Reduplicative paramnesia

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Reduplicative paramnesia
Specialty Psychiatry

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. [1] [2]

Contents

Presentation

Reduplicative paramnesia has been reported in the context of a number of neurological disorders, including stroke, intracerebral hemorrhage, tumor, dementia, encephalopathy and various psychiatric disorders. [3]

Taken from the Benson and colleagues study, the following example illustrates some of the core features of the delusion. In this instance, the patient had had a head injury after a fall in his home. The impact had caused a fractured skull and frontal lobe damage to both sides (although more pronounced on the right) owing to the formation of intracerebral hematomas:

A few days after admission to the Neurobehavioural Center, orientation for time was intact, he could give details of the accident (as related to him by others), could remember his doctors' names and could learn new information and retain it indefinitely. He exhibited, however, a distinct abnormality of orientation for place. While he quickly learned and remembered that he was at the Jamaica Plain Veterans Hospital (also known as the Boston Veterans Administration Hospital), he insisted that the hospital was located in Taunton, Massachusetts, his home town. Under close questioning, he acknowledged that Jamaica Plain was part of Boston and admitted it would be strange for there to be two Jamaica Plain Veterans Hospitals. Nonetheless, he insisted that he was presently hospitalized in a branch of the Jamaica Plain Veterans Hospital located in Taunton. At one time he stated that the hospital was located in the spare bedroom of his house.

The illusory relocation to a familiar place (such as a home or town the patient knows well) is a common theme, although occasionally the patient may believe that they are resident in more fantastical or exotic locations. [4]

Mechanism

Early psychodynamic explanations suggested that reduplicative paramnesia was not directly connected to brain injury, but arises from a motivated denial of illness; particularly, as Weinstein and Kahn [5] claimed, in those that regard illness as an "imperfection, weakness or disgrace". Other early investigators did accept that brain injury was an important factor, but suggested that the disorientation was a "hysterical reaction" motivated by a desire to return home. [6]

The majority of modern theories, however, suggest that the disorder is caused by disruption to the brain systems involved in memory and familiarity. This was the theme of Pick's original explanation, in which he suggested that the crucial mechanism was a "convulsive attack" that disrupted conscious memory. [7]

Benson and colleagues [8] later argued that damage to the right hemisphere of the brain rendered patients unable to maintain orientation owing to impaired visuospatial perception and visual memory, while frontal lobe damage made it difficult to inhibit the false impressions caused by disorientation.

More recent research has broadly supported this view, [9] and links have been made to the literature on confabulation, where patients seem to recall false memories without any realisation that they are false, often also in the context of frontal lobe damage. Right hemisphere damage is also linked to anosognosia, where patients seem unaware of often striking disabilities present after brain injury, also suggesting a link to the lack of insight seen in this disorder.

One case study has suggested a more refined explanation, [10] suggesting that damage to the ventral stream of the visual system, that connects the visual cortex to areas in the temporal lobes, could produce the required visuospatial disorientation and poor memory integration. The temporal areas (including the hippocampus) are known strongly to interact with the frontal lobes during memory formation and retrieval, suggesting an explanation for why frontal damage could also lead to the condition.

History

The term reduplicative paramnesia was first used in 1903 by psychiatrist Arnold Pick to describe a condition in a patient with suspected Alzheimer's disease who insisted that she had been moved from Pick's city clinic to one she claimed looked identical but was in a familiar suburb. To explain the discrepancy she further claimed that Pick and the medical staff worked at both locations. [7]

In retrospect, however, the phenomenon has been found to have been first reported by the Swiss naturalist Charles Bonnet in 1788, [11] who described a woman who also had what would now be called Cotard delusion. Henry Head [12] and Paterson and Zangwill [6] later reported on soldiers who had the delusional belief that their hospital was located in their home town, although in these cases traumatic brain injury seemed to be the most likely cause.

It wasn't until 1976 that serious consideration was given to the disorder, when three cases were reported by Benson and colleagues. [8] Benson not only described striking reduplication syndromes in his patients, but also attempted to explain the phenomena in terms of the neurocognitive deficits also present in the patients. This was one of the first attempts to give a neuropsychological explanation for the disorder.

