Fregoli delusion

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Fregoli delusion
Other namesFregoli syndrome
Specialty Neuropsychiatry

The Fregoli delusion (or Fregoli syndrome) is a rare disorder in which a person holds a delusional belief that different people are in fact a single person who changes appearance or is in disguise. [1] The syndrome may be related to a brain lesion [2] [3] and is often of a paranoid nature, with the delusional person believing themselves persecuted by the person they believe is in disguise. [4]

Contents

A person with the Fregoli delusion may also inaccurately recall places, objects, and events. This disorder can be explained by "associative nodes". The associative nodes serve as a biological link of information about other people with a particular familiar face (to the patient). This means that for any face that is similar to a recognizable face to the patient, the patient will recall that face as the person they know. [5]

The Fregoli delusion is classed both as a monothematic delusion, since it only encompasses one delusional topic, and as a delusional misidentification syndrome (DMS), a class of delusional beliefs that involve misidentifying people, places, or objects. [6] Like Capgras delusion, psychiatrists believe it is related to a breakdown in normal face perception.

Signs and symptoms

Signs and symptoms of Fregoli's: [7]

Causes

Levodopa treatment

Levodopa, also known as L-DOPA, is the precursor to several catecholamines, specifically of dopamine, epinephrine and norepinephrine. It is clinically used to treat Parkinson's disease and dopamine-responsive dystonia. Clinical studies have shown that the use of levodopa can lead to visual hallucinations and delusions. In most patients, delusions were more salient than hallucinations. With prolonged use of levodopa, the delusions occupy almost all of a patient's attention. In experimental studies, when the concentration of levodopa decreases, the number of reported delusions decreases as well. It has been concluded that delusions related to antiparkinsonian medications are one of the leading causes of Fregoli syndrome. [8]

Traumatic brain injury

Injury to the right frontal and left temporo-parietal areas can cause Fregoli syndrome. [9] Research by Feinberg, et al. has shown that significant deficits in executive and memory functions follow shortly after damage in the right frontal or left temporoparietal areas. Tests performed on patients that have had a brain injury revealed that basic attention ability and visuomotor processing speed are typically normal. However, these patients made many errors when they were called to participate in detailed attention tasks. Selective attention tests involving auditory targets were also performed, and brain-injured patients had many errors; this meant that they were deficient in their response regulation and inhibition.

The most profound finding in Feinberg et al.'s paper is that performance tests on the retrieval process of memory was significantly damaged in brain-injured patients. They found, however, that these patients chose incorrect answers that were related semantically (i.e., chose vegetable instead of fruit). More importantly, tests of visual memory showed that there was a severe inability in visual recollection. Overall, brain-injured patients were severely impaired in many executive functions such as self-monitoring, mental flexibility, and social reasoning.

Fregoli syndrome is an illusion of positive doubles where there is an over-familiarity with the environment. This over-familiarity may have four causes:

Thus, executive dysfunction appears to be necessary to identify one as having Fregoli's syndrome. [10] [11]

Fusiform gyrus

Current research has shown that lesions in the right temporal lobe and the fusiform gyrus may contribute to DMSs. MRIs of patients exemplifying Fregoli symptoms have shown parahippocampal and hippocampal damage in the anterior fusiform gyrus, as well as the middle and inferior of the right temporal gyri. The inferior and medial of the right temporal gyri are the storage locations for long-term memory in retrieving information on visual recognition, specifically of faces; thus, damage to these intricate connections could be one of the leading factors in face misidentification disorders.

Recently, a face-specific area in the fusiform gyrus has been discovered and is close to the anterior fusiform gyrus. MRI studies performed by Hudson, et al. have shown lesions in the anterior fusiform gyrus, which is close to the face specific area (ventral fusiform cortex), may also be associated with Fregoli syndrome and other DMSs. Such damage may cause disruption in long-term visual memory and lead to improper associations of human faces.

