The Elusive Little People of Leroy: A Systematic Review of Lilliputian Hallucinations

https://doi.org/10.1016/j.neubiorev.2021.03.002

Commentary

Lilliputian hallucinations are said to be related to minute sized hallucinated human, animal or fantasy entities.

This was famously described by the French psychiatrist Raoul Leroy in 1909, and they are routinely mentioned in psychiatric textbooks, but not with any deep knowledge.

Therefore, this study systematically reviewed a case series consisting of 145 case reports and 226 case descriptions and concluded that Lilliputian hallucinations are visual in nature (61%) and multimodal (39%).

In 97% of cases, they are perceived as being based on the actual environment, indicating the involvement of higher-level areas of the perceptual network that maintain the fusion of sensory and hallucinatory content.

Although perceptual release and afferent pathway blockade were described as the most likely underlying mechanisms, the etiology was very diverse, with schizophrenia spectrum disorders, alcohol use disorders, and vision loss accounting for 50% of cases, and neurological disorders accounting for 36%.

In addition, 62% of cases recovered, 18% became chronic, and 8% were reported dead.