See also

Related Research Articles

<span class="mw-page-title-main">Jules Cotard</span>

Jules Cotard was a French physician who practiced neurology and psychiatry. He is best known for first describing the Cotard delusion, a patient's delusional belief that they are dead, do not exist or do not have bodily organs.

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">Brain injury</span> Destruction or degeneration of brain cells

Brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating trauma-induced damage.

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">Cognitive neuropsychology</span>

Cognitive neuropsychology is a branch of cognitive psychology that aims to understand how the structure and function of the brain relates to specific psychological processes. Cognitive psychology is the science that looks at how mental processes are responsible for the cognitive abilities to store and produce new memories, produce language, recognize people and objects, as well as our ability to reason and problem solve. Cognitive neuropsychology places a particular emphasis on studying the cognitive effects of brain injury or neurological illness with a view to inferring models of normal cognitive functioning. Evidence is based on case studies of individual brain damaged patients who show deficits in brain areas and from patients who exhibit double dissociations. Double dissociations involve two patients and two tasks. One patient is impaired at one task but normal on the other, while the other patient is normal on the first task and impaired on the other. For example, patient A would be poor at reading printed words while still being normal at understanding spoken words, while the patient B would be normal at understanding written words and be poor at understanding spoken words. Scientists can interpret this information to explain how there is a single cognitive module for word comprehension. From studies like these, researchers infer that different areas of the brain are highly specialised. Cognitive neuropsychology can be distinguished from cognitive neuroscience, which is also interested in brain-damaged patients, but is particularly focused on uncovering the neural mechanisms underlying cognitive processes.

Anosognosia is a condition in which a person with a disability is cognitively unaware of having it due to an underlying physical condition. Anosognosia results from physiological damage to brain structures, typically to the parietal lobe or a diffuse lesion on the fronto-temporal-parietal area in the right hemisphere, and is thus a neuropsychiatric disorder. A deficit of self-awareness, the term was first coined by the neurologist Joseph Babinski in 1914, in order to describe the unawareness of hemiplegia.

<span class="mw-page-title-main">Bálint's syndrome</span> Medical condition

Bálint's syndrome is an uncommon and incompletely understood triad of severe neuropsychological impairments: inability to perceive the visual field as a whole (simultanagnosia), difficulty in fixating the eyes, and inability to move the hand to a specific object by using vision. It was named in 1909 for the Austro-Hungarian neurologist and psychiatrist Rezső Bálint who first identified it.

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.

Cerebral atrophy is a common feature of many of the diseases that affect the brain. Atrophy of any tissue means a decrement in the size of the cell, which can be due to progressive loss of cytoplasmic proteins. In brain tissue, atrophy describes a loss of neurons and the connections between them. Brain atrophy can be classified into two main categories: generalized and focal atrophy. Generalized atrophy occurs across the entire brain whereas focal atrophy affects cells in a specific location. If the cerebral hemispheres are affected, conscious thought and voluntary processes may be impaired.

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.

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.

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.

<span class="mw-page-title-main">Frontal lobe disorder</span> Brain disorder

Frontal lobe disorder, also frontal lobe syndrome, is an impairment of the frontal lobe of the brain due to disease or frontal lobe injury. The frontal lobe plays a key role in executive functions such as motivation, planning, social behaviour, and speech production. Frontal lobe syndrome can be caused by a range of conditions including head trauma, tumours, neurodegenerative diseases, neurodevelopmental disorders, neurosurgery and cerebrovascular disease. Frontal lobe impairment can be detected by recognition of typical signs and symptoms, use of simple screening tests, and specialist neurological testing.

Post-traumatic amnesia (PTA) is a state of confusion that occurs immediately following a traumatic brain injury (TBI) in which the injured person is disoriented and unable to remember events that occur after the injury. The person may be unable to state their name, where they are, and what time it is. When continuous memory returns, PTA is considered to have resolved. While PTA lasts, new events cannot be stored in the memory. About a third of patients with mild head injury are reported to have "islands of memory", in which the patient can recall only some events. During PTA, the patient's consciousness is "clouded". Because PTA involves confusion in addition to the memory loss typical of amnesia, the term "post-traumatic confusional state" has been proposed as an alternative.

Topographical disorientation is the inability to orient oneself in one's surroundings, sometimes as a result of focal brain damage. This disability may result from the inability to make use of selective spatial information or to orient by means of specific cognitive strategies such as the ability to form a mental representation of the environment, also known as a cognitive map. It may be part of a syndrome known as visuospatial dysgnosia.

