Delusional Misidentification Research Articles

Differentiation of dissociative psychosis, delirious mania and unspecified dissociative disorder in an adolescent case: a case report

Dissociative psychosis is, it is a condition that usually occurs after a trauma, when psychotic and dissociative symptoms occur together.In this process, disorganized behaviors increase, insight is lost, and hallucinations become worse.It usually results in sudden improvement over a period of several days to several weeks and most patients remain amnesic into the dissociative psychosis phase. A sixteen-year-old female adolescent was brought in with severe manic and psychotic complaints that started suddenly a week ago.In-mental-status-examination; her associations, thought content and perception examination were particularly striking.During-the-hospitalization-process, passivity, delusional delusions of misidentification, and disorganized speech and behavior were also observed.The adolescent, whose complaints regressed in the fourth week, was amnesic during the episode.This study aims to present the differential diagnosis and treatment process of dissociative psychosis, delirious mania, and unspecified dissociative disorder in an adolescent female.

Prosopagnosie et syndrome de Capgras : deux syndromes en miroir ?

First described in the 19th century in patients with brain lesions, prosopagnosia was named in 1947 by Joachim Bodamer (1910–1985), a German neuropsychiatrist. The term refers to the inability to recognise a familiar face, a rarely isolated symptom. Prosopagnosia is thought to result from brain lesions, predominantly at the ventral right temporo-occipital junction. There are more common cases of developmental prosopagnosia, where no lesion has been identified. Capgras syndrome (CS), described by Joseph Capgras (1873–1950), a psychiatrist, consists of the persistent belief that a close relative, identified, has been replaced by a look-alike. SC, considered a delusional disorder of identification or familiarity, has been described in chronic psychoses, mainly schizophrenia. It is also reported in the course of neurodegenerative diseases (mainly Alzheimer's disease, Lewy body dementia, Parkinson's dementia). Lesion-based forms have recently been described. Prosopagnosia and SC were initially thought to result from mirror-image lesions involving a single factor, one affecting an overt ventral circuit for face recognition (in the case of prosopagnosia), the other a covert dorsal circuit involved in emotional and vegetative responses (in the case of CS). Lesion network mapping has been used in both lesion-related conditions and suggests a more complex figure. Lesions causing prosopagnosia were correlated with one of the main regions associated with face recognition, the right fusiform face area, and anticorrelated with left frontal regions possibly involved in visual attentional control. In lesional forms of CS or other delusional misidentification syndromes, there was a correlation with left retrosplenial cortex, an area associated with familiarity processing, and a correlation with right frontal regions associated with belief evaluation. This finding supports the intervention of two factors in CS, one generating the impaired familiarity associated with perception and the other the genesis and persistence of a delusional idea. The debate on the mechanisms of CS is not settled, especially as it is limited to its lesional forms, but studies using lesion network mapping already mark a more general paradigm shift, with attention shifting from lesions (clinico-anatomical method) to circuit dysfunction.

The Capgras delusion in the United Kingdom. From 1933 to the present: A clinical theoretical review

The first clinical case report of the Capgras Delusion in the British literature appeared in 1933, a decade after the seminal article by Capgras and Reboul-Lachaux. The author endeavoured to explain it psychodynamically on the basis of Freud's theory of infantile sexual development, arguing that it was due to a mental mechanism peculiar to women. Despite often ill founded and convoluted, psychodynamic formulations held sway for several decades until cases occurring in toxic-metabolic and structural brain disorders were described. However, by the 1990's it was recognised that the presence of brain dysfunction did not in itself explain the delusion. What was needed in addition was an appropriate cognitive theory of the mechanisms underlying the delusion. The advent of cognitive neuropsychiatry, pioneered by the late Hadyn Ellis, provided a framework for a more systematic and predictive approach to our understanding of delusional misidentification.

Capgras Syndrome with Non-Violent Behaviour Presenting in Postpartum Period: Case Study with Literature Review

