Identifying misidentifications: a phenomenological study

Identification, recognition and misidentification syndromes: a psychoanalytical perspective

Misidentification syndromes are currently often understood as cognitive disorders of either the "sense of uniqueness" (Margariti and Kontaxakis, 2006) or the recognition of people (Ellis and Lewis, 2001). It is however, necessary to consider how a normal "sense of uniqueness" or normal person recognition are acquired by normal or neurotic subjects. It will be shown here that the normal conditions of cognition can be considered as one of the possible forms of a complex structure and not as just a setting for our sense and perception data. The consistency and the permanency of the body image in neurosis is what permits the recognition of other people and ourselves as unique beings. This consistency and permanency are related to object repression, as shown by neurological disorders of body image (somatoparaphrenia), which cause the object to come to the foreground in the patient's words (Thibierge and Morin, 2010). In misidentification syndromes, as in other psychotic syndromes, one can also observe damage to the specular image as well as an absence of object repression. This leads us to question whether, in the psychiatric disorders related to a damaged specular image, disorders of cognition can be studied and managed using the same methods as for neurotic patients.

Neuropsychological relationships in paranoid schizophrenia with and without delusional misidentification syndromes. A comparative study

Delusional misidentification syndromes (DMSs) and schizophrenia are strongly associated, since the former occur predominantly in the context of paranoid schizophrenia. However, the possible underlying neuropsychological relationships between DMSs and paranoid schizophrenia have not been thoroughly investigated. The aim of the present study was to investigate whether DMSs in paranoid schizophrenia are associated with a distinct neuropsychological substrate indicative of differential bilateral frontal and right hemisphere dysfunction. We compared two matched groups of paranoid schizophrenic patients with (N=22) and without (N=22) DMS(s) on a battery of neuropsychological tests assessing mainly frontal and right hemisphere functions. No statistically significant differences were detected between the two groups. Our findings are indicative of a bilateral frontal and right hemisphere dysfunction of equal severity in both DMS and non-DMS patients with paranoid schizophrenia.

Classification of psychotic symptoms in dementia with Lewy bodies

OBJECTIVE

The aim of this study is to determine empirically a possible classification of psychotic symptoms, and identify the frequency of such symptoms in dementia with Lewy bodies (DLB).

METHODS

This was a clinical study of prospectively observed patients from the memory clinic at Shiga Medical Center. The authors conducted a factor analysis of psychotic symptoms in 96 probable DLB and 4 possible DLB patients, clinically diagnosed according to the consensus criteria, were included.

RESULTS

Four factors were obtained. Factor 1 was closely akin to misidentifications, including Capgras syndrome, phantom boarder, and reduplication of people and places. Factor 2 consisted of reduplication of people, the belief that deceased relatives are still alive, and the belief that absent relatives are in the house, which was classified as a type of misidentification or paramnesia. Factor 3 was akin to visual hallucinations of nonhuman objects, and factor 4 mirrored the hallucination of people and feeling of presence. Delusions were independent of these factors. Following the results of factor analysis, the rates of each symptom group were identified. Hallucinations were the most frequent psychotic symptom in DLB (78%), followed by misidentifications (56%) and delusions (25%).

CONCLUSION

This study suggested that hallucinations, misidentifications, and delusions should be separately considered in understanding of underlying pathophysiology or psychopathology of DLB.

Delusional misidentification syndrome: why such nosologic challenge remains intractable

The delusional misidentification syndrome has lately been the object of lengthy psychopathological discussions. Controversies persist as to how best to define it, distinguish its subtypes and set their limits. Attempts to provide this syndrome with a better conceptual framework have usually relied on proposing new definitions and classifications. In this article, we suggest that some prevailing difficulties are basically related to two separate but intertwined issues: the self-reflexive property of the human mental functioning and the first-person linguistic expression of human experience. We argue that this discussion belongs to a broader context than the one it is usually referred to, as it deals with problems germane to conceptual psychopathological investigations in general. In that regard, DMS provides us with a very telling example, to the extent to which it has, at its core, to account for the puzzling phenomena of identity, which are particularly affected by cultural and linguistic variables.

Koro-misidentification syndrome in schizophrenia? A plea for clinical psychopathology

Although current diagnostic procedures favour the diagnosis of similar syndromes in different pathological processes, it cannot be overlooked that many psychiatric symptoms that share a similar 'surface grammar' differ in their 'deep grammar' or structure. In the case presented, we describe an acute psychosis where a Koro-misidentification syndrome might be diagnosed. In the discussion we point out how confusing this approach might be, as well as a feasible way to compensate for the shortcomings of contemporary descriptive psychopathology.

'Clonal pluralization of the self': a new form of delusional misidentification syndrome

The authors present a patient with paranoid schizophrenia, who has the delusion that he exists in plural numbers. The patient declares these doubles to be both psychologically and physically completely identical to him, and he believes 'them' to be in fact women. In connection with the case, the authors discuss the phenomena of reduplicative paramnesia and clonal pluralization, and they suggest introducing the psychopathological term 'clonal pluralization of the self' for the reported phenomenon.