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Table of Contents
CASE REPORT
Year : 2013  |  Volume : 1  |  Issue : 1  |  Page : 59-61

Delusional Misidentification Syndrome (DMS) - An unidentified entity of DSM


1 Resident, Department of Psychiatry, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
2 Professor & Head, Department of Psychiatry, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
3 AssociateProfessor, Department of Psychiatry, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India

Date of Web Publication13-Aug-2018

Correspondence Address:
Vidhi Patel
Resident, Department of Psychiatry, SBKS Medical Institute & Research Center, Sumandeep Vidyapeeth, Piparia, Vadodara-391760, Gujarat, India
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.238984

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  Abstract 


Delusional misidentification syndromes (DMS), which includes the Capgras, Fregoli, Inter metamorphosis and Syndrome of Subjective doubles gain curiosity due to the bizarreness in their symptomatology. However they are diagnosed as some form of Schizophrenia and related psychosis and treated accordingly. An issue that remains unresolved is whether DMS (either in its pure form or as embedded symptoms of other diagnoses) can be accommodated in the present Diagnostic and Statistical Manual of Mental Disorders, (DSM-IV TR). As we await the DSM – V, it is still not clear as where do we diagnose patients with monothematic bizarre delusions due to lack of proper guidelines in DSM IV TR. Here we present two cases with Capgras Delusions and express our concern regarding the short comings of current Diagnostic system

Keywords: Capgras, Delusion, DMS


How to cite this article:
Patel V, Shah S, Kataria L. Delusional Misidentification Syndrome (DMS) - An unidentified entity of DSM. J Integr Health Sci 2013;1:59-61

How to cite this URL:
Patel V, Shah S, Kataria L. Delusional Misidentification Syndrome (DMS) - An unidentified entity of DSM. J Integr Health Sci [serial online] 2013 [cited 2021 Dec 3];1:59-61. Available from: https://www.jihs.in/text.asp?2013/1/1/59/238984




  Introduction Top


Delusional Misidentification Syndromes fails to find a rightful place in the current Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Text revised (DSM IV TR). The signs and symptoms of DMS are often seen as a part of other disorders, most commonly in descending order of frequency of occurrence – Delusional Disorder, schizophrenia (paranoid type), affective disorders, [1] organic brain disorders (e.g., ischemic brain damage, Dementias),[2] traumatic head injury and even typhoid fever.

Capgras syndrome is a type of Delusional Misidentification Syndrome that comprises of a delusion that an impostor has replaced a close friend or relative. It is named after Joseph Capgras (1873–1950), a French psychiatrist who first described the disorder (1923).[3] He used the term l’illusion des sosies (the illusion of doubles) to describe the case of a woman who complained that various “doubles” had taken the place of people she knew.


  Case Report: Top


Case 1:

Mrs. M a female Hindu patient 30 years in age complained that the man who had accompanied her was not her husband but was some imposter who had assumed the form of her husband. The patient had started complaining of seeing spirits moving around her and constantly trying to harass her for past 2 years. She became suspicious and had ideas that people were talking bad things about her and keeping a watch on her actions with fear of being poisoned were present. Diagnosed elsewhere with Schizophrenia she was started on 2 mg of Risperidone about one and a half years ago. There was a partial remission in symptoms like suspiciousness and visual hallucinations. On one occasion patient called the Police and reported that an intruder had entered in her house with two children and was claiming to be her husband.

Case 2:

Mrs. P, a 36-year-old unmarried female Muslim patient complained that her father was not actually her father but some stranger who had assumed his form. She thought that he was an imposter and her actual father was killed. She started withdrawing from her dear ones like mother, sister and later friends, doubting that all of them were actually imposters and her dear ones were actually replaced by them and killed. Her hostility towards all her family members kept on increasing. Though she was regular in work and her tasks of daily routine, she failed to have any emotional attachment with all her dear ones.


  Discussion Top


The initial reports of Capgras syndrome involved patients with psychiatric illness. Thus, earlier studies put forward psychodynamic interpretations for the occurrence of the symptoms. It was suggested that Capgras Syndrome might develop out of oedipal issues in women as a defence against hostility or incestuous desires [4] or out of latent homosexuality in men[5]. The anxiety-induced regression model resulted in hypotheses of cognitive and emotional functioning, pathological splitting of internalized object representations, inadequately repressed conflicting or ambivalent feelings toward the implicated person and the projection of negative emotions arising from these conflicting feelings[6]. Capgras syndrome is considered a psychological solution to the love–hate conflict.[6] The patient “imagines” the existence of a double that becomes the “bad” object, while the original remains the “ideal.”

