Psychosis induced by invocation presenting as possession state: A case of Kitousei-Seishinbyo still emerging in modern Japan.

Abstract

Kitousei-Seishinbyo, or psychosis induced by invocation, was first described by Morita in 1915 as a culture-bound syndrome characterized by possession-like states and personality transformation triggered by prayer or spiritual practices. New psychosocial triggers (e.g., self-improvement seminars, emerging religious groups) have been identified. However, reports of possession-related episodes have become extremely rare. Diagnostic confusion with dissociative identity disorder or other specified dissociative disorders persists. A woman in her 50s, with no prior psychiatric history, developed acute possession-like symptoms after visiting a fortune-teller. She was told her misfortune was caused by the spirit of her aborted child. Soon after, she entered trance states, spoke in altered voices (male and childlike), and exhibited personality changes, agitation, and dangerous behaviors, leading to involuntary admission. On evaluation, laboratory tests, electroencephalogram (EEG), and imaging were unremarkable. During hospitalization, she exhibited mutism, rigidity, temporary auditory hallucinations, and somatic complaints such as heaviness and dizziness, which fluctuated depending on spiritual contact. Retrospective review revealed significant psychosocial stressors, including marital discord, caregiving burden, and strained family relationships. Management involved family psychoeducation, occupational therapy, and low-dose psychotropics (tandospirone and zolpidem). Her symptoms gradually stabilized, and she voluntarily discontinued spiritual practices. She was discharged after 62 days with improved family dynamics and sustained recovery. This case illustrates a present-day example of Kitousei-Seishinbyo triggered by encountering a fortune-teller. Improvement was achieved through combined psychosocial interventions and low-dose pharmacotherapy.

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