Reduplicative paramnesia for places: A comprehensive review of the literature and a new case report

Clinical Reasoning: An 81-Year-Old Woman Who Insisted the Hospital Was Her Home

“…RPP is rare making it difficult to classify and study in detail. Borghesani et al (2019) propose a classification system distinguishing whether duplication and/or displacement is present, including reduplication with displacement, reduplication without displacement, and displacement without reduplication. RPP itself is a problematic term as reduplication is not always present nor is memory impairment the only neuropsychological feature present in the disorder.…”

“…2 The delusion is most often difficult to correct with behavioral modification. 2 Confronting a patient with RPP about the delusion has been successful in one reported case using an unequivocal landmark for place orientation. 9 Treatment has been attempted with antipsychotic medications, however with mixed results.…”

“…4,5 Prior theories about the underpinnings of RPP have included purely spatial disorientation, disconnection/disorientation of memories, disconnection of limbic (e.g., self-monitoring and error detection) from frontal regions (e.g., familiarity), and the combination of memory, visuospatial, and executive dysfunction. 2 Borghesani et al (2019) propose that a two-factor theory is the most comprehensive, such that a perceptual/affective deficit (the cause variable) and impaired belief evaluation (often from right lateral prefrontal involvement) are both required for the development of RPP.…”

Clinical presentation and neural correlates of stroke‐associated spatial delusions

“…She could not be convinced otherwise and insistently tried to find explanations to justify her belief [2]. Since Pick's description, reduplicative paramnesias (also called spatial delusions or delusional misidentifications of space) were defined as a firm conviction of being in a different place from the real one, which does not change when the patient is confronted with clear counterfactual evidence [3,4]. Different forms of spatial delusions have been described [5], representing different poles of pathological familiarity [6].…”

“…At the structural and functional levels, spatial delusions are associated with a dual pattern of structural disconnection involving right frontothalamic and right occipitotemporal circuits [ 8 ], which prompts structural–functional decoupling of belief, familiarity, and place‐associated functional networks [ 9 ]. At the clinical level, the striking incongruence between the patient's conviction and the surrounding environment may markedly disturb the patient's behavior [ 3 , 10 ]. Although traditionally seen as a rare syndrome, evidence suggests that spatial delusions can be a frequent manifestation of right hemisphere lesions [ 11 , 12 , 13 ], particularly in the acute phase of right hemisphere strokes [8 ].…”