Background: Capgras syndrome (CS) is one of the delusional misidentification syndromes (DMS) characterized by the belief by the patient that the close person, usually a close relative or family member is replaced by an imposter who looks physically the same. Since the first case of Capgras syndrome was described in 1923, the published literature is confined to a small number of case reports and a single case series. Capgras syndrome rarely occurs in postpartum period; there are few references in the literature to any of the delusions of misidentification occurring in a post partum period. Moreover, some authors described Capgras syndrome as frequently involving hostility, violence and risk of neglect towards an object of delusional misidentification. Their reports based on single cases report or small case series that may be subject to significant reporting bias. This case outlined here on a female patient affected by Capgras syndrome in post partum period with brief review of the literature. Case presentation: A 32-year-old woman presented to the psychiatric clinic for a delusional belief that newborn had been replaced by another one. Capgras delusion was developed after caesarean section on her 12th postpartum day. The patient was healthy individual whose Capgras syndrome was not linked to any psychiatric or neurological states in the past. Anxiety and depressive symptoms followed progressively without postpartum psychosis. Though she has a fixed belief, which is that her baby was replaced by another one, she did not show any psychotic features or aggression behaviour. Conclusion: In this case report, Capgras syndrome is typically a monothematic delusion (delusion about the baby may have an altered identity or replaced by another one) and is not accompanied by other delusions. Also, it displays the course of anxiety and depression in the period of postpartum period that accompanied with Capgras syndrome. The patient has no postpartum psychosis, only a delusion about the baby replaced by another one. Though her ambivalent emotions toward the baby, the patient did not show any hostility, aggression behaviour or violence and denied thoughts of harming baby.

Auditory Delusional Misidentification: A Case of Capgras Syndrome During the COVID-19 Pandemic

Auditory Delusional Misidentification: A Case of Capgras Syndrome During the COVID-19 Pandemic

Reviewing Delusional Misidentification Syndromes with Examples

Delusional misidentification syndrome is characterized by individuals perceiving familiar people, places, and objects as different entities, often associated with delusional disorders. These disorders are typically linked to abnormalities in cognitive processes, resulting in incongruent and unalterable beliefs. The loss of familiarity is believed to be the consequence leading to the emergence of these disorders. While commonly associated with psychiatric illnesses, they are also frequently observed in conjunction with neurodegenerative diseases. Diagnosis is primarily established through clinical evaluation. However, cases of these syndromes pose a significant burden on caregivers. Therefore, it is crucial not to overlook the possibility of dementia in these syndromes. This consideration is vital for providing appropriate support and treatment to patients and their families. This case report aimed to provide a detailed examination of this topic by presenting five cases.

Delusional misidentification syndrome in Parkinson’s dementia resolved with rivastigmine

In advanced Parkinson’s Disease (PD), and especially in PD related Dementia (PDD), psychotic symptoms are common. One of the manifestations of psychosis in PD is delusional misidentification syndrome, a phenomenon in which the patient believes the identity of a person, object or location has been duplicated or altered. Our patient, a 75-year-old female, was diagnosed with idiopathic Parkinson’s disease at the age of 68. Recently, her cognition deteriorated and she developed the believe that she lived in a replica of her real home. The delusion resolved completely with rivastigmine patches. Also visual hallucinations improved on treatment. This suggests that the dysfunctional connections were likely to be cholinergic.

Capgras Syndrome with Pregnant Woman: A Case Report and Literature Review

Background: Capgras syndrome is one of the delusional misidentification syndromes characterized by the delusional belief by the patient that the close person is replaced by an imposter who looks physically the same. Capgras syndrome was initially considered a purely psychotic disorder, but recently, Capgras syndrome understands as a neurological disorder, in which the delusion primarily results from organic brain lesions or degeneration. The case report aims to review previous literature on topic and present a case of pregnant woman experiencing Capgras delusion under full consciousness and whose expediencies are not linked to any psychiatric or neurological illness. Case presentation: A 29 year old, pregnant woman was brought for psychiatric consultation by her family with chief complaints of belief that her husband had been replaced by identical impostor, associated with irritability, anger and hostility since 4 months and aggravated in the last month. This pregnant woman showing absence of emotional response, no familiarity toward her husband and delusion that her husband replaced by imposter. Conclusion: Capgras syndrome is not necessarily pathological and can occur in a healthy population. Capgras syndrome may happen spontaneously under full consciousness in the healthy subjects; like in neurological and psychiatric patients. In this case report the phenomenological aspects of Capgras syndrome may similar in the content of the delusion to other studies were carried out with psychiatric or neurological patients, but no evidence of depersonalization, physical violence or aggression.

Reverse Intermetamorphosis Coexisting in a Case of Capgras Syndrome with Delusion of Subjective Doubles

‘Delusional misidentification syndrome’ is a fascinating phenomenon in which an individual misidentifies person, place, object or even themselves and falsely believes that they have been replaced or some sort of transformation has occurred. Capgras delusion, Fregoli delusion, Intermetamorphosis, Delusion of subjective doubles, all these phenomena broadly come under the psychiatric disorder of delusional misidentification syndromes. This case was established by its clinical characteristics along with associated clinical findings, the patient’s response to treatment in concurrence with psychological and neuro-cognitive theories. The present case report suggests that these symptomatology of misperception, miscomprehension and misinterpretation of others and of self are probably more prevalent than thought previously and should be actively sought and recognised in patients. This article sought to showcase a phenomenon which had a rare component of Reverse Intermetamorphosis along with Capgras Syndrome and Delusion of Subjective Doubles having no organic component in a 22 year old male patient who responded to pharmacotherapy with neuroleptics. The psychopathological symptoms demonstrating Capgras in itself is rare and inadequately researched. Presence of three distinctive patterns of symptomatology together in one subject is intriguingly unique.

