Delusional misidentifications and duplications
Right brain lesions, left brain delusions
Abstract
When the delusional misidentification syndromes reduplicative paramnesia and Capgras syndromes result from neurologic disease, lesions are usually bifrontal and/or right hemispheric. The related disorders of confabulation and anosognosis share overlapping mechanisms and anatomic pathology. A dual mechanism is postulated for the delusional misidentification syndromes: negative effects from right hemisphere and frontal lobe dysfunction as well as positive effects from release (i.e., overactivity) of preserved left hemisphere areas. Negative effects of right hemisphere injury impair self-monitoring, ego boundaries, and attaching emotional valence and familiarity to stimuli. The unchecked left hemisphere unleashes a creative narrator from the monitoring of self, memory, and reality by the frontal and right hemisphere areas, leading to excessive and false explanations. Further, the left hemisphere's cognitive style of categorization, often into dual categories, leads it to invent a duplicate or impostor to resolve conflicting information. Delusions result from right hemisphere lesions. But it is the left hemisphere that is deluded.
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REFERENCES
1.
Lahti AC, Weiler MA, Holcomb HH, Tamminga CA, Carpenter WT, McMahon R. Correlations between rCBF and symptoms in two independent cohorts of drug-free patients with schizophrenia. Neuropsychopharmacology 2006;31:221–230.
2.
Cummings JL. Organic delusions. Br J Psychiatry 1985;46:184–197.
3.
Joseph KA. Capgras syndrome and its relationship to neurodegenerative disease. Arch Neurol 2007;64:1762–1766.
4.
Gorman DG, Cummings JL. Organic delusional syndrome. Semin Neurol 1990;10:229–238.
5.
Malloy PF, Richardson ED. The frontal lobes and content-specific delusions. J Neuropsychiatry 1994;6:455–466.
6.
Feinberg TE, Deluca J, Giacino JT, Roane DM, Solms M. Right-hemisphere pathology and the self: delusional misidentification and reduplication. In: Feinberg TE, Keenan JP, eds. The Lost Self. New York: Oxford University Press; 2005:100–130.
7.
Benson DF, Djenderedjian A, Miller BL, et al. Neural basis of confabulation. Neurology 1996;46:1239–1243.
8.
Moscovitch M, Melo B. Strategic recall and the frontal lobes: evidence from confabulation and amnesia. Neuropsychologia 1997;35:1017–1034.
9.
Johnson MK, Hayes SM, D'Esposito M, Raye CL. Confabulation. In: Grafman J, Boller F. Handbook of Neuropsychology, 2nd Ed. Amsterdam: Elsevier Science; 2000:383–407.
10.
Box O, Laing H, Kopelman M. The evolution of spontaneous confabulation, delusional misidentification and a related delusion in a case of severe head injury. Neurocase 1999;5:251–262.
11.
Mattioli F, Miozzo A, Vignolo LA. Confabulation and delusional misidentification: A four year followup study. Cortex 1999;35:413–422.
12.
Deluca J, Diamond BJ. Aneurysm of the anterior communicating artery: a review of neuroanatomical and neuropsychologic sequelae. Clin Exp Neuropsychol 1995;17:100–121.
13.
Malloy P, Cimino C, Westlake R. Differential diagnosis of primary and secondary Capgras delusions. Neuropsychiatry Neuropsychol Behav Neurol 1992;2:83–96.
14.
Devinsky O. Right cerebral hemisphere dominance for a sense of corporeal and emotional self. Epilepsy Behav 2000;1:60–73.
15.
Feinberg TE, Roane DM. Anosognosia, completion and confabulation: the neutral-personal dichotomy. Neurocase 1997;3:73–85.
16.
Babinski J. Contribution a l'etude des mentaux dans l'hemiplegie organique (anosognosie). Rev Neurol 1914;27:845–848.
17.
Critchley M. Observations on anosodiaphoria. Encephale 1953;46:540–546.
18.
Critchley M. Personification of paralyzed limbs in hemiplegics. BMJ 1955;30:284.
19.
Critchley M. Misoplegia or hatred of hemiplegia. Mt Sinai J Med 1974;41:82–87.
20.
Capgras J, Reboul-Lachaux J