Intermetamorphosis

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Intermetamorphosis
Specialty Psychiatry

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. [1] 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. [2] Intermetamorphosis is rare, although issues with diagnostics and comorbidity may lead to under-reporting. [3]

Contents

Signs and symptoms

Individuals experiencing intermetamorphosis, as well as the other delusional misidentification syndromes (DMS), tend to misidentify those people that are both physically and emotionally close to them; the most commonly misidentified people are parents, siblings and spouses. [4] There are instances of individuals misidentifying people not known to them, however, they still held an affective importance, such as celebrities or politicians. [4] The explanations for the inauthenticity of the misidentified people are associated with the individual experiencing the delusions' cultural background. [4]

Example

An example from medical literature is a man who was diagnosed with Alzheimer's disease. He mistook his wife for his deceased mother and later for his sister. He explained that he had never been married or that his wife had left him. Later he mistook his son for his brother and his daughter for another sister. Visual agnosia or prosopagnosia were not diagnosed, as the misidentification also took place during phone calls. On several occasions he mistook the hospital for the church he used to go to.

Violence

There is an association in the literature between misidentification syndromes and violent or aggressive behavior. [3] [5] [6] [7] In several case studies, individuals with misidentification syndromes acted aggressively towards the object of misidentification, which has the potential for criminal behavior. [3] [5] [7] This may be because the delusions cause individuals to view the misidentified object with suspicion, and they become paranoid about the inauthenticity of the object, leading to an act of presumed preemptive self-defense. [7] [4] Although gender differences in the occurrence of intermetamorphosis are not pronounced, the research demonstrates that a majority (70%) of occurrences with violent behavior involves males. [4] The issue of violent and aggressive behavior within this set of syndromes continues to play an important role in the discussion of criminal responsibility and risk assessment. [7]

Comorbidity

Intermetamorphosis and other DMSs often occur together or interchange. [8] [3] [7] [9] DMSs are also often comorbid with psychiatric disorders, such as schizophrenia, schizoaffective disorder, bipolar disorder, and PTSD. [6] [7] [4] Paranoid schizophrenia is most commonly associated with DMSs. [6] [7] [4] They are also associated with neurological conditions or diseases, including dementia, Alzheimer's disease and alcohol- or drug-induced cognitive impairment. [3] [6] [7] Among comorbid symptoms, paranoid psychotic symptoms, depressive psychotic symptoms and auditory hallucinations are the most often present. [6]

Cause

Explanations for the occurrence of intermetamorphosis were first given by psychodynamic theorists. [3] [6] [9] These theories typically involve a psychotic resolution towards an individual's feelings of intense ambivalence about the misidentified object. [5] These theories may also involve the egos and identity-forming, as well as defense mechanisms involving splitting the negative and positive aspects of the self. [7] Despite their initial popularity, there is not much empirical support for these psychodynamic explanations.

Recent advancements in neuroimaging and structural studies have provided evidence of an organic etiology. [3] [9] Neurological dysfunction and neuropsychiatric abnormalities, in various forms, are now believed to be a central feature in DMSs. [3] [4] Neuropsychological findings suggest that symptoms are produced in some aspect by brain dysfunction or damage, specifically in the right hemisphere. [3] [8] [6] Lesions in the right frontal lobe and adjacent areas have been found through neuroimaging in case reports of intermetamorphosis. [7] [9] In studying over 20 patients with misidentification syndromes, Christodoulou [8] found electroencephalographic abnormalities in over 90%. In one case of intermetamorphosis, Joseph [10] reported electroencephalographic abnormalities with right temporo-parietal predominance. Impaired connectivity or dysconnectivity between the right fusiform and right parahippocampal areas and the frontal lobes and the right temporolimbic regions have also been seen in case reports of this syndrome, which are thought to be implicated in deficits in face recognition, visual memory recall, and identification processes. [7] While impairments in facial processing are experienced by most DMSs, it appears to be experienced more consciously in intermetamorphosis than in other DMSs. [4] Cortical atrophy is also sometimes present, although this may be due to co-occurring dementia and other organic mental syndromes. [6] Overactivity in the perirhinal cortex appears to be associated with the loss of familiarity in intermetamorphosis. [3] Depersonalization has also been postulated as a contributing factor to the development of intermetamorphosis; under conditions like the presence of a paranoid element, a charged emotional relationship to the principal misidentified person, and cerebral dysfunction, depersonalization and derealization symptoms may develop into a full delusional misidentification syndrome. [8]