On another note, our brains interpret visual scenes in two pathways: one is via the Parietal lobe-occipital dorsal pathway (visual spatial material is analyzed here), and the other is via the temporal-occipital ventral pathway (recognizes objects and faces). Thus, lesions in either structures or disruption of delicate connections may produce DMSs. [12] [13]

Abnormal P300

Delusional misidentification syndrome is thought to occur due to a dissociation between identification and recognition processes. The integration of information for further processing is referred to as working memory (WM). The P300 (P stands for positive voltage potential and the 300 for the 300-millisecond poststimulus) is an index of WM and is used during a WM test in DMS patients. In comparison to normal patients, DMS patients generally exhibit an attenuated amplitude of P300 at many abductions. These patients also exhibit prolonged latencies of P300 at all abductions. These implications suggest that DMSs are accompanied by abnormal WM, specifically affecting the prefrontal cortex (both outside and inside).

Past studies have shown correlations between DMS and damages to the right-hemispheric function, which has an array of functions (insight, 3D shapes, art awareness, imagination, left-hand control, music awareness, etc.). In recent years, the P300 auditory component, which forms in response to a detection task that occurs a short time after a stimulus, has acquired a great deal of recognition. The P300 component is an index of mental activity in that its amplitude increases highly with increased stimuli. This P300 component is correlated with updating the working memory to what is expected in the environment. Other findings enhance the belief that defects in the working memory are associated with DMS. Papageorgio et al.'s paper, psychological evidence for altered information processing in delusional misidentification syndromes, hypothesized that electrophysiological brain activity in the working memory and P300 component can help identify the mechanisms of DMS. Thus, they concentrated on P300 released during a working memory test in DMS patients.

Papageorgio et al. also found that DMS patients had a lower P300 amplitude in the right hemisphere compared to the control group (non-DMS patients). From this result, the researchers implied that shorter P300 amplitudes are highly correlated with gray matter abnormalities; this finding is consistent with the DMS patients' characteristics and the presence of gray-matter deterioration. DMS patients were also found to have prolonged P300 lag, and their memory performance was lower than the control groups. The researchers were, thus, able to imply that DMS patients have trouble in focusing their resources to a stimulus; this was hypothesized to be caused by the neurodegeneration of the right hemisphere. Overall, other research studies have also provided evidence in the correlation of DMS and gray-matter degeneration of the right frontal region, which controls attentional resources. This research is important, because it can help determine the mechanisms of DMS, which can then help conjure a more effective target drug and/or treatment plan for those with DMS. [14]

Treatment

Once it has been positively identified, pharmacotherapy follows. Antipsychotic drugs are the frontrunners in treatment for Fregoli and other DMSs. In addition to antipsychotics, anticonvulsants and antidepressants are also prescribed in some treatment courses. [15] [16] [17]

History

The condition is named after the Italian actor Leopoldo Fregoli, who was renowned for his ability to make quick changes of appearance during his stage act. [1]

P. Courbon and G. Fail first reported the condition in a 1927 paper (Syndrome d'illusion de Frégoli et schizophrénie). [18] They described a 27-year-old woman living in London who believed she was being persecuted by two actors she often saw at the theatre. She believed these people pursued her closely, taking the form of people she knew or met. [1]

Delusional misidentification syndromes and Fregoli

Delusional misidentification syndromes (DMS) are rooted in the inability to register the identity of something, whether it is an object, event, place or even a person. There are various forms of DMS, such as the syndrome of subjective doubles, intermetamorphosis, Capgras syndrome and Fregoli syndrome. However, all of these various syndromes have a common denominator: they are all due to malfunctional familiarity processing during information processing. The most common syndromes are Capgras and Fregoli. Capgras syndrome is the delusional belief that a friend, family member, etc., has been replaced by a twin impostor. Fregoli syndrome is the delusional belief that different people are in fact a single person who is in disguise. Other commonalities among these syndromes are that they are discriminatory in which object(s) are misidentified. Lastly, dopamine hyperactivity is evident in all DMSs and thus, all syndromes utilize antipsychotic medications to help control DMS.

