Delusional Misidentification Insights
This platform serves healthcare professionals and medical students, providing comprehensive information on delusional misidentification syndromes, including symptoms, case studies, and treatment options.
Delusional Misidentification Insights
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Case Study 1: Fregoli Syndrome in a Young Man with Schizophrenia
Background:
Mr. A, a 21-year-old man, was referred to psychiatric outpatient services with a first episode of schizophrenia. He developed a delusional belief related to his use of social media, specifically Facebook.Clinical Features:
- Mr. A began to believe that a facial cream he used made him very attractive to female students.
- After interacting with a particular young woman online, she ceased contact. Subsequently, he became convinced that other women contacting him were actually the same woman, now disguising herself.
- He believed this woman could physically change her appearance by using the same facial cream he did, essentially “transforming” into others.
- These beliefs persisted even after full neurological assessments (including MRI), which found no abnormalities.
Diagnosis & Management:
- Mr. A was diagnosed with schizophrenia and Fregoli syndrome—a delusional misidentification disorder.
- The presentation of Fregoli syndrome appeared in the context of psychosis, heavily influenced by his online interactions, and with no evidence of organic brain dysfunction.
Case Study 2: Fregoli Syndrome in a Middle-Aged Woman with Cerebrovascular Damage and Prosopagnosia
Background:
A 68-year-old woman with a 40-year history of schizophrenia suffered a cerebrovascular accident resulting in right medial temporal and occipital lobe damage.Clinical Features:
- She began misidentifying a specific male patient in her hospital as her deceased husband. There was no physical resemblance between the patient and her late husband.
- She was absolutely convinced the other patient was her husband in disguise, maintaining this belief despite contrary evidence.
- Neuropsychological tests revealed she had prosopagnosia (impaired facial recognition) and unilateral neglect.
Progression:
- Her Fregoli syndrome symptoms coincided with these cognitive deficits, notably the inability to recognize familiar faces.
- Remarkably, her Fregoli symptoms resolved within three months as her neuropsychological symptoms improved, highlighting the potential neurological underpinnings of the disorder.
Assessment:
- Neurological imaging demonstrated damage in areas commonly associated with facial processing, reinforcing the connection between organic brain injury, prosopagnosia, and the emergence of Fregoli syndrome.
These two cases illustrate the varied presentation and underlying causes of Fregoli syndrome: one emerging in the context of psychotic illness without identifiable organic brain disease, and the other associated with clear neuroanatomical deficits following a stroke. Both demonstrate profound impacts on patient behavior and interpersonal relationships.
Case Study 2: Fregoli Syndrome in a Middle-Aged Woman with Cerebrovascular Damage and Prosopagnosia
Background:
A 68-year-old woman with a 40-year history of schizophrenia suffered a cerebrovascular accident resulting in right medial temporal and occipital lobe damage.Clinical Features:
- She began misidentifying a specific male patient in her hospital as her deceased husband. There was no physical resemblance between the patient and her late husband.
- She was absolutely convinced the other patient was her husband in disguise, maintaining this belief despite contrary evidence.
- Neuropsychological tests revealed she had prosopagnosia (impaired facial recognition) and unilateral neglect.
Progression:
- Her Fregoli syndrome symptoms coincided with these cognitive deficits, notably the inability to recognize familiar faces.
- Remarkably, her Fregoli symptoms resolved within three months as her neuropsychological symptoms improved, highlighting the potential neurological underpinnings of the disorder.
Assessment:
- Neurological imaging demonstrated damage in areas commonly associated with facial processing, reinforcing the connection between organic brain injury, prosopagnosia, and the emergence of Fregoli syndrome.
These two cases illustrate the varied presentation and underlying causes of Fregoli syndrome: one emerging in the context of psychotic illness without identifiable organic brain disease, and the other associated with clear neuroanatomical deficits following a stroke. Both demonstrate profound impacts on patient behavior and interpersonal relationships.
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Case Study 1: Fregoli Syndrome in a Young Man with Schizophrenia
Background:
Mr. A, a 21-year-old man, was referred to psychiatric outpatient services with a first episode of schizophrenia. He developed a delusional belief related to his use of social media, specifically Facebook.Clinical Features:
- Mr. A began to believe that a facial cream he used made him very attractive to female students.
- After interacting with a particular young woman online, she ceased contact. Subsequently, he became convinced that other women contacting him were actually the same woman, now disguising herself.
- He believed this woman could physically change her appearance by using the same facial cream he did, essentially “transforming” into others.
- These beliefs persisted even after full neurological assessments (including MRI), which found no abnormalities.
Diagnosis & Management:
- Mr. A was diagnosed with schizophrenia and Fregoli syndrome—a delusional misidentification disorder.
- The presentation of Fregoli syndrome appeared in the context of psychosis, heavily influenced by his online interactions, and with no evidence of organic brain dysfunction.
Case Study 2: Fregoli Syndrome in a Middle-Aged Woman with Cerebrovascular Damage and Prosopagnosia
Background:
A 68-year-old woman with a 40-year history of schizophrenia suffered a cerebrovascular accident resulting in right medial temporal and occipital lobe damage.Clinical Features:
- She began misidentifying a specific male patient in her hospital as her deceased husband. There was no physical resemblance between the patient and her late husband.
- She was absolutely convinced the other patient was her husband in disguise, maintaining this belief despite contrary evidence.
- Neuropsychological tests revealed she had prosopagnosia (impaired facial recognition) and unilateral neglect.
Progression:
- Her Fregoli syndrome symptoms coincided with these cognitive deficits, notably the inability to recognize familiar faces.
- Remarkably, her Fregoli symptoms resolved within three months as her neuropsychological symptoms improved, highlighting the potential neurological underpinnings of the disorder.
Assessment:
- Neurological imaging demonstrated damage in areas commonly associated with facial processing, reinforcing the connection between organic brain injury, prosopagnosia, and the emergence of Fregoli syndrome.
These two cases illustrate the varied presentation and underlying causes of Fregoli syndrome: one emerging in the context of psychotic illness without identifiable organic brain disease, and the other associated with clear neuroanatomical deficits following a stroke. Both demonstrate profound impacts on patient behavior and interpersonal relationships.
Case Study 2: Fregoli Syndrome in a Middle-Aged Woman with Cerebrovascular Damage and Prosopagnosia
Background:
A 68-year-old woman with a 40-year history of schizophrenia suffered a cerebrovascular accident resulting in right medial temporal and occipital lobe damage.Clinical Features:
- She began misidentifying a specific male patient in her hospital as her deceased husband. There was no physical resemblance between the patient and her late husband.
- She was absolutely convinced the other patient was her husband in disguise, maintaining this belief despite contrary evidence.
- Neuropsychological tests revealed she had prosopagnosia (impaired facial recognition) and unilateral neglect.
Progression:
- Her Fregoli syndrome symptoms coincided with these cognitive deficits, notably the inability to recognize familiar faces.
- Remarkably, her Fregoli symptoms resolved within three months as her neuropsychological symptoms improved, highlighting the potential neurological underpinnings of the disorder.
Assessment:
- Neurological imaging demonstrated damage in areas commonly associated with facial processing, reinforcing the connection between organic brain injury, prosopagnosia, and the emergence of Fregoli syndrome.
These two cases illustrate the varied presentation and underlying causes of Fregoli syndrome: one emerging in the context of psychotic illness without identifiable organic brain disease, and the other associated with clear neuroanatomical deficits following a stroke. Both demonstrate profound impacts on patient behavior and interpersonal relationships.
