DELUSIONAL MISIDENTIFICATION SYNDROME- presentation-1.pptx

Delusional Misidentification syndrome is a group of delusional phenomena in which patients misidentify familiar persons, objects, or self, and believe that they have been replaced or transformed.

Delusion is defined as a psychiatric disorder of thought content characterized by a belief, usually false, that is held with utter conviction despite evidence to the contrary and it cannot be explained by the educational or socio-cultural background of the person who holds the belief.

1. DELUSIONAL MISIDENTIFICATION SYNDROME Olugbenga t. awe 600L mb;bs STUDENT Behavioral science posting (2022 ) University of Ilorin teaching hospital, Ilorin, Nigeria.

2. outline INTRODUCTION EPIDEMIOLOGY Etiology Variants Psychiatric Manifestations Management ASSOCIATED DISORDERS Clinical Scenario

3. INTRODUCTION Delusion is defined as a psychiatric disorder of thought content characterized by a belief, usually false, that is held with utter conviction despite evidence to the contrary and it cannot be explained by the educational or socio-cultural background of the person who holds the belief. Delusional Misidentification syndrome is a group of delusional phenomena in which patients misidentify familiar persons, objects, or self, and believe that they have been replaced or transformed.

4. epidemiology Rare

5. etiology Precise etiology not known. Neuroimaging has pointed to the presence of identifiable brain lesions especially in the right frontal and temporal region and adjacent regions. According to Joseph Capgras, some of the people that had it had a prior brain injury or head trauma.

6. etiology Psychoanalytical View Believe that it is as a result of Oedipus/Electra complex (Freudian explanation) They try to resolve the guilt of their sexual desire by identifying them as impostor Psycho dynamic theory Some researches think that it results from organic cause leading to breakdown of communication between the part of the brain that processes visual information and the limbic system, which controls emotional response.

7. Variants Capgras Syndrome Fregoli Syndrome Inter-metamorphosis Syndrome of Subjective double

8. Capgras syndrome It is a delusional disorder in which a patient believes that a person closely related to her has been replaced by a double. Patient believes that an impostor has replaced a close friend . Patient believes that the physical appearance of the impostor has not changed, but the internal personality has changed. It is commoner in women, and the misidentified person is usually his partner or another relative. It is named after Joseph Capgras, a French psychiatrist who first described the disorder in a paper he co-authored with Reboul- Lachaux in 1923. It is seen in Schizophrenia, Lewy body disease, etc.

9. Fregoli Syndrome It is a disorder in which a person holds a delusional belief that different people are a single person who changes his appearance in disguise, usually in order to persecute the patient in some way. Patient believes that it is the physical appearance that changes, but the internal/psychological personality did not change. It was named after an Italian actor, Leopoldo Fregoli, who was renowned for his ability to make quick changes in his appearance during his stage acts. It is seen in Scizophrenia , Organic brain disease, etc.

10. Inter-metamorphosis It is a delusion in which patient believes that one or more individuals have been transformed, physically and psychologically, into another person or people, or that they have exchanged identities with each other. Patient believes that they can see others change into someone else both in external appearance and in internal personality.

11. Syndrome of subjective double It is a delusion in which patient believes that they have a double or Doppelganger with the same appearance, but usually with different character traits, that is leading a life of its own. Doppelganger is a German word which literary means double-walker i.e. biologically unrelated look-alike.

12. Psychiatric manifestations Delusion Decrease Memory Hallucination Confusion Anxiety Irritability Fatigue Social withdrawal Ataxic gait Etc.

13. management Detailed History (hx . suggests the variant, hx. of seizure, point to the underlining pathology) Mental State Examination (poorly kempt, sad mood, disorder of thought content, depending on the psychopathology) Physical Examination ( bruises, scar of previous head trauma ) Investigation(FBC, E/U/Cr, ECG, FBS, brain CT Scan) Treatment

14. BIOLOGICAL THERAPY SSRI Antipsychotics (Haloperidol, Risperidone) BEHAVIOURAL PSYCHO-THERAPY Acknowledge their feelings Never argue or correct Focus on creating positive emotional experiences to address challenging behavior (impostor should not be allowed around) MULTIDISCIPLINARY Ps ychiatric Doctors Psychiatric Nurses Clinical Psychologists Radiologist MULTILAYERED Layer by layer INDIVIDUALIZED Treat the patient based on the underlining psychiatric condition. SOCIAL THERAPY Family therapy Couple therapy

15. Putting all together

16. POSSIBLE ASSOCIATED DISORDERS Scizophrenia (paranoid) Affective disorders Organic brain disorders ( ischaemic brain damage) Traumatic brain injury.

17. Clinical scenario Mrs C, a 58 year old woman brought to the psychiatry emergency room after she called the police and reported there was a stranger in her house. She had a prior history of psychiatric hospitalizations and was previously diagnosed with schizophrenia(paranoid type). When the police arrived, she explained that her husband was not her husband but was a stranger. She became argumentative and combative toward the police officers. Due to her history of past psychiatric incidents involving the police, she was brought to the psychiatric emergency room. At the time of incidence, she was known to have consumed half a pint of brandy, and some of her symptoms were thought to be alcohol-related. When evaluated in the emergency room, she reported her distress was due to the impostor that had recently been substituted for her husband and that the impostor made her life miserable…

18. references http:// www.slideshare.net/indhumadhav/capgras-syndrome-57917752?from_m_app=android Kirov G, Jones P, Lewis SW. Prevalence of delusional misidentification syndromes. Psychopathology. 1994;27(3-5):148-9. doi : 10.1159/000284862. PMID: 7846230 . Textbook of Understanding Psychiatry wikipedia

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