Coexistence of Capgras and Fregoli

Delusional misidentification syndromes (DMSs) are four types of syndromes: the syndrome of subjective doubles, the syndrome of intermetamorphosis, Fregoli delusion and Capgras syndrome. Of the four, Fregoli syndrome is the least frequent, followed by Capgras. Of more rarity is the coexistence of both Fregoli and Capgras syndromes. Coexistence of DMSs are enhanced when coupled with other mental disorders such as schizophrenia, bipolar disorder and other mood disorders. Depersonalization and derealization symptoms are usually manifested in patients exhibiting two misidentification delusions. However, such symptoms have been witnessed to cease once the coexisting DMSs are fully developed. [19]

Fregoli syndrome for environment

Some patients can experience Fregoli delusion for environment or place; in this instance the patient misidentifies their current and unfamiliar location (e.g. a hospital) for a place that is familiar to them, such as their home or job. [9] [20] A patient can simultaneously suffer from Fregoli delusion for both persons and environments. In some cases, the patient holds the belief that they exist in both the correct and an incorrect location, a delusion that has been termed reduplicative paramnesia; the latter being a variant of the delusional misidentification syndromes. [9]

Current research

The study of DMS currently remains controversial,[ citation needed ] as they are often coupled with many psychological disorders (i.e. schizophrenia, bipolar disorder, obsessive compulsive disorder, etc.). Although there is an abundance of information on DMS, there are still many mysteries of the physiological and anatomical details of DMS. An accurate semiological analysis of higher visual anomalies and their corresponding topographic sites may help elucidate the aetiology of Fregoli's and other misidentification disorders.

Charlie Kaufman's 2015 film Anomalisa has several direct and indirect references to the Fregoli delusion. Kaufman adapted the screenplay from his 2005 audio play Anomalisa, written under the pseudonym Francis Fregoli, and the hotel that Michael stays in is called "The Fregoli". [21]

The science fiction short story "Liking What You See: A Documentary", from the collection Stories of Your Life and Others by Ted Chiang, refers to Fregoli syndrome in the context of artificial targeted neurological impairment. [22]

In March 2020, the delusion was covered in an episode of the BBC medical soap opera Doctors when Lizzie Milton (Adele James) believes she is being stalked by Joe Pasquale. [23]

There is an oblique reference to the delusion in Marco Polo, an episode of The Sopranos. The character Russ Fegoli (R Fegoli being an anagram of Fregoli) is implied to be the father of Paulie "Walnuts" Gualtieri. [24]

See also

Related Research Articles

Psychosis is a condition of the mind or psyche that results in difficulties determining what is real and what is not real. Symptoms may include delusions and hallucinations, among other features. Additional symptoms are disorganized thinking and incoherent speech and behavior that is inappropriate for a given situation. There may also be sleep problems, social withdrawal, lack of motivation, and difficulties carrying out daily activities. Psychosis can have serious adverse outcomes.

A delusion is a false fixed belief that is not amenable to change in light of conflicting evidence. As a pathology, it is distinct from a belief based on false or incomplete information, confabulation, dogma, illusion, hallucination, or some other misleading effects of perception, as individuals with those beliefs are able to change or readjust their beliefs upon reviewing the evidence. However:

<span class="mw-page-title-main">Agnosia</span> Inability to process sensory information

Agnosia is a neurological disorder characterized by an inability to process sensory information. Often there is a loss of ability to recognize objects, persons, sounds, shapes, or smells while the specific sense is not defective nor is there any significant memory loss. It is usually associated with brain injury or neurological illness, particularly after damage to the occipitotemporal border, which is part of the ventral stream. Agnosia only affects a single modality, such as vision or hearing. More recently, a top-down interruption is considered to cause the disturbance of handling perceptual information.

Capgras delusion or Capgras syndrome is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, other close family member, or pet has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), the French psychiatrist who first described the disorder.