In psychology, confabulation is a memory error consisting of the production of fabricated, distorted, or misinterpreted memories about oneself or the world. It is generally associated with certain types of brain damage or a specific subset of dementias. While still an area of ongoing research, the basal forebrain is implicated in the phenomenon of confabulation. People who confabulate present with incorrect memories ranging from subtle inaccuracies to surreal fabrications, and may include confusion or distortion in the temporal framing of memories. In general, they are very confident about their recollections, even when challenged with contradictory evidence.

<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.

<span class="mw-page-title-main">Donald Stuss</span> Canadian neuropsychologist (1941–2019)

Donald Thomas Stuss was a Canadian neuropsychologist who studied the frontal lobes of the human brain. He also directed the Rotman Research Institute at Baycrest from 1989 until 2009 and the Ontario Brain Institute from 2011 until 2016.

References

  1. ↑ ABPN, Arthur MacNeill Horton, Jr, EdD, ABPP; ABN, Chad A. Noggle, PhD; ABPdN, Raymond S. Dean, PhD, ABPP, ABN (2011-10-25). The Encyclopedia of Neuropsychological Disorders. Springer Publishing Company. p. 268. ISBN   978-0-8261-9855-6.{{cite book}}: CS1 maint: multiple names: authors list (link)
  2. ↑ Granacher, Jr, Robert P. (2003-06-27). Traumatic Brain Injury: Methods for Clinical and Forensic Neuropsychiatric Assessment. CRC Press. p. 45. ISBN   978-0-203-50174-0.{{cite book}}: CS1 maint: multiple names: authors list (link)
  3. ↑ Forstl H.; Almeida O.P.; Owen A.M.; Burns A.; Howard R. (1991). "Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases". Psychological Medicine. 21 (4): 905–10. doi:10.1017/S0033291700029895. PMID   1780403. S2CID   24026245.
  4. ↑ Fisher C.M. (1982). "Disorientation for place". Archives of Neurology. 39 (1): 33–6. doi:10.1001/archneur.1982.00510130035008. PMID   7055444.
  5. ↑ Weinstein, E.A. & Kahn, R.L. (1955) Denial of Illness: Symbolic and Physiological Aspects. Springfield, IL: Thomas.
  6. 1 2 Paterson A.; Zangwill O. (1944). "Recovery of spatial orientation in the post-traumatic confusional state". Brain. 67: 54–68. doi:10.1093/brain/67.1.54.
  7. 1 2 Pick A (1903). "On reduplicative paramnesia". Brain. 26 (2): 242–267. doi:10.1093/brain/26.2.242.
  8. 1 2 Benson DF, Gardner H, Meadows JC (February 1976). "Reduplicative paramnesia". Neurology. 26 (2): 147–51. doi:10.1212/wnl.26.2.147. PMID   943070. S2CID   41547561.
  9. ↑ Sellal F.; Fontaine S.F.; van der Linden M.; Rainville C.; Labrecque R. (1996). "To be or not to be at home? A neuropsychological approach to delusion for place. Journal". Of Clinical and Experimental Neuropsychology. 18 (2): 234–48. doi:10.1080/01688639608408278. hdl: 2268/179082 . PMID   8780958.
  10. ↑ Budson A.E.; Roth H.L.; Rentz D.M.; Ronthal M. (2000). "Disruption of the ventral visual stream in a case of reduplicative paramnesia". Annals of the New York Academy of Sciences. 911 (1): 447–52. Bibcode:2000NYASA.911..447B. doi:10.1111/j.1749-6632.2000.tb06742.x. PMID   10911890. S2CID   13943779.
  11. ↑ Charles Bonnet's description of Cotard's delusion and reduplicative paramnesia in an elderly patient (1788) Förstl H, Beats B (March 1992). "Charles Bonnet's description of Cotard's delusion and reduplicative paramnesia in an elderly patient (1788)" (PDF). British Journal of Psychiatry . 160 (3): 416–8. doi:10.1192/bjp.160.3.416. PMID   1562875. S2CID   8421104.
  12. ↑ Head, H. (1926) Aphasia and Kindred Disorders. London: Cambridge University Press.
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