Unlocking the Enigma of Cotard’s Syndrome: A Narrative Review of its Clinical Manifestations and Therapeutic Strategies

This narrative review explores Cotard’s Syndrome (CS), a rare psychiatric condition characterised by delusions of death or nonexistence, originally described by Jules Cotard in 1880. The syndrome presents a complex clinical picture, encompassing grandiosity, damnation, and physical breakdown. Despite its historical origins, CS remains poorly understood and often misdiagnosed. This review elucidates the clinical complexity, diagnostic challenges, and therapeutic strategies associated with CS. It highlights the neurological aspects, such as delusional misidentification and negation, shedding light on underlying mechanisms. Treatment approaches, including pharmacotherapy, Electroconvulsive Therapy (ECT), and psychotherapy, are discussed, emphasising the importance of ongoing mental health support across the illness’s stages. The review draws from a comprehensive search methodology, encompassing diverse scholarly sources, to provide a nuanced understanding of CS. By increasing awareness among clinicians and researchers, this review aimed to improve diagnosis and treatment outcomes for individuals affected by this enigmatic syndrome.

A Case Study on Cardiovascular Embolism and Its Impact on Facial Recognition

This case study presents an 84-year-old man patient with cardio-genic cerebral embolism in the right middle artery territory, who showed difficulty in recognizing faces and often mistook unfamiliar people for someone he knew. He was fully conscious, with normal visual acuity, and no hemianopia, neglect, and deafness. Results from a neuropsychological examination indicated visual agnosia for prosopagnosia. An MRI showed hyperintense signals from the frontal to temporal lobes on the right side. Initially suspected to be delusional misidentification syndrome, the patient’s case differed from Fregoli syndrome as he identified unfamiliar people as persons close to him. This case highlights the importance of careful diagnosis and assessment in patients with visual agnosia for prosopagnosia, which can have significant impact on daily life and functioning.

Delusional Misidentification Syndrome Associated with Frontal Lobe Injury : Focusing on Pregnancy Delusion

Delusional Misidentification Syndrome Associated with Frontal Lobe Injury : Focusing on Pregnancy Delusion

Delusional Misidentifications Formed from the Memories of the Deceased Loved One : Concerning a Case of Nurturing Syndrome Converting to Fregoli Delusion

Delusional Misidentifications Formed from the Memories of the Deceased Loved One : Concerning a Case of Nurturing Syndrome Converting to Fregoli Delusion

Capgras syndrome

One hundred years ago, Joseph Capgras published the first description of the disorder of delusional misidentification that now bears his name. Alan Carson marks the centenary of that publication by reflecting on Capgras and his eponymous syndrome.

Coexistence of different delusional misidentification syndromes in clinical practice: A case series

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.

Feigning Capgras Syndrome and Developmental Prosopagnosia: A Rare Case of Pediatric Factitious Disorder

Background: Factitious Disorder is a condition included among psychiatric disorders, where symptoms are intentionally produced to seek medical attention. Its epidemiology, treatment, and outcome are largely unknown. Objective: To increase knowledge of the condition, we discuss a pediatric case where the patient feigned neuropsychiatric symptoms. Methods: A 15-year-old female adolescent presented with neuropsychiatric symptoms suggestive of rare conditions such as Delusional Misidentification Syndrome (i.e., Capgras and Fregoli syndromes) and Developmental Prosopagnosia as well as epileptic seizures. Results: When Delusional Misidentification Syndrome was suspected, she was treated with Risperidone. Due to suboptimal response, Alprazolam and Sertraline were added and then Risperidone was cross-titrated to Haloperidol. The condition severity led to her admission to an inpatient Child and Adolescent Neuropsychiatry Unit. MRI scan and electroencephalographic recording were normal. The self- and parent-reported psychological assessment indicated several psychiatric symptoms. Instead, the clinician-administered Minnesota Multiphasic Personality Inventory-Adolescent and Structured Inventory of Malingered Symptomatology suggested a fake-bad profile and neuropsychiatric symptom simulation. Along with evidence of incongruent symptoms between the patient’s interviews, such investigations led to the diagnosis of Factitious Disorder. Psychopharmacological treatment was discontinued, and psychological support was offered to the patient and her parents. Conclusion: Increasing knowledge about Factitious Disorder is needed.

