and epilepsy.
With the right support and encouragement, people with Asperger syndrome can lead full and
independent lives.

Three main areas of difficulty
The characteristics of Asperger syndrome vary from one person to another but are generally
divided into three main groups.
Difficulty with social communication
If you have Asperger syndrome, understanding conversation is like trying to understand a
foreign language.
People with Asperger syndrome sometimes find it difficult to express themselves emotionally
and socially. For example, they may:
 have difficulty understanding gestures, facial expressions or tone of voice
 have difficulty knowing when to start or end a conversation and choosing topics to talk about
 use complex words and phrases but may not fully understand what they mean
 be very literal in what they say and can have difficulty understanding jokes, metaphor and
sarcasm. For example, a person with Asperger syndrome may be confused by the phrase 'That's
cool' when people use it to say something is good.

In order to help a person with Asperger syndrome understand you, keep your sentences short -
be clear and concise.
Difficulty with social interaction
I have difficulty picking up social cues, and difficulty in knowing what to do when I get things
wrong.
Many people with Asperger syndrome want to be sociable but have difficulty with initiating and
sustaining social relationships, which can make them very anxious. People with the condition
may:
 struggle to make and maintain friendships
 not understand the unwritten 'social rules' that most of us pick up without thinking. For example,
they may stand too close to another person, or start an inappropriate topic of conversation
 find other people unpredictable and confusing
 become withdrawn and seem uninterested in other people, appearing almost aloof
 behave in what may seem an inappropriate manner.

Difficulty with social imagination
We have trouble working out what other people know. We have more difficulty guessing what
other people are thinking.
People with Asperger syndrome can be imaginative in the conventional use of the word. For
example, many are accomplished writers, artists and musicians. But people with Asperger
syndrome can have difficulty with social imagination. This can include:
 imagining alternative outcomes to situations and finding it hard to predict what will happen next
 understanding or interpreting other people's thoughts, feelings or actions. The subtle messages
that are put across by facial expression and body language are often missed
 having a limited range of imaginative activities, which can be pursued rigidly and repetitively, eg
lining up toys or collecting and organising things related to his or her interest.

Some children with Asperger syndrome may find it difficult to play 'let's pretend' games or prefer
subjects rooted in logic and systems, such as mathematics.

Characteristics of Asperger syndrome
The characteristics of Asperger syndrome vary from one person to another but as well as
the three main areas of difficulty, people with the condition may have:
 love of routines
 special interests
 sensory difficulties.



Love of routines
If I get anxious I get in a tizz. I have a timetable; it helps me to see what I have to do next,
otherwise I get confused.
To try and make the world less confusing, people with Asperger syndrome may have rules and
rituals (ways of doing things) which they insist upon. Young children, for example, may insist on
always walking the same way to school. In class, they may get upset if there is a sudden change
to the timetable. People with Asperger syndrome often prefer to order their day to a set pattern.
For example, if they work set hours, an unexpected delay to their journey to or from work can
make them anxious or upset.
Special interests
I remember Samuel reciting the distances of all the planets from the sun to a baffled
classmate in the playground when he was five. Since then he has had many obsessions, which
he loves to talk about at length!
People with Asperger syndrome may develop an intense, sometimes obsessive, interest in a
hobby or collecting. Sometimes these interests are lifelong; in other cases, one interest is
replaced by an unconnected interest. For example, a person with Asperger syndrome may focus
on learning all there is to know about trains or computers. Some are exceptionally
knowledgeable in their chosen field of interest. With encouragement, interests and skills can be
developed so that people with Asperger syndrome can study or work in their favourite subjects.
Sensory difficulties
Robert only has problems with touch when he doesn't know what's coming - like jostling in
queues and people accidentally brushing into him. Light touch seems to be worse for him than a
firm touch.
People with Asperger syndrome may have sensory difficulties. These can occur in one or all of
the senses (sight, sound, smell, touch, or taste). The degree of difficulty varies from one
individual to another. Most commonly, an individual's senses are either intensified (over-
sensitive) or underdeveloped (under-sensitive). For example, bright lights, loud noises,
overpowering smells, particular food textures and the feeling of certain materials can be a cause
of anxiety and pain for people with Asperger syndrome.
People with sensory sensitivity may also find it harder to use their body awareness system. This
system tells us where our bodies are, so for those with reduced body awareness, it can be
harder to navigate rooms avoiding obstructions, stand at an appropriate distance from other
people and carry out 'fine motor' tasks such as tying shoelaces. Some people with Asperger
syndrome may rock or spin to help with balance and posture or to help them deal with stress.
Who is affected by Asperger syndrome?
There are over half a million people in the UK with an autism spectrum disorder - that's around 1
in 100. People with Asperger syndrome come from all nationalities, cultures, social backgrounds
and religions. However, the condition appears to bemore common in males than females; the
reason for this is unknown.

Causes and cures
What causes Asperger syndrome?
The exact cause of Asperger syndrome is still being investigated. However, research suggests
that a combination of factors - genetic and environmental - may account for changes in brain
development.
Asperger syndrome is not caused by a person's upbringing, their social circumstances and is not
the fault of the individual with the condition.
Is there a cure?
There is currently no 'cure' and no specific treatment for Asperger syndrome. Children with
Asperger syndrome become adults with Asperger syndrome. However, as our understanding of
the condition improves and services continue to develop, people with Asperger syndrome have
more opportunity than ever of reaching their full potential.
There are many approaches, therapies and interventions, which can improve an individual's
quality of life. These may include communication-based interventions, behavioural therapy and
dietary changes. Information about many of these can be found
at: www.autism.org.uk/approaches

Diagnosis
Because Asperger syndrome varies widely from person to person, making a diagnosis can be
difficult. It is often diagnosed later in children than autism and sometimes difficulties may not be
recognised and diagnosed until adulthood.
The typical route for getting a diagnosis is to visit a GP. He or she can refer an individual to other
health professionals who can make a formal diagnosis. Most frequently they will be psychiatrists
or clinical psychologists and, in the case of children, paediatricians.
Some people see a formal diagnosis as an unhelpful label; however, for many a diagnosis:
 helps the individual, families, friends, partners, carers, professionals and colleagues to better
understand and manage their needs and behaviour
 is the key needed to open the door to specialised support, eg supported living or finding suitable
employment.

There are diagnostic differences between conditions on the autism spectrum. Sometimes people
may receive a diagnosis of autism or autistic spectrum disorder (ASD), high-functioning autism
(HFA) or atypical autism instead of Asperger syndrome. Alternatively, they may be given a
diagnosis of pervasive developmental disorder - not otherwise specified (PDD-NOS) or semantic
pragmatic disorder. However, people who have been given these diagnoses will have similar
difficulties and similar support needs to those who have Asperger syndrome.
You can find more information about diagnosis and how to get one here.
If you would like to read more about the different types of autism (including Asperger syndrome)
and the diagnoses that people get, see:
 High-functioning autism and Asperger syndrome: what's the difference?
 The use and misuse of diagnostic labels.