Snake Inside My Stomach: Delusional Zoopathy with Cenesthopathic Hallucinations in Chronic Schizophrenia: A Case Report
Venugopal Vijay Ratnam, Suranjita Mazumdar
Medical Science and Discovery March 30, 2026 DOI: 10.36472/msd.v13i3.1348 (opens in new tab)
Study at a glance
AI-extracted from the abstract| Characteristics | Case study Case report Peer reviewed |
|---|---|
| Sample size | 1 |
| Population | A 35-year-old married woman from Assam with chronic schizophrenia and comorbid hypothyroidism |
| Interventions | Aripiprazole Olanzapine Clozapine |
| Dose | clozapine 200 mg/day |
| Key findings | The authors report that a highly bizarre zoopathic delusion—a belief that a snake inhabited the stomach—emerged in chronic, treatment-resistant schizophrenia, with cenesthopathic hallucinations reinforcing the somatic delusional conviction. The patient showed no response to adequate trials of aripiprazole and olanzapine but improved markedly with clozapine 200 mg/day, including reduced somatic complaints, attenuated cenesthopathic sensations, and partial insight. |
Abstract
Objective: Somatic delusions are common in schizophrenia; however, delusional zoopathy—defined as the conviction that macroscopic animals (e.g., reptiles or mammals) inhabit the body—is rare and phenomenologically distinct from classical delusional infestation (Ekbom syndrome), which typically involves microscopic organisms. We report a 35-year-old married woman from Assam with chronic schizophrenia and comorbid hypothyroidism who, following an 11-year illness course characterized by persecutory delusions toward neighbors and family members, third-person auditory hallucinations, self-talking, and inappropriate smiling, developed a fixed belief that a snake had entered through her mouth and was residing in her stomach. Case: This delusion was accompanied by severe abdominal pain, marked restlessness, and prominent cenesthopathic “writhing” sensations attributed to the snake’s movements, resulting in persistent demands for abdominal ultrasonography to “detect the snake,” despite normal findings and repeated reassurance. The patient showed no response to adequate trials of aripiprazole and olanzapine but demonstrated marked clinical improvement with clozapine 200 mg/day, including reduction in somatic complaints, attenuation of cenesthopathic sensations, and emergence of partial insight.
Conclusion: This case illustrates that highly bizarre zoopathic delusions may emerge in chronic, treatment-resistant schizophrenia, highlights the reinforcing role of cenesthopathic hallucinations in somatic delusional conviction, and underscores the importance of addressing both positive psychotic symptoms and aberrant bodily experiences, including timely initiation of clozapine when standard antipsychotics fail.