Performance during Face Processing Differentiates Schizophrenia Patients with Delusional Misidentifications

Abstract

Background: Delusional misidentification syndrome (DMS) is of considerable interest, but rarely diagnosed clinically. It is supposed to occur relatively frequently in schizophrenia, and to be related to the pathophysiology of face processing. Two antagonistic forms of DMS are the hypoidentification (Capgras) and hyperidentification (Fregoli) syndromes. We aimed to highlight differences between these subtypes using a face recognition memory task. Methods: Twenty schizophrenia patients (10 with DMS) and 21 healthy controls memorized the images of unknown neutral faces (targets). After a 10-min interval, accuracy and reaction times were recorded during a recognition task consisting of targets (newly learned faces), as well as familiar and unfamiliar face images. The 10 DMS patients could be further subdivided into 6 patients with Fregoli syndrome and 4 with Capgras syndrome. Results: Patients with DMS had longer reaction times than controls or patients without DMS (p < 0.001). Fregoli patients had longer reaction times (p < 0.001) and lower discrimination accuracy than Capgras patients (p = 0.019). These results were independent of other clinical variables. Conclusions: Face recognition differs between clinically identified subgroups of schizophrenia and between types of DMS. The results indicate independent pathophysiological mechanisms for Capgras (hypoidentification) and Fregoli (hyperidentification) syndromes in schizophrenia.

Delusional Misidentification Syndromes: Psychopathology and Culture

“…There is evidence to support the idea that an emotional processing module in the brain, especially as it related to feelings of familiarity and unfamiliarity, and its connection to facial recognition is flawed in Capgras sufferers (Pacherie, 2009). This flaw in emotional processing can be demonstrated via facial recognition tasks and eye movement patterns (Brighetti et al, 2007;Grignon & Trottier, 2005;Walther et al, 2010). Similar differences in audio perceptions related to working memory have also been reported for Capgras syndrome sufferers (Papageorgiou et al, 2002).…”

An unusual delusion of duplication in a patient affected by Dementia with Lewy bodies

“…In fact, several studies have addressed their attention to Capgras syndrome, but other misidentification syndromes have been scarcely studied. With regard to Capgras syndrome, proposed alterations include the presence of impairment in facial processing [10, 11], dysfunction of working memory [12], altered connectivity among associative areas and limbic/paralimbic structures [13], bilateral dysfunction of fronto-temporal connectivity [14, 15], and right hemispheric hypo function [16, 17]. …”

Capgras' Syndrome in First-Episode Psychotic Disorders

“…Other case series found large excesses of the phenomenon in patients diagnosed with schizophrenia, particularly of the paranoid type, even based on modern diagnostic criteria [33–36]. In addition, the Capgras phenomenon and other delusional misidentification syndromes have been surprisingly prevalent among patients with various neurological disorders [29,32,34,38,40,41,49,62,63]. Although lifetime neurological comorbidities were taken into account in the present analysis of factors associated with Capgras phenomenon, neurological patients were not included.…”

“…The phenomenon has also been associated with epilepsy [42–45]. Proposed neurobiological mechanisms that might contribute to Capgras phenomenon include right hemisphere hypofunction [46], altered connectivity of multimodal cortical association areas and paralimbic and limbic structures [47], deficits in facial processing [29,48], dysfunction of working memory [17], dopamine deficiency [49], and bilateral dysfunction of fronto-temporal connectivity [50,51]. However, further research is required.…”