Obstructive Sleep Apnea, Psychotic Symptoms Common in Alzheimer’s Disease Patients

Obstructive Sleep Apnea, Psychotic Symptoms Common in Alzheimer’s Disease Patients

LIVING IN A DOLL HOUSE: A CASE REPORT AND LITERATURE REVIEW OF REDUPLICATIVE PARAMNESIA

Introduction Reduplicative paramnesia (RP) is a very rare content-specific delusional misidentification syndrome (DMS). RP entails the delusion that a place, an object, or an event has been duplicated or exists in two different places at the same time. RP is thought to result from an organic rather than psychiatric cause distinguishing it from other DMS. It has been suggested that damage to the right frontal and temporal lobe plays a crucial role, although other areas involved in visuospatial processing have also been reported.ObjectivesThe aim of this study is to review the literature and report a clinical case of RP.MethodsWe describe a case of an 81 year old woman admitted in a Neurology ward, with a 2 week clinical presentation of temporo-spatial disorientation, behavioural changes, persecutory delusions and reduplicative paramnesia phenomena concerning her house. She had previous history of a stroke 3 years prior to admission and, about one year before, the patient also started to present cognitive decline in the context of Parkinson’s dementia. One month before admission, treatment with Rotigotine was started and later suspended when the aforementioned clinical manifestations started. Upon admission it was diagnosed an urinary tract infection and treatment with antibiotics was started. Two days afterwards, the patient recovered orientation and her usual behaviour, but persecutory delusions and RP persisted. She then started treatment with low dose Olanzapine. Following 2 weeks of treatment the psychotic symptoms fully remitted, including RP.ResultsWe underline CT-scan and EEG relevant findings upon admission. In the CT-scan sequelar lesions in left frontoparietal junction, right posterior frontal cortex, left inferior occipital cortex, bilateral cerebellar hemispheres, left caudate nucleae and thalamus were identified. The EEG showed a preserved posterior alpha rhythm associated with slow discontinuous right temporal and mainly left parieto-temporo-occipital activity, indicating dysfunction in these locations.ConclusionsIn line with literature our patient had lesions in the right frontal and temporal lobe. She also presented lesions in other areas involved with visuospatial processing. Particularly the involvement of the left hemisphere reported in our case seems to be an exception. Other factors potentially played a role triggering this episode, namely the cognitive compromise due to dementia interposed with infectious disease, and the rotigotine treatment as well. Another aspect worth mentioning in our case was the remission of symptoms with the use of Olanzapine, even though only a few cases in literature have fully remitted with treatment with antipsychotics.Disclosure of InterestNone Declared

Symptomatological Transversality and the Absence of Pathognomonic Symptoms in Psychiatry

IntroductionThe diagnosis of the main psychiatric syndromes is still almost exclusively phenotypic and depends essentially of the recognition of characteristic signs and symptoms. The clinical evalution allows the formulation of a set of differential diagnoses, according to the pathological meaning of certain symptomatic patterns and combinations. Aside from the entire dependence on the clinical interview, there are still no complementary psychiatric diagnostic exams and it is also worth noting the absence of pathognomonic symptoms.ObjectivesThrough the presentation of the case of a patient with Bipolar Affective Disorder who manifests, during a manic episode, a Capgras delusion, we intend to approach the heterogeneity of the manifestation of some symptoms that tend to be specific of concrete psychiatric syndromes.MethodsClinical case presentation and non-systematic literature review using Pubmed plataform.ResultsAB, female, 49 years old, diagnosed with Bipolar Affective Disorder. Hospitalized for a manic episode with dysphoric mood, increased energy levels and delusional activity of grandiose and persecutory content. During hospitalization, a Capgras delusion centered on the husband emerged: he was replaced by a stranger, I was able to detect him by smell.Capgras delusion is a delusional misidentification syndrome characterized by the belief that someone close has been replaced by an imposter. Despite being a rare syndrome, vastly more common in schizophrenia, affecting about 73% of cases, it can also occur in other psychiatric conditions such as dementia syndromes and, less often, mood disorders (16.7%).Additionally, there are several examples that demonstrate the versatility of psychiatric symptom occurrence in different diagnoses, with first-rank symptoms serving as an example. Described in 1959 by Kurt Schneider, they were considered specific symptoms of schizophrenia, assuming this diagnosis based on the recognition of only one symptom. Over time, its pathognomonic character has become extinct, and its detection in mood disorders and acute psychotic disorder is relatively common.Another example is the overlap between depressive and anxious symptoms. In fact, anxiety symptoms occur in about 85% of patients diagnosed with depressive disorder and, in turn, the presence of depressive symptoms in about 90% of patients diagnosed with anxiety disorder. This evidence has allowed, over time, a review of the diagnostic criteria for these disorders, leading to a progressive blurring of the threshold between them.ConclusionsPsychiatric diagnosis is still a delicate task, totally dependent on the clinical interview. The lack of analytical and imaging tests, as well as the absence of pathognomonic symptoms, constitute a particular challenge in diagnosis. For this reason, we highlight the importance of recognizing combinations and patterns of symptoms rather than the specificity of just one symptom.Disclosure of InterestNone Declared