Diagnosis

How to define intermetamorphosis and other delusional misidentification syndromes is frequently debated in the literature. Some believe that misidentification is a symptom, and that the overlapping nature of these syndromes suggests that they are "states" associated with other psychiatric or neurological disorders, but that they're not diagnostic in themselves. [5] [6] [7] [4] As their name suggests, many professionals consider them syndromes, because misidentification appears to occur more often in association with certain symptoms, like depersonalization, derealization, and paranoia. [3] [4] Lastly, some believe that they should be discrete diagnoses in the Diagnostic and Statistical Manual of Mental Disorders. [3] [4]

Treatment

Results regarding the efficacy of treatments for intermetamorphosis are mixed. Treatment of any co-occurring mental disorder or substance abuse is necessary. [7] There have been no controlled studies about pharmacological treatments of intermetamorphosis. [3] However, both atypical and typical antipsychotics are often used, and have been found to be effective in patients with both organic and functional disorders. [3] [7] Some that have been effective in case studies are clozapine, olanzapine, risperidone, quetiapine, sulpiride, trifluoperazine, pimozide, haloperidol and carbamazepine. [3] [7] [9] Clorazepate, a benzodiazepine used in the treatment of anxiety and seizure disorders, has also been used effectively. [7] [10] Occasionally, antidepressants and lithium have been used, especially in the instance of a co-occurring mood or bipolar disorder. [7]

Reverse Intermetamorphosis

A proposed variant of intermetamorphosis is the syndrome of "reverse" intermetamorphosis, in which there is the delusional belief that an individual is undergoing radical changes in both physical and psychological identities. [4]

Related Research Articles

Capgras delusion or Capgras syndrome is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, another 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.

The Fregoli delusion 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. The syndrome may be related to a brain lesion and is often of a paranoid nature, with the delusional person believing themselves persecuted by the person they believe is in disguise.

<span class="mw-page-title-main">Depersonalization</span> Anomaly of self-awareness

Depersonalization is a dissociative phenomenon characterized by a subjective feeling of detachment from oneself, manifesting as a sense of disconnection from one's thoughts, emotions, sensations, or actions, and often accompanied by a feeling of observing oneself from an external perspective. Subjects perceive that the world has become vague, dreamlike, surreal, or strange, leading to a diminished sense of individuality or identity. Sufferers often feel as though they are observing the world from a distance, as if separated by a barrier "behind glass". They maintain insight into the subjective nature of their experience, recognizing that it pertains to their own perception rather than altering objective reality. This distinction between subjective experience and objective reality distinguishes depersonalization from delusions, where individuals firmly believe in false perceptions as genuine truths. Depersonalization is also distinct from derealization, which involves a sense of detachment from the external world rather than from oneself.

Clinical lycanthropy is a rare psychiatric syndrome that involves a delusion that the affected person can transform into, has transformed into, or is, a non-human animal. Its name is associated with the mythical condition of lycanthropy, a supernatural affliction in which humans are said to physically shapeshift into wolves. The term is used by researchers mostly in the broader sense of transformation into animals in general.

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.

Depersonalization-derealization disorder is a mental disorder in which the person has persistent or recurrent feelings of depersonalization and/or derealization. Depersonalization is described as feeling disconnected or detached from one's self. Individuals may report feeling as if they are an outside observer of their own thoughts or body, and often report feeling a loss of control over their thoughts or actions. Derealization is described as detachment from one's surroundings. Individuals experiencing derealization may report perceiving the world around them as foggy, dreamlike, surreal, and/or visually distorted.

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.

Thought broadcasting is a type of delusional condition in which the affected person believes that others can hear their inner thoughts, despite a clear lack of evidence. The person may believe that either those nearby can perceive their thoughts or that they are being transmitted via mediums such as television, radio or the internet. Different people can experience thought broadcasting in different ways. Thought broadcasting is most commonly found among people who have a psychotic disorder, specifically schizophrenia.

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.

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.

Memory disorders are the result of damage to neuroanatomical structures that hinders the storage, retention and recollection of memories. Memory disorders can be progressive, including Alzheimer's disease, or they can be immediate including disorders resulting from head injury.

Paraphrenia is a mental disorder characterized by an organized system of paranoid delusions with or without hallucinations and without deterioration of intellect or personality.

Multiple complex developmental disorder (MCDD) is a research category, proposed to involve several neurological and psychological symptoms where at least some symptoms are first noticed during early childhood and persist throughout life. It was originally suggested to be a subtype of pervasive developmental disorders (PDD) with co-morbid schizophrenia or another psychotic disorder; however, there is some controversy that not everyone with MCDD meets criteria for both PDD and psychosis. The term multiplex developmental disorder was coined by Donald J. Cohen in 1986.

