Dangerousness and Management of Delusional Misidentification Syndrome

Abstract

Many theories have been proposed to help understand delusional misidentification syndromes (DMS) and the danger associated with them. We report on three cases with histories of paranoid schizophrenia who developed DMS. Two of them acted out on delusional thinking toward their sons. Case 1 managed to kill her son and Case 2 was caught twice trying to choke him. Our case reports suggest that the degree of threat perceived by the patient from the delusionally misidentified object is the most important factor in determining the patient’s response to the delusions. Alcohol and substance intoxication facilitated the patients’ acting out on their delusions, but did not explain the genesis of the delusions. There is a need to continue to study patients with DMS in order to provide opportunity for greater understanding of the psychopathology of DMS.

Mental illness, violence and delusional misidentifications: The role of Capgras' syndrome in matricide

“…23 Moreover, they highlight the fact that CS delusions often exist for some time before the act and that the ensuing violence is usually well planned. 12 Other factors that may be important in evaluating the potential for violent behavior in patients with CS are the degree of threat perceived by the patient from the erroneously identified person 41 and the coexistence of alcohol or substances abuse. 42 Despite this evidence, however, relatively little forensic attention has been paid to the role of Capgras' delusion in the progression to severely violent acts.…”

Treatment-resistant, five-year long, postpartum-onset Capgras episode resolving after electroconvulsive therapy

“…14 Since it is a socially dangerous condition, [29][30][31] it should be treated timely. They may respond to older 12 or newer antipsychotic drugs.…”

“…Capgras syndrome, which is specular to prosopagnosia, since it involves a damage to the covert emotional face recognition system but leaves the overt system intact, 26 has often its onset in relation to stressful events 27 and brain insults 28 and usually runs a recurrent or a single episode course but may last as long as 19 years. 14 Since it is a socially dangerous condition, 29–31 it should be treated timely. They may respond to older 12 or newer antipsychotic drugs.…”

Serial killing in schizophrenia

“…Within the framework of these studies, the authors put the question: Are the subjects suffering from Fregoli syndrome within the framework of any confused psychiatric pathology more violent than the subjects not affected by these delusions? 3 It has been shown that, apart from delusional misidentification, there are other risk factors for an aggressive act, namely: a history of physical violence, 14 anger, targets of violence being close relatives, and attachment figures being significantly higher, 15 the masculine gender (in 70% of cases), 13 delusional themes of erotomania 16,17 or jealousy, 18 substance abuse, 19,20 as well as impulsivity and dissociation. 11 Statistically, schizophrenia is the first etiology in which occurs Fregoli syndrome, 21,22 and which is the case of our patient.…”