DILEMAS ENFRENTADOS PELOS MÉDICOS PERITOS DIANTE DA PSICOSE PUERPERAL RELACIONADA AO INFANTICÍDIO

Introduction: Puerperal psychosis is defined as a type of brief psychotic disorder occurring within three weeks after delivery, but predominantly within the first 48-72 hours, although rare (0.1 to 0.2%), it is a medical emergency and should be be treated as soon as possible. The presence of prodromal symptoms (irritability, sudden change in behavior, among others) that rapidly progress to a psychotic condition (delusions and hallucinations). In this context, infanticide is the apex for forensic interpretation. In 2021, The Lancet publishes an article questioning whether puerperal psychosis is a new disease. Neither the ICD nor the DSM bring this diagnosis as a distinct disease . Objective: To expose the main conflicts faced by medical experts in the face of the alleged crime of infanticide from the perspective of the Penal Code Conceptual framework: Establishing the nexus between puerperal psychosis and infanticide is a very difficult task and often depends on documents from the attending physician. Material and methods: Study carried out at the Department of Legal Medicine, Bioethics, Occupational Medicine and Physical and Rehabilitation Medicine of the Faculty of Medicine of the University of São Paulo. A narrative review of the literature was carried out, focusing on signs and symptoms suggestive or conclusive of puerperal psychosis in the face of the crime of infanticide. Articles in the Lilacs and PubMed databases were accessed, applying the descriptors “psychotic disorder”, “postpartum psychosis”, “expertise”; Textbooks were also included. No time limit was established for the search, but articles obtained in full were included. Results: Article 123 of the Penal Code, from 1940, determines that the crime of infanticide is “killing, under the influence of the puerperal state, one’s own child, during childbirth or shortly after: Penalty – detention, from two to six years. ”, at this point it is visible the difficulty to assertively define what it is right after, as well as to establish the mental criteria that made this crime an action in which the woman was not aware of the fact performed. Science still struggles to establish nosology and the temporal relationship between the onset of mental changes and childbirth and which biological changes are involved, these are the words of one of the greatest researchers on the subject, Patrick McGorry. The search for a genetic relationship between bipolar disorder and puerperal psychosis has been suggested. But, another issue to be discussed, not all puerperal psychoses are linked to infanticide. Another dilemma faced is the lack of habit in applying the terms infanticide and neonaticide with their individual designations. The first would be the death of a child in the first year of life by its mother and the second would be the death within the first 24 hours of life. The central question for the medical expert is to establish whether the neonaticide stems from a social issue in which the child is unwanted or whether it stems from a dissociative, depersonalization or hallucinatory disorder in which the mother does not have the capacity for understanding and self-determination. The medical literature rarely attributes neonaticide to mental illness. It is up to the medical expert to establish with technical rigor that at the time of the criminal act the woman was under a condition of illness that completely abolished her capacity. In this way, the medical expert must carry out the examination by complying with the technical rite and request medical documentation on the clinical and mental conditions of the expert at the time of the puerperium. The search for risk factors can help the doctor, but it is necessary to know that the profile of women varies according to the typology of the fact, that is, neonaticide and infanticide. Differential diagnoses between delusional misidentification syndrome which may be accompanied by hostility towards delusional erratic identification, Capgras syndrome in which the woman may believe that her child has been switched and that the child in front of her is an imposter. Due to the transience of psychotic symptoms, the psychiatric expertise that determines the imputability of the infanticidal mother is often performed in the absence of any clinical manifestation of psychosis. Conclusion: The psychiatric expertise of the woman who claims puerperal psychosis is challenging due to the elusiveness of the symptomatic picture and the late realization. It is based on an analysis of medical documentation – from the moment of childbirth and the puerperium – symptoms described by close family members, the epidemiology of the condition and its association with mood disorders.