Delusional misidentification syndrome is an umbrella term, introduced by Christodoulou for a group of four delusional disorders that occur in the context of mental and neurological illness. They are grouped together as they often occur simultaneously or interchange, and they display the common concept of the double (sosie). They all involve a belief that the identity of a person, object, or place has somehow changed or has been altered. Christodoulu further categorized these disorders into those including hypo -identification of a well-known person, and hyper -identification of an unknown person. As these delusions typically only concern one particular topic, they also fall under the category called monothematic delusions.

<span class="mw-page-title-main">Temporal lobe</span> One of the four lobes of the mammalian brain

The temporal lobe is one of the four major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the mammalian brain.

Cognitive neuropsychiatry is a growing multidisciplinary field arising out of cognitive psychology and neuropsychiatry that aims to understand mental illness and psychopathology in terms of models of normal psychological function. A concern with the neural substrates of impaired cognitive mechanisms links cognitive neuropsychiatry to the basic neuroscience. Alternatively, CNP provides a way of uncovering normal psychological processes by studying the effects of their change or impairment.

The mental status examination (MSE) is an important part of the clinical assessment process in neurological and psychiatric practice. It is a structured way of observing and describing a patient's psychological functioning at a given point in time, under the domains of appearance, attitude, behavior, mood and affect, speech, thought process, thought content, perception, cognition, insight, and judgment. There are some minor variations in the subdivision of the MSE and the sequence and names of MSE domains.

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Intermetamorphosis is a delusional misidentification syndrome, related to agnosia. The main symptoms consist of patients believing that they can see others change into someone else in both external appearance and internal personality. The disorder is usually comorbid with neurological disorders or mental disorders. The disorder was first described in 1932 by Paul Courbon (1879–1958), a French psychiatrist. Intermetamorphosis is rare, although issues with diagnostics and comorbidity may lead to under-reporting.

The syndrome of subjective doubles is a rare delusional misidentification syndrome in which a person experiences the delusion that they have a double or Doppelgänger with the same appearance, but usually with different character traits, that is leading a life of its own. The syndrome is also called the syndrome of doubles of the self, delusion of subjective doubles, or simply subjective doubles. Sometimes, the patient is under the impression that there is more than one double. A double may be projected onto any person, from a stranger to a family member.

<span class="mw-page-title-main">Parahippocampal gyrus</span> Grey matter region surrounding the hippocampus

The parahippocampal gyrus is a grey matter cortical region of the brain that surrounds the hippocampus and is part of the limbic system. The region plays an important role in memory encoding and retrieval. It has been involved in some cases of hippocampal sclerosis. Asymmetry has been observed in schizophrenia.

Reduplicative paramnesia is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been 'relocated' to another site. It is one of the delusional misidentification syndromes; although rare, it is most commonly associated with traumatic or acquired brain injury, such as stroke, particularly when there is simultaneous damage to the right cerebral hemisphere and to both frontal lobes.

Mirrored-self misidentification is the delusional belief that one's reflection in the mirror is another person – typically a younger or second version of one's self, a stranger, or a relative. This delusion occurs most frequently in patients with dementia and an affected patient maintains the ability to recognize others' reflections in the mirror. It is caused by right hemisphere cranial dysfunction that results from traumatic brain injury, stroke, or general neurological illness. It is an example of a monothematic delusion, a condition in which all abnormal beliefs have one common theme, as opposed to a polythematic delusion, in which a variety of unrelated delusional beliefs exist. This delusion is also classified as one of the delusional misidentification syndromes (DMS). A patient with a DMS condition consistently misidentifies places, objects, persons, or events. DMS patients are not aware of their psychological condition, are resistant to correction and their conditions are associated with brain disease – particularly right hemisphere brain damage and dysfunction.

