Vampiric Delusions in Treatment-Resistant Schizoaffective Disorder: A Case Report.

Clinical vampirism, or Renfield syndrome, is a rare psychiatric phenomenon characterized by the compulsion or desire to consume blood and has been described in association with psychotic and other psychiatric disorders. Reported presentations may include blood-drinking behaviors, urges to consume blood, and delusions or hallucinations involving blood. This report details the case of a 28-year-old man with a history of treatment-resistant schizoaffective disorder and adolescent-onset polysubstance use who presented with prominent vampiric delusions. The patient endorsed urges to consume blood in the setting of persistent auditory hallucinations and religious delusions without acting upon these impulses. His presentation was complicated by psychosocial vulnerabilities, including chronic homelessness, medication nonadherence, and prior incarceration. Following psychiatric evaluation and resumption of antipsychotic therapy, his homicidal ideation decreased, and he was transferred to an inpatient psychiatric facility for continued treatment. This case highlights the relationship between clinical vampirism and underlying psychotic disorders and underscores the importance of addressing barriers to continuity of care when managing these rare presentations.