Delusional Misidentification Research Articles

Capgras syndrome epidemiology, aetiology, characteristics of psychopathology: literature review

Geistė Tubutytė1, Augustina Zaveriuchaitė1 1 Vilnius University, Faculty of Medicine, Vilnius, Lithuania Abstract Background. Capgras syndrome is a monothematic delusional misidentification syndrome that leads to the delusional conviction that an acquaintance or a relative of a patient has been replaced by a double. This syndrome is associated with positive and negative double symptoms. In the clinical psychiatric practice such symptoms appear in the structure of acute fantasy delusion with a confusion affect, also in acute paraphrenia. Aim. To review the latest – literature about Capgras syndrome epidemioly, aetiolgy, psychopathology and treatment. Materials and methods. The literature search was conducted in the international database PubMed. Keywords ,,Capgras syndrome’’, ,,delusional misidentification syndrome’’, ,,delusion of doubles’’ were used. 122 articles were rejected according to their title and abstract non-compliance to our subject. 52 articles, published in English language in the period of 1976-2022 were included to this literature review. Results. Capgras syndrome’s prevalence is the highest among the delusional misidentification syndromes reaching 0,12% in the general population. Its origin can be divided into organic, functional, mixed and unspecified. Any pathology that affects the right parietal-occipital and temporal lobes can be of influence for the development of this disorder. Capgras syndrome is often to be differentiated from the delusion of subjective doubles and prosopagnosia. Conclusions. Capgras syndrome is a complex psychopathological phenomenon occuring with a wide spectrum of psychiatric, neurologic and other organic diseases. Subject to the aetiology the clinical appearance varies. Determining and treating the adjacent psychiatric and organic disorders is the basis of Capgras syndrome management. Keywords: Capgras syndrome, delusional misidentification syndrome, psychopathologic characteristics.

Clinical presentation and neural correlates of stroke-associated spatial delusions.

Incongruent beliefs about self-localization in space markedly disturb patients' behavior. Spatial delusions, or reduplicative paramnesias, are characterized by a firm conviction of place reduplication, transformation, or mislocation. Evidence suggests they are frequent after right hemisphere lesions, but comprehensive information about their clinical features is lacking. We prospectively screened 504 acute right-hemisphere stroke patients for the presence of spatial delusions. Their behavioral and clinical features were systematically assessed. Then, we analyzed the correlation of their duration with the magnitude of structural disruption of belief-associated functional networks. Finally, we described the syndrome subtypes and evaluated whether the clinical categorization would be predicted by the structural disruption of familiarity-associated functional networks using an unsupervised k-means clustering algorithm. Sixty patients with spatial delusions were identified and fully characterized. Most (93%) localized the misidentified places closer to home than the hospital. The median time duration was 3 days (interquartile range=1-7 days), and it was moderately correlated with the magnitude of structural-functional decoupling of belief-associated functional networks (r= 0.39, p= 0.02; beta coefficient regressing for lesion volume=3.18, p= 0.04). Each clinical subtype had characteristic response patterns, which were reported, and representative examples were provided. Clustering based on structural disruption of familiarity- and unfamiliarity-associated functional networks poorly matched the clinical categorization (lesion: Rand index=0.47; structural disconnection: Rand index=0.51). The systematic characterization of the peculiar clinical features of stroke-associated spatial delusions may improve the syndrome diagnosis and clinical approaches. The novel evidence about their neural correlates fosters the clarification of the pathophysiology of delusional misidentifications.

Capgras Syndrome and Other Delusions of Misidentification: a Summary of the Psychological, Psychiatric, and Neurophysiological Literature on DMI

Capgras Syndrome and Other Delusions of Misidentification: a Summary of the Psychological, Psychiatric, and Neurophysiological Literature on DMI

Capgras Syndrome and Other Delusions of Misidentification: Integrating Neuropsychological Models of Delusion Formation with Psychoanalytic Object-Relations Theory

Capgras Syndrome and Other Delusions of Misidentification: Integrating Neuropsychological Models of Delusion Formation with Psychoanalytic Object-Relations Theory

Capgras and Fregoli delusions - a case report

IntroductionCapgras and Fregoli delusions are psychotic complex conditions that integrate a larger group of Delusional Misidentification Syndromes (DMS), where the patient misidentifies people, places or objects.ObjectivesReview of the literature and exposure of a case report of a first psychotic episode with DMS.MethodsCase report and a nonsystematic review through databases. With the keywords: Capgras; Fregoli; DMS.ResultsThis case presents a caucasian male, 34-year-old, with no personal or family history of psychiatric pathology. He was taken to the emergency service, due to behavior disorder with verbal aggressiveness to his mother. During the psychiatric emergency he was restless, with accelerated speech and presented Capgras and Fregoli delusion. He believed that his mother had been replaced by an imposter and that the doctor was actually his childhood friend disguised, all with the intention of harming him. The patient was hospitalized, analytical and brain scan show no abnormally. Improvement in symptoms was been seen when a long-term injectable antipsychotic was started. The diagnosis was Bipolar type I disorder.ConclusionsDSM are more frequent than previously considered, they often occur in association with psychiatric or neurological disorders. Case reports like this one helps to clarify the association between DMS and psychiatric disorders. Given the high incidence of DMS, it is essential to recognize them, carry out an early treatment and be alert to other psychopathological or neurological symptoms that may coexist.DisclosureNo significant relationships.

