Fregoli syndrome associated with violent behavior

Abstract

dear editor,Fregoli syndrome is one of the misidentification delusional syndromes which occur in the setting of schizophrenic, affective or organic disorders 1 . In Fregoli syndrome the patient believes that one or more familiar persons, considered as persecutors, repeatedly change their appearance, becoming a double or a look-alike 2 . Diagnosing this phenotypic syndrome may be important for personalizing treatment and research.The aim of this letter was to describe a case of Fregoli syndrome and violent behavior in woman presenting paranoid schizophrenia. A 30 year old unemployed single woman was admitted to the Psychiatric Emergency Department by official request because she presented with incoherent speech during a police investigation. The patient reported that during psychiatric anamnesis she was convinced that one of her boy friends often changed his appearance into other people (a look-alike) in order to follow her. According to her, she was investigated because she had broken her General Practitioner's Office Windows 3 months before and because she had the conviction that he was a look-alike. After that episode she then took a plane to go abroad on vacation in order to escape from him. In her medical history a previous diagnosis of paranoid schizophrenia was found 2 years earlier and the patient reported interruption of psychiatric medication 6 months prior to consultation. During the physical examination she appeared anxious and presented a normal speech pattern with delusional persecutory content. Hallucinatory perceptions referred to the existence of look-alikes. She also presented marked affective flattening and avolition. Facial recognition tests 3 and CT brain scan did not show any abnormalities. Her delusional symptoms resumed with antipsychotic medication (aripiprazol®) after 10 days of treatment.To our knowledge reports of Fregoli syndrome are rare and little is known about the physiopathology and treatment of this misidentification delusional syndrome 2 . They occur in the setting of psychiatric disorders and neurologic diseases, such as dementia, partial epilepsy and cerebral vascular accidents 1,4 . The right cerebral lobe is involved in most cases. At a cognitive level, dysfunctions of identity attribution have been reported rather than dysfunction of facial recognition 5 . As this syndrome is seldom associated with violent behavior 6 a better understanding of its psychopathology may increase its screening in emergency practice and subsequently avoid violent behavior.

Uxoricide by a schizophrenic patient with delusional misidentification syndromes: A case report

“…The violent behavior was also reported. [24][25][26] In conclusion, the case reported here highlights the association between a major psychiatric disorder in a phase of acute decompensation and the delusional misidentification syndrome resulting in homicide and aggressive behavior. It is essential to identify such syndromes and evaluate the dangerousness in these patients.…”