Case 20: A man in contact with aliens who prevents earthquakes

Case 20: A man in contact with aliens who prevents earthquakes

A 48-year-old man, admitted with burning and "hardening" in his limbs and blood vessels, who says aliens cause it and that he stops earthquakes by telepathy.

  • 2 min read
  • Checked 01 Nov 2026

The case

A 48-year-old man is admitted to a psychiatric clinic complaining that his limbs burn and his blood vessels are "hardening". Aliens are doing this to him, he says; he is in contact with them every evening. He also says that he has personally stopped earthquakes in South America by telepathy. He has no job and lives with his mother.

Summary

Diagnosis

Schizophrenia, paranoid type, with a chronic course. The vignette does not give the history; a long illness is suggested by his life without work, at home with his mother, and should be confirmed.

What points to it

  • Delusions of grandeur (he stops earthquakes), of control and of harm (aliens act on his body), with fantastic, bizarre content.
  • Disturbed perception: the burning and hardening are best read as bodily (somatic) hallucinations.
  • Older texts use the name paraphrenia for an elaborate, well-organised delusional world of this grandiose kind. The term is not used in ICD-11 or DSM-5.
  • Signs of negative symptoms in how he lives: no work, dependent on his mother.

What else it could be

Delusional disorder is possible, but the perceptual disturbances and the probable negative symptoms favour schizophrenia. Burning limbs should not be put down to psychosis without a physical examination: peripheral neuropathy and vascular disease are common at 48.

Management

  • An antipsychotic, as a long-acting injection (depot) if he may not take tablets reliably.
  • Clozapine if two adequate trials of antipsychotics leave the delusions unchanged.
  • Cognitive behavioural therapy for psychosis, aimed at keeping him from acting on his delusions.
  • Psychoeducation for him and his mother, and rehabilitation focused on social skills and work, with supported employment where available.
  • Physical health checks, including for the side effects of long-term antipsychotics.

Outlook

Chronic, but with positive symptoms still more prominent than negative ones, so there is room for treatment to help.