A monothematic delusion is a delusional state that concerns only one particular topic. This is contrasted by what is sometimes called multi-thematic or polythematic delusions where the person has a range of delusions. These disorders can occur within the context of schizophrenia or dementia or they can occur without any other signs of mental illness. When these disorders are found outside the context of mental illness, they are often caused by organic dysfunction as a result of traumatic brain injury, stroke, or neurological illness.

This glossary covers terms found in the psychiatric literature; the word origins are primarily Greek, but there are also Latin, French, German, and English terms. Many of these terms refer to expressions dating from the early days of psychiatry in Europe.

<span class="mw-page-title-main">Inferior temporal gyrus</span> One of three gyri of the temporal lobe of the brain

The inferior temporal gyrus is one of three gyri of the temporal lobe and is located below the middle temporal gyrus, connected behind with the inferior occipital gyrus; it also extends around the infero-lateral border on to the inferior surface of the temporal lobe, where it is limited by the inferior sulcus. This region is one of the higher levels of the ventral stream of visual processing, associated with the representation of objects, places, faces, and colors. It may also be involved in face perception, and in the recognition of numbers and words.

<span class="mw-page-title-main">Grandiose delusions</span> Subtype of delusion

Grandiose delusions (GDs), also known as delusions of grandeur or expansive delusions, are a subtype of delusion characterized by the extraordinary belief that one is famous, omnipotent, wealthy, or otherwise very powerful or of a high status. Grandiose delusions often have a religious, science fictional, or supernatural theme. Examples include the extraordinary belief that one is a deity or celebrity, or that one possesses fantastical talents, accomplishments, or superpowers.

<span class="mw-page-title-main">Cotard's syndrome</span> Delusion that one is dead or non-existent

Cotard's syndrome, also known as Cotard's delusion or walking corpse syndrome, is a rare mental disorder in which the affected person holds the delusional belief that they are dead, do not exist, are putrefying, or have lost their blood or internal organs. Statistical analysis of a hundred-patient cohort indicated that denial of self-existence is present in 45% of the cases of Cotard's syndrome; the other 55% of the patients presented with delusions of immortality.