Reports of an association between Capgras Syndrome and medical and neurological conditions have led to the belief that cerebral dysfunction underlies the delusion’s development. The syndrome has been linked to dopaminergic over activity[7], serotonin abnormality and reduced platelet monoamine oxidase in some but not all studies.[8]

Neuroimaging evidence revealed a link between Capgras syndrome and right hemisphere abnormalities, particularly in the frontal and temporal regions.[9] Neuropsychological research has provided empirical support for these findings by consistently reporting the presence of impairments in facial processing, which is considered a right hemispheric function[10]. As indicated by studies using abnormal event-related potentials, DMS may be related to working memory dysfunction affecting prefrontal, parietal, and adjacent brain regions’ The recording of event-related potentials, specifically P 300 that explores working memory function have shown promising results in the investigation of DMS.[11] The connections from face-processing areas of temporal lobe to the limbic system may be faulty.[12] Capgras syndrome may help explore the formation of new memories caught in flagrante delicto, a Latin term that means “in the act of committing the error.[13]

It is often unclear if DMS is only a result of brain damage to specific areas of the brain, as some studies suggest, or a manifestation of an underlying psychiatric disorder. It is also unclear if DMS has its rightful place as separate disorders or whether it should be considered part of existing DSM-IV TR categories. There is often a mismatch between such patients’ symptoms and the diagnosing categories and criteria.

Both the above-mentioned patients were managed with olanzapine and neither showed much improvement in their symptom profile. Though both the patients had complaints for treatment plan provided to them, the encapsulated monothematic delusions persisted. Treatment options available today may not be effective and thus symptoms of DMS remains troublesome. The information available today calls for a closer and comprehensive study of patients exhibiting DMS phenomenon.



 
  References Top

1.
Ellis HD, Luaute JP, Retterstol N. Delusional misidentification syndromes. Psychopathology 1994;27:117-20  Back to cited text no. 1
    
2.
Munro A. Delusional disorder. Paranoia and related illnesses. Cambridge (UK): Cambridge University Press; 1999.  Back to cited text no. 2
    
3.
Vie’ J. Un trouble de l’identification des personnes: L’illusion des sosies. Ann Med Psychol (Paris) 1930; 88:214–37.  Back to cited text no. 3
    
4.
Capgras J, Carrette P. Illusions des sosies et complex d’oedipe. Ann Médico-psychol 1924;82:48-68  Back to cited text no. 4
    
5.
Murray JR. A case of Capgras syndrome in the male. J Ment Sci 1936; 82:63–6.  Back to cited text no. 5
    
6.
Debruille JB, Stip E. Capgras syndrome: Evolution of the hypothesis. Can J Psychiatry 1996;41(3):181–7  Back to cited text no. 6
    
7.
Alexander MP, Stuss DT, Benson DF. Capgras syndrome: a reduplicative phenomenon. Neurology 1979; 334 –9.  Back to cited text no. 7
    
8.
McAllister TW. Neuropsychiatric aspects of delusions. Psychiatr Ann 1992;22:269–77  Back to cited text no. 8
    
9.
Lewis SW. Brain imaging in a case of Capgras syndrome. Br J Psychiatry 1987; 150:117–21.  Back to cited text no. 9
    
10.
Hudson AJ, Grace GM, Misidentification syndromes related to face specific area in the fusiform gyrus. J Neurol Neurosurg Psychiatry 2000;69(5):645–8.  Back to cited text no. 10
    
11.
Papageorgiou C, Lykouras L, Ventouras E, et al. Psychophysiological differences in schizophrenics with and without delusional misidentification syndromes: A P300 study. Prog Neuropsychopharmacol Biol Psychiatry 2005; 29(4):593–601.  Back to cited text no. 11
    
12.
Lykouras L, Ventouras E, Christodoulou GN. Abnormal P 300 in a case of delusional misidentification with coinciding Capgras and Fregoli symptoms. Prog Neuropsychopharmacol Biol Psyciatry 2002; 26(4):805–10.  Back to cited text no. 12
    
13.
Enoch MD: The Capgras syndrome. Acta Psychiatr Scand 1963, 39:437–462.  Back to cited text no. 13
    




 

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