A spectrum disorder is a disorder that includes a range of linked conditions, sometimes also extending to include singular symptoms and traits. The different elements of a spectrum either have a similar appearance or are thought to be caused by the same underlying mechanism. In either case, a spectrum approach is taken because there appears to be "not a unitary disorder but rather a syndrome composed of subgroups". The spectrum may represent a range of severity, comprising relatively "severe" mental disorders through to relatively "mild and nonclinical deficits".

Oneiroid syndrome (OS) is a condition involving dream-like disturbances of one's consciousness by vivid scenic hallucinations, accompanied by catatonic symptoms (either catatonic stupor or excitement), delusions, or psychopathological experiences of a kaleidoscopic nature. The term is from Ancient Greek "ὄνειρος" (óneiros, meaning "dream") and "εἶδος" (eîdos, meaning "form, likeness"; literally dream-like / oneiric or oniric, sometimes called "nightmare-like"). It is a common complication of catatonic schizophrenia, although it can also be caused by other mental disorders. The dream-like experiences are vivid enough to seem real to the patient. OS is distinguished from delirium by the fact that the imaginative experiences of patients always have an internal projection. This syndrome is hardly mentioned in standard psychiatric textbooks, possibly because it is not listed in DSM.

Pseudodementia is a condition where mental cognition can be temporarily decreased. The term pseudodementia is applied to the range of functional psychiatric conditions such as depression, schizophrenia and other psychosis, mania, dissociative disorder and conversion disorder that may mimic organic dementia, but are essentially reversible on treatment. Pseudodementia typically involves three cognitive components: memory issues, deficits in executive functioning, and deficits in speech and language. Specific cognitive symptoms might include trouble recalling words or remembering things in general, decreased attentional control and concentration, difficulty completing tasks or making decisions, decreased speed and fluency of speech, and impaired processing speed. People with pseudodementia are typically very distressed about the cognitive impairment they experience. Two treatments found to be effective for the treatment of depression may also be beneficial in the treatment of pseudodementia: Cognitive behavioral therapy (CBT) which identifies behaviors that positively and negatively impact mood, and Interpersonal therapy which focuses on identifying ways in which interpersonal relationships contribute to depression.

Derealization is an alteration in the perception of the external world, causing those with the condition to perceive it as unreal, distant, distorted or in other words falsified. Other symptoms include feeling as if one's environment is lacking in spontaneity, emotional coloring, and depth. It is a dissociative symptom that may appear in moments of severe stress.

<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.

References

  1. ↑ Semple, David. "Oxford Hand Book Of Psychiatry" Oxford Press. 2005. p238.
  2. ↑ Illusions d'intermétamorphose et de la charme, Annales Medico-Psychologiques, issue 14, page 401-406.
  3. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 Cipriani, G., Vedovello, M., Ulivi, M., Lucetti, C., Fiorino, A. D., & Nuti, A. (2013). Delusional Misidentification Syndromes and Dementia: A Border Zone Between Neurology and Psychiatry. American Journal of Alzheimer’s Disease & Other Dementias, 28(7), 671–678.
  4. 1 2 3 4 5 6 7 8 9 10 11 12 13 Silva, J. A., Leong, G. B., & Weinstock, R. (1992). The dangerousness of persons with misidentification syndromes. Bulletin of the American Academy of Psychiatry & the Law, 20(1), 77–86.
  5. 1 2 3 4 De Pauw, K. W., & Szulecka, T. K. (1988). Dangerous delusions: Violence and the misidentification syndromes. The British Journal of Psychiatry, 152, 91–96.
  6. 1 2 3 4 5 6 7 8 9 Förstl, H., Almeida, O., Owen, A., Burns, A., & Howard, R. (1991). Psychiatric, neurological and medical aspects of misidentification syndromes: A review of 260 cases. Psychological Medicine, 21(4), 905–910.
  7. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 Klein, C. A., & Hirachan, S. (2014). The masks of identities: Who's who? delusional misidentification syndromes. Journal of the American Academy of Psychiatry and the Law, 42(3), 369–378.
  8. 1 2 3 4 Christodoulou, G.N., Margariti, M., Kontaxakis, V.P. (2009). The delusional misidentification syndromes: Strange, fascinating, and instructive. Current Psychiatry Reports, 11, 185–189.
  9. 1 2 3 4 5 Young, A. H., Ellis, H. D., Szulecka, T. K., & de Pauw, K. W. (1990). Face processing impairments and delusional misidentification. Behavioural Neurology, 3(3), 153–168.
  10. 1 2 Joseph, A. B. (1987). Delusional misidentification of the Capgras and intermetamorphosis types responding to clorazepate. Acta Psychiatrica Scandinavica, 75, 330–332.
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