DMS (Delusional Misidentification Syndromes)

DMS (Delusional Misidentification Syndromes)

Presented by Fay Borrego

References

Klein, C.A., Hirachan, S. (2014). The Masks of Identities: Who’s Who? Delusional Misidentifaction Syndromes. Analysis and Commentary,Vol 42 (3). Retrieved from:

http://www.jaapl.org/content/42/3/369.full.pdf

Patel, V., Shah, S., Kataria, L. (2013). Delusional Misidentification Syndrome (DMS) – An unidentified entity of DSM. The Journal of Integrated Health Sciences, Vol 1 (1). Retrived from: http://jihs.in/assets/articles/0e68dfeae5ca0e6e6e48b334c9dd3b82.pdf

Atta, K., Forlenza, N., Gujski, M. (2006). Delusional Misidentification Syndromes. Psychiatry, Vol 3 (9). Retrived from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2963468/

Picture URLS

https://www.google.com/search?q=capgras+syndrome&biw=1366&bih=622&source=lnms&tbm=isch&sa=X&sqi=2&ved=0ahUKEwiC3tqC8r3LAhXIgYMKHd6bCDcQ_AUICCgD#imgrc=JFAvv__0dkCDWM%3A

http://ichef.bbci.co.uk/news/660/cpsprodpb/4CE3/production/_86138691_brainscans.png

http://www.cell.com/cms/attachment/2009272785/2032279071/gr2.jpg

http://images.addictionblog.org/cherrycake/wp-content/uploads/2012/05/Can-you-overdose-OD-on-hydrocodone2.jpg

Suggested Etiology

Treatments

There is still debate about the cause of DMSs and whether DMS is a symptom of other brain disorders or a disorder in itself

• DMS may be linked to working memory disfunction

• Some studies ( but not all) have linked Capgras to dopaminergic over activity

• Impairment of Facial recognition is a key factor in some studies

Associations and Prevalence of Syndromes

There are no treatments specifically for DMS. The standard procedure is to treat the coexisting problem. Antipsychotics are often given, with greatly varying degrees of success.

DMS (Delusional Misidentification Syndromes)

Suggested types of Delusional Misidentification Syndromes

• A disconnection between the frontal lobes and the hippocampus can be observed in some patients

This connection is important for integrating facial recognition information, self-identification and emotional information

• Brain malfunctions create inablility to integrate memories with current experiences

• Underactivity in the perirhinal cortex is implied for loss of familiarity in Capgras syndrome

• Overactivity in the perirhinal cortex is implied for hyperfamiliarity seen in the Fregoli

DMSs are comorbid with many other illnesses including:

• Hypothyroidism

• Right hemispheric stroke

• Multiple sclerosis

• Dementia

• Alzheimer’s disease

• PTSD

• Paranoid schizophrenia

• Lewy Body Disease

Prevalence

• Delusional Misidentification Syndromes are rare and usually present alongside other mental illness or brain injury.

• The main theme of DMSs is that a person (or sometimes objects or places) look exactly like another person (or object or place). It has a “double.”

• DMS’s can be either acute or chronic

• There is debate about whether DMSs qualify as their own disorder, or as a symptom of other disorders

• There is overlap with DMSs and some turn into each other

Case Study

• Capgras Syndrome

• Fregoli Syndrome

• Intermetamorphosis,

• Subjective doubles

• Reduplicative paramnesia

• Mirrored self

• Delusional companions

• Clonal pluralization of the self

• Often DMSs are diagnosed with paranoid Schizophrenia

• The estimated prevalence of DMSs depend on the study that you look at

• Prevalence of inpatient psychiatric patients range from 1.3 to 4.3 percent (This puts the general population estimate at about 0.12 percent )

• Patient "Cyndi" was born at just above five pounds to a smoking mother ( possible pre-disposition to mental illness?)
• She was living in a large city ( Mexico City) just before her first diagnosis ( It is unclear if she was having delusions before the move or after)
• Cyndi was initial diagnosed as SchizoEffective and later on with Capgras Syndrom

Capgras Syndrome

Fregoli Syndrome

• Most common of the DMSs.

• People with Capgras Syndrome (also known as Capgras Delusion) believe a close family member (or several people) has been replaced with an exact duplicate(s). The person looks like the patient’s spouse/cousin/sibling but he or she is a different person.

• The patients may also have difficulty with time perception

• First decribed by Joseph Capgras and Jean Reboul-Lachaux in 1923

Interview

• People with Fregoli Syndrome believe that a familiar person (or several people) repeatedly change their appearance so that they look like someone else. Often these people are after the patient.

• Named after Leopoldo Fregoli, an entertainer from the late 19th century, who could so quickly change costumes, people believed there had to be more than one of him.

*the video ended up upside down so the play button is on the top right*.

Cyndi's Mental Illness

• Cyndi's delusions started out typical of Capgras but later spread to the other "types" of DMSs
• Despite the wide range of typical, atypical and antidepressendants she has been prescibed her Capgras delusions remained. ( Her paranoia reponded to the antipychotics)
• Cyndi has had a history of poor compliance to her medications and is periodically hospitalized

After Notes on Cyndi

• Cyndi has recently been moved to a assisted living facility and put on new medication ( Clazril and Adril), which has greatly improved her compliance
• Some days she denies she that she has psychosis, and insists the doubles do in fact exist
• She has not had contact with her exhusband in well over 15 years and only has contact with two of her three children