Case Report: A 39-year-old right-handed male began experiencing visual hallucinations of his son three days following discontinuation of 4 mg per day of alprazolam. The patient entered his bathroom with the belief that his son was taking a bath, which was confirmed with a hallucination of the six-year-old; however, as the patient reached his son, the boy transformed into a dog and began wagging his tail.

Abnormalities in Neurological Examination: Cranial nerves IX and X: uvula deviated to the left. Motor: drift test with right abductor digiti minimi sign. Cerebellar: finger-to-nose dysmetria bilaterally. Low amplitude, high frequency tremor on extension (upper extremities). Reflexes: 0 branchioradialis, 1+ biceps, 0 triceps, 0 quadriceps femoris, 1+ right ankle jerk, and 0 left ankle jerk. Beck's Depression Inventory Type II: 27 (definite depression). Beck’s Anxiety Inventory: 27 (severe).

The mechanism for benzodiazepine withdrawal-induced metamorphosis is unknown. Possibly benzodiazepine withdrawal leads to a reduction in gamma-aminobutyric acid with associated disinhibition phenomenon and thus positive symptoms occur. While metamorphosis has been described with occipital/occipitotemporal lobe lesions (Pryse-Phillips, 2003), no such pathology was noted in this patient. In those who undergo benzodiazepine withdrawal, query as to metamorphosis is warranted. Alternatively, in those presenting with metamorphosis, investigation into benzodiazepine use may be revealing.

Pryse-Phillips, W. (2003). Companion to clinical neurology. New York: Oxford University Press.

Seens, H., & Hirsch A. (2018). T214. Two Sisters Too Many: A Case of Benzodiazepine Withdrawal-Induced Reduplicative Paramnesia. Biological Psychiatry, 83(9), S211.