Coexistência das síndromes de Capgras e Frégoli associadas à redução de volume frontotemporal e hiperintensidades em substância branca cerebral

Abstract

Background: Delusional misidentification syndromes are conditions in which the patients pathologically misidentify people, places, objects or events. They have been categorized in four subtypes: Capgras, Frégoli, intermetamorphosis and subjective double syndromes. Such syndromes may be present in patients with psychiatric disorders such as schizophrenia and mood disorders, and with neurological diseases such as Alzheimer, Parkinson and brain injury (trauma, vascular). Objectives: To describe and discuss a case of coexistent between Capgras and Frégoli syndromes in a female patient with paranoid schizophrenia and brain MRI findings. Methods: Psychiatric interview and brain MRI scanning. Results: The patient presented structural magnetic resonance imaging periventricular and subcortical white matter hyperintensities on flair images mainly concentrated in the right frontotemporal region and bilateral frontotemporal volume loss. Discussion: The described neuroimaging findings may represent an organic substrate to the delusional misidentification syndromes of the present case. The delusional symptoms in Capgras and Frégoli syndromes could be the result of a right temporolimbic-frontal disconnection which results in impossibility to associate previous memories to new information and consequently misidentifying symptoms. Moreover a volume loss of such cerebral regions, as observed in the present case, may also play a significant role in the development of delusional misidentification syndromes. G, et al. / Rev Psiq Clín. 2009;36(6):240-3 Keywords: Schizophrenia, neuroimaging, magnetic resonance imaging, pathophysiology, psychosis. Turkiewicz ResumoContexto: Transtornos delirantes de identificação são condições nas quais os pacientes identificam de maneira patologicamente equivocada pessoas, lugares, objetos ou eventos. Esses transtornos têm sido categorizados em quatro diferentes subtipos: Capgras, Frégoli, intermetamorfose e síndrome do duplo subjetivo. Tais síndromes podem estar presentes em diferentes transtornos psiquiátricos, como esquizofrenia e transtornos do humor, bem como em diferentes doenças neurológicas, como Alzheimer, Parkinson, lesões cerebrais traumáticas ou vasculares. Objetivos: Descrever e discutir um caso de coexistência entre as síndromes de Capgras e Frégoli em uma paciente com esquizofrenia paranoide e com alterações cerebrais. Métodos: Entrevista psiquiátrica e ressonância magnética de crânio. Resultados: A paciente apresentava hiperintensidades periventriculares em aquisição flair e de substância branca subcortical concentradas principalmente na região frontotemporal direita, bem como perda do volume da região frontotemporal bilateral. Discussão: As alterações descritas podem representar substrato orgânico das síndromes dos transtornos delirantes de identificação. Os delírios nas síndromes de Capgras e Frégoli podem ocorrer como reCoexistence of Capgras and Frégoli syndromes associated to frontotemporal volume reduction and cerebral white matter hyperintensities Coexistência das sín...

Two processes are not necessary to understand memory deficits

“…Meta-analyses of delusional misidentification syndrome point to the involvement of the right frontal lobes (Atta et al 2006;Feinberg & Roane 2005), with other changes observed in the left temporal lobes (Edelstyn & Oyebode 1999;Feinberg et al 1999;Huang et al 1999;Signer 1994). Further, neuroimaging data in delusional misidentification syndrome and schizophrenia have demonstrated structural volume reduction in the frontotemporal area of the brain (Turkiewicz et al 2009), as well as reductions in structural magnetic resonance in the right frontal lobe (Coltheart et al 2007). A few studies showed damage to the right fusiform gyrus and para/hippocampal atrophy indicating temporal lobe deficiencies (Hudson 2000).…”

Refining the bigger picture: On the integrative memory model

“…Meta-analyses of delusional misidentification syndrome point to the involvement of the right frontal lobes (Atta et al 2006;Feinberg & Roane 2005), with other changes observed in the left temporal lobes (Edelstyn & Oyebode 1999;Feinberg et al 1999;Huang et al 1999;Signer 1994). Further, neuroimaging data in delusional misidentification syndrome and schizophrenia have demonstrated structural volume reduction in the frontotemporal area of the brain (Turkiewicz et al 2009), as well as reductions in structural magnetic resonance in the right frontal lobe (Coltheart et al 2007). A few studies showed damage to the right fusiform gyrus and para/hippocampal atrophy indicating temporal lobe deficiencies (Hudson 2000).…”

Understanding misidentification syndromes using the integrative memory model

“…Meta-analyses of delusional misidentification syndrome point to the involvement of the right frontal lobes (Atta et al 2006; Feinberg & Roane 2005), with other changes observed in the left temporal lobes (Edelstyn & Oyebode 1999; Feinberg et al 1999; Huang et al 1999; Signer 1994). Further, neuroimaging data in delusional misidentification syndrome and schizophrenia have demonstrated structural volume reduction in the frontotemporal area of the brain (Turkiewicz et al 2009), as well as reductions in structural magnetic resonance in the right frontal lobe (Coltheart et al 2007). A few studies showed damage to the right fusiform gyrus and para/hippocampal atrophy indicating temporal lobe deficiencies (Hudson 2000).…”