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References

  1. 1 2 3 Bate, Sarah (2017-09-09). Face Recognition and its Disorders. Bloomsbury Publishing. p. 72. ISBN   978-1-137-29277-3.
  2. ↑ Devinsky, Orrin (6 January 2009). "Delusional misidentifications and duplications: Right brain lesions, left brain delusions". Neurology. 72 (1): 80–87. doi:10.1212/01.wnl.0000338625.47892.74. PMID   19122035. S2CID   207103708.
  3. ↑ Feinberg, Todd; Eaton, Lisa; Roane, David; Giacino, Joseph (1999). "Multiple Fregoli Delusions after Traumatic Brain Injury". Cortex. 35 (3): 373–387. doi:10.1016/S0010-9452(08)70806-2. PMID   10440075. S2CID   43432798.
  4. ↑ Meagher, David; O’Connell, Henry; McFarland, John; Moloney, Noreen; Leonard, Maeve (2020). Problem-Based Psychiatry E-Book: Problem-Based Psychiatry E-Book. Elsevier Health Sciences. p. 35. ISBN   978-0-7020-8069-2.
  5. ↑ Tibbetts, Paul. " Symbolic Interaction Theory and the Cognitively Disabled: A neglected Dimension." Jstor. Winter 2004. Web. 28 September 2011 Symbolic Interaction Theory and the Cognitively Disabled: A Neglected Dimension
  6. ↑ Mojtabai R (September 1994). "Fregoli syndrome". Aust N Z J Psychiatry. 28 (3): 458–62. doi:10.3109/00048679409075874. PMID   7893241. S2CID   1436302.
  7. ↑ "Fregoli Syndrome". PharmaTutor. 2013-10-29. Retrieved 2022-02-17.
  8. ↑ Stewart JT (January 2008). "Frégoli syndrome associated with levodopa treatment". Mov. Disord. 23 (2): 308–9. doi:10.1002/mds.21843. PMID   18044770. S2CID   45475039.
  9. 1 2 3 M.D, Todd E. Feinberg; Keenan, Julian Paul (2005-07-14). The Lost Self: Pathologies of the Brain and Identity. Oxford University Press. p. 105. ISBN   978-0-19-803864-1.
  10. ↑ Feinberg TE, Eaton LA, Roane DM, Giacino JT (June 1999). "Multiple Fregoli delusions after traumatic brain injury". Cortex. 35 (3): 373–87. doi:10.1016/S0010-9452(08)70806-2. PMID   10440075. S2CID   43432798.
  11. ↑ Pires-Barata, S., Gois, J. P., & da Silva, M. H. T. (2008). Fregoli's syndrome and traumatic brain injury.
  12. ↑ Hudson AJ, Grace GM (2000). "Misidentification syndromes related to face specific area in the fusiform gyrus". J. Neurol. Neurosurg. Psychiatry. 69 (5): 645–8. doi:10.1136/jnnp.69.5.645. PMC   1763428 . PMID   11032619.
  13. ↑ Perez-Martinez DA, Porta-Etessam J (2007). "Higher visual integration abnormalities, illusions and visual hallucinations". Neurologia: 34–41.
  14. ↑ Papageorgiou C, Lykouras L, Ventouras E, Uzunoglu N, Christodoulou GN (May 2002). "Abnormal P300 in a case of delusional misidentification with coinciding Capgras and Frégoli symptoms". Prog. Neuropsychopharmacol. Biol. Psychiatry. 26 (4): 805–10. doi:10.1016/S0278-5846(01)00293-7. PMID   12188110. S2CID   42238987.
  15. ↑ Silva JA, Leong GB, Miller AL (1996). "Delusional misidentification syndromes — Drug treatment options". CNS Drugs. 5 (2): 89–102. doi:10.2165/00023210-199605020-00002. S2CID   141846450.
  16. ↑ McAllister TW, Ferrell RB (2002). "Evaluation and treatment of psychosis after traumatic brain injury". NeuroRehabilitation. 17 (4): 357–68. doi:10.3233/NRE-2002-17409. PMID   12547983. Archived from the original on 2020-03-14. Retrieved 2009-12-13.
  17. ↑ Christodoulou GN (1977). "Treatment of the "syndrome of doubles"". Acta Psychiatr Belg. 77 (2): 254–9. PMID   20738.
  18. ↑ Ellis HD, Whitley J, Luauté JP (March 1994). "Delusional misidentification. The three original papers on the Capgras, Frégoli and intermetamorphosis delusions. (Classic Text No. 17)". Hist Psychiatry. 5 (17 Pt 1): 117–46. doi:10.1177/0957154X9400501708. PMID   11639277. S2CID   2639651.
  19. ↑ Lykouras L, Typaldou M, Gournellis R, Vaslamatzis G, Christodoulou GN (July 2002). "Coexistence of Capgras and Frégoli syndromes in a single patient. Clinical, neuroimaging and neuropsychological findings". Eur. Psychiatry. 17 (4): 234–5. doi:10.1016/S0924-9338(02)00660-0. PMID   12231272. S2CID   41263135.
  20. ↑ Blom, Jan Dirk (2023-06-23). A Dictionary of Hallucinations. Springer Nature. p. 295. ISBN   978-3-031-25248-8.
  21. ↑ Stevens, Dana (31 December 2015). "Psychiatric Times: Anomalisa: A beautiful, tricky, heartbreaking puppet show from Charlie Kaufman". Slate.
  22. ↑ Chiang, Ted (2016). Stories of Your Life and Others. Vintage Books. p.  257. ISBN   978-1-101-97212-0.
  23. ↑ Writer: Stephen Keyworth; Director: David Lewis Richardson; Producer: Peter Leslie Wild (12 March 2020). "The Joe Pasquale Problem". Doctors. BBC. BBC One.
  24. ↑ See Chapter Eight of Made in America and the Hidden Stories of The Sopranos by Steve Else (KDP, 2022)
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