Het Alice in Wonderland-syndroom en psychotische ervaringen: een differentiaaldiagnostische uitdaging

Alice in Wonderland syndrome and psychotic experiences: a challenging differential diagnosis Alice in Wonderland syndrome (AIWS) is an understudied condition associated with a variety of symptoms, from visual and somesthetic perceptual distortions to disturbances in time perception and symptoms in the psychotic spectrum. The syndrome is pathophysiologically associated with cortical dysfunction in sensory brain areas. When AIWS symptoms occur, possible underlying neurological conditions should be investigated as they may be amenable to treatment. From a psychiatric perspective, distinguishing it from disorders within the psychotic spectrum poses a challenge. This article aims to clearly describe the phenomenology and definition of AIWS and to explore whether a strict differential diagnosis with psychotic experiences is possible. To the best of the authors’ knowledge, psychiatric disorders have to this date only been associated with AIWS in adults. A case of a 14-year-old girl with depression and subclinical psychotic symptoms with an unclear origin of AIWS is presented. Presumably, there was a looping effect and the subclinical psychotic symptoms were mistakenly identified as AIWS symptoms. Due to substantial differences in prognosis and treatment, the authors want to emphasize the importance of differentiating AIWS from a (subclinical) psychotic syndrome. It is crucial to thoroughly examine each individual AIWS symptom phenomenologically in all its facets. Additionally, clinicians should be aware of the influence of the looping effect.