A 56-year-old Greek woman developed personality changes, presenting first with prominent hyper-religiosity alternating with periods of retardation, together with social disinhibition. For 10 months before, she had expressed extravagant religiosity, having previously been religiously indifferent. She had begun praying at home, reading Christian magazines and attending church frequently. She had also collected and decorated personal health folders with collages of religious pictures (figure 1). There were no problems with memory, facial recognition or visuospatial function.
On examination, she showed psychomotor agitation with severe inability to maintain concentration and could not focus on specific tasks. Nevertheless, she remained orientated to person, place and time, and there were no obvious focal signs.
Laboratory investigations, including routine cerebrospinal fluid studies, were normal. Electroencephalography showed mild generalised slowing (5 Hz) and a single-photon emission CT scan of brain showed decreased perfusion in the right temporal lobe and in both frontal lobes. MR scan…