WHO IS THAT MAN I SEE STARING STRAIGHT BACK AT ME? - Mirror Delusional Misidentification: A Case Report And Literature Review

IntroductionThe delusional misidentification syndromes (DMS) are uncommon but fascinating neuropsychiatric disorders. One particularly intriguing form of DMS is called the mirror sign or mirror delusional misidentification (MDM).ObjectivesWe aim to present a case on MDM and a review on MDM and its correlation with neurological lesions.MethodsNon-systematic review of the literature and case report.ResultsA 72 years old patient was admitted to the emergency department with disorientation, behavioral changes and persecutory delusional ideation. The patient was also unable to recognize his face in the mirror, claiming to be his son. On neuroimaging tests, the patient presented with moderate diffuse cortical-subcortical cerebral atrophy associated with mild diffuse cortical cerebellar atrophy, as well as atheromatous calcifications in carotid siphons. In the MDM, the patient treats the mirror image as separate from the self. It is commonly seen in patients with dementia. Unlike Capgras syndrome, MDM is typically associated with neurological illness, particularly with neurodegenerative conditions. Findings on neuroimaging have shown a pattern of right hemisphere cortical and subcortical lesions. the most common findings included the following: generalized or localized atrophy on Magnetic Resonance Imaging, ventricular dilatation on Computed Tomography scan, and slowing on Electroencephalography.ConclusionsMirror delusional misidentification differs from other forms of DMS as it is seen exclusively in patients with neurological disease. While right hemisphere dysfunction appears to be a requirement for MDM, patients with this condition do not show consistent enough neuroimaging findings to allow for a localization within the right hemisphere.DisclosureNo significant relationships.

Asymptomatic COVID-19 Infection Induced First Episode Psychosis: A Case Series

Aims: We presented 3 similar cases of 1st episode psychosis that occurred after Corona Virus Disease -2019 (COVID-19) infection which we treated at our institute’s on going post-COVID-19 mental health clinic, to provide more evidence to the existing literature and to describe whether an asymptomatic COVID-19 infection can also induce psychosis in previously healthy individuals and tried to elaborate the probable etiology and nature of the psychotic symptoms.
 Presentation of the Cases: All the 3 cases had COVID-19 infection, few days before their psychotic symptoms started for the 1st time. They didn’t have any history of regular substance or medication use that are known to induce psychosis or any previous history of psychiatric disease or family history of psychiatric disease, without any abnormality in physical examinations and laboratory investigations. All the cases had history of stress which were not overwhelming (except the 3rd case) and were mostly related to COVID-19 infection and pandemic associated social and financial stress. 1st case (54 years, married male) developed delusion of persecution, delusion of reference, 2nd and 3rd person auditory hallucinations, 2nd case (61 years, widower male) developed delusion of persecution, 2nd person auditory hallucination (commanding type), disinhibited behaviour (disrobing in public) and the 3rd case (32 years, unmarried male) developed delusion of persecution and delusional misidentification (Intermetamorphosis). All of them responded well to commonly used antipsychotics within 4 weeks that prompted a diagnosis of Acute and Transient Psychotic disorder according to ICD-10 criteria.
 Discussion: This study points out that even an asymptomatic COVID-19 can induce psychosis for the first time in life, where the etiology most probably is the direct effect of the virus itself on brain or the COVID-19 and pandemic related stress which is supported by the fact that factors like family history of psychiatric disease, substance use or medication use or any comorbidity that can induce psychosis were also absent. The psychopathological findings were persecutory delusion and auditory hallucinations with one case having Intermetamorphosis phenomenon which is a rare finding and perhaps a novel finding in post-COVID-19 Psychosis.
 Conclusion: All COVID-19 infected individuals should be screened early for appearance of any symptom that raises the suspicion of psychosis. Large studies are needed to ascertain the etiology of post-COVID-19 psychosis.

Misidentification delusions as mentalization disorders

Misidentification delusions as mentalization disorders

Treatment and Care for Elderly Patients with Dementia with Lewy Bodies Presenting with Delusional Misidentification Syndrome Including Capgras Syndrome: Severe Psychiatric Symptoms Associated with Dementia with Lewy Bodies

The treatment and care for severe psychiatric symptoms associated with dementia with Lewy bodies is challenging. This is especially true for elderly patients because the use of antipsychotics is associated with an attendant mortality risk. In this article, dementia patients with Lewy bodies who presented with severe psychiatric symptoms such as Capgras syndrome (delusional misidentification syndrome), are described, and pharmacological and non-pharmacological strategies to address these symptoms are discussed. Measures to be avoided include antipsychotic administration and physical restraint, both of which often lead to medical conditions and a bedridden status. Conversely, changing antiparkinsonian drugs (levodopa rather than dopamine agonists), cholinesterase inhibitor administration, physical rehabilitation, and providing a supportive, patient-friendly environment may help improve psychiatric symptoms or maintain functionality. In some cases, electroconvulsive therapy may be effective for severe psychiatric symptoms.

Treatment and Care for Elderly Patients with Dementia with Lewy Bodies Presenting with Delusional Misidentification Syndrome Including Capgras Syndrome: How to Respond and Intervene from a Neurologist's Perspective

Aged patients with dementia with Lewy body (DLB) present with delusional misidentification syndrome and occasionally Capgras' syndrome. It is difficult to treat the DLB patients presenting with these psychiatric symptoms, as well as dementia, parkinsonism, sleep disorders, and autonomic dysfunction. In advanced stage of DLB, it is necessary to pay careful attentions to the appropriate choice of drugs as well as to improve the environment surrounding the DLB patients. At an earlier stage of DLB, before the exacerbation of illness, it is important to explain the clinical features and treatments of various symptoms for the patient, their family members, and caregivers.

Choroid Plexus and Its Association of Subtypes of Delusion in Patient With Alzheimer’s Disease

Objective: This study examined the volume of choroid plexus across AD without delusion (AD-D), AD with paranoid delusion (AD+PD), and AD with misidentification delusion (AD+MD). Methods: This is a hospital based cross-sectional study of patients with AD. The main outcome measure is the volume of choroid plexus that were measured as regions of interest with magnetic resonance imaging and the FreeSurfer analysis at baseline. Analysis of covariance (ANCOVA) was conducted to compare the differences on the volume of choroid plexus across AD-D, AD+PD, and AD+MD after controlling demographics. Results: There was no volume difference in the both choroid plexus between AD-D and AD+D. However, the volumes of both choroid plexus were significantly reduced in AD+MD compared to AD+PD. Conclusion: Our study demonstrates that AD+MD has significantly reduced volumes of choroid plexus compared to AD+PD. These findings suggest that AD+MD and AD+PD may have different pathophysiological mechanisms related to neuroimmune responses in the choroid plexus.

Delusional Misidentification Post-Traumatic Brain Injury Responding to Clozapine.

Delusional Misidentification Post-Traumatic Brain Injury Responding to Clozapine.

"ZOOM effect". The TV sign in patients with dementia: Is there an increased incidence during pandemia due to a rise in isolation and virtuality?

Delusional misidentification syndromes are misperceptions of external stimuli with an associated belief or elaboration that is held with delusional intensity. In the TV sign patient believes that the observed television events are occurring in a real three-dimensional space. It is one of the very rare forms of delusional misidentification syndrome in patients withdementia.Wereport7patientswithcognitiveimpairmentcaseswhohavepresentedTVsignduringtheCOVID-19 pandemic. Two patients had Alzheimer's dementia type diagnosis, 1 atypical Alzheimer dementia, 1 vascular dementia and 3 of them had mixed etiology (2 Alzheimer dementia + vascular and 1 dementia with Lewy bodies + vascular). Three presented other psychotic symptoms and 1 patient also had Capgras syndrome. These 7 cases series raise the possibility of an increase incidence of TV sign in patients with dementia during pandemia triggered by the rise in expo- sure to screen devices and a social isolation during this period.

These Are Not the Droids You Are Looking For: Mechanical Variant of Cotard’s Syndrome

Cotard's syndrome is a nihilistic delusion where the individual believes they are dead, partly dead, or replaced by an animal. The delusion that their body has been replaced by a purely inanimate azooic (but physical entity), such as a robot or a droid, has not hitherto been described. Case study: This 60-year-old, right-handed, female, with a past history of schizophrenia presented with complaints of depression, irritability, and anger. When confronted with commitment papers signed by her father, she denied their truthfulness, insisting that he had been replaced by an imposter. This belief persisted unabated, despite treatment with 20mg of haloperidol per day. Over time, she expressed the belief that she had been replaced by another person, whom she refused to identify. The following day she refused all food and water proclaiming that she had died and been replaced by a machine revealing, "I am not her. I am a robot." Soon thereafter she developed tremulousness, stiffness, and rigidity. After haloperidol was decreased and benztropine started, these parkinsonism symptoms subsided, but her delusions persisted. Abnormalities in physical examination: General: decreased blink frequency. Neurologic examination: Mental status examination: bradyphrenia, hypoverbal, blunted affect. Oriented ×2. Motor examination: bradykinetic, cogwheel rigidity in both upper extremities. Gait examination: slow shuffling gait, reduced bilateral arm swing. Cerebellar examination: resting tremor in both upper extremities at 3 cycles per second. Other: EEG: focal sharp transients in the left temporal region. MRI with and without contrast: normal. Toxicological, metabolic, endocrine screening: normal. This illustrated sequential presentations of three delusions of misidentification. Upon presentation, she exhibited Capgras syndrome, the delusional belief that a familiar person has been replaced by a double. The nidus for this may have been the discovery that her father had signed her commitment papers. This was followed by the belief she was a double of herself, which is the syndrome of Reverse Subjective Doubles. Finally, she manifested Cotard's syndrome in a previously undescribed manner, believing she had died and become a robot. Cotard's and Capgras syndromes are known to present sequentially rather than concurrently, whereas the patient presented concurrently with all three syndromes. Drug-induced parkinsonism may have made the patient subjectively feel stiff, which she interpreted as being rigid like a robot. She was bradykinetic, did not eat or drink, and had rigidity, suggesting that these were somatic manifestations of her underlying delusion of being a robot or alternatively, may have been the somatic nidus for the delusion. Those who present with Cotard's syndrome warrant evaluation for underlying medical conditions, serving as a substrate for this delusion. No funding.

Capgras Syndrome: Introduction, Overview, and Literature Review

Capgras Syndrome (CS) is a delusional disorder, one of the Delusional Misidentification Syndromes (DMSs), in which the patient believes that an ‘imposter’ has taken the place of one of their loved ones. This, at instances, results in violence and aggression towards the supposed imposter. In this paper, the aim is to see to it that the syndrome receives the attention that it deserves and that the most recent advances in the research related to the syndrome are illustrated in a concise manner.

Abstract- Poster

Abstract- Poster

Phantom boarder symptom in elderly Japanese.

Phantom boarder symptom (PBS) is classified as a delusional misidentification syndrome, and is often encountered in elderly individuals who have mild or major neurocognitive disorders. With the ageing of society, patients presenting with PBS are increasing in Japan. This retrospective study was conducted to examine the aetiology and identify significant predictors of PBS. The records of 511 consecutive patients who visited our hospital with suspicion of dementia between September 2013 and September 2019 were retrospectively examined. From those, 16 patients who presented with PBS (1 male, 15 females; mean age 79.9 ± 4 years) were selected and case features were investigated in detail. Clinical symptoms, background factors, and final diagnoses were noted. PBS was most common in patients affected by dementia with Lewy bodies (DLB). Predictive factors were evaluated using multiple logistic regression analysis. The final diagnosis of the 16 subjects was DLB in 7, Alzheimer's disease in 3, delusional disorder in 3, unspecified dementia in 2, and vascular dementia in 1. Analysis limited to DLB cases showed that a low Mini-Mental State Examination (MMSE) score and living alone were related to higher risk for PBS. Various types of dementia, especially DLB, as well as cognitive impairment and living alone were found to be strong predictors of PBS.

A Case Report of Delusional Misidentification of Television, Person and Location and Behavioral Spontaneous Confabulation

A Case Report of Delusional Misidentification of Television, Person and Location and Behavioral Spontaneous Confabulation

An Innovative Non-Pharmacologic Treatment for Delusional Misidentification in Persons with Major Neurocognitive Disorder.

Misidentification delusions are false, fixed beliefs that assign an incorrect identity to a previously familiar or unfamiliar person or place. Such delusions are common in several neuropsychiatric disorders and place a particular burden on individuals with Major Neurocognitive Disorder and their caregivers. No standard pharmacologic or non-pharmacologic treatment approaches have been shown to be consistently effective in addressing this problem. We describe two caregiver-care recipient dyads in which an innovative non-pharmacologic, digital intervention reduced delusional misidentification, improved care recipient behavior, and decreased caregiver burden.

Coexistencia de distintos síndromes de falsos reconocimientos delirantes en la práctica clínica: serie de casos

ObjectiveThe objective of this study is to analyse the coexistence of several delusional misidentification syndromes in a clinical sample. MethodsOver one year, a sample of six patients presenting two or more types of delusional misidentification syndromes was selected. All these patients were admitted to the psychiatric inpatient unit of a Spanish hospital. ResultsDespite the different diagnoses, the patients included presented different types of delusional misidentification syndromes, both hyperidentification and hypoidentification. Antipsychotic treatment was not very effective against these delusional misidentification syndromes ConclusionsThe coexistence of several delusional misidentification syndromes indicates that the aetiopathogenesis of the different types is similar. It is a field with important clinical implications, due to the poor response to treatment, as well as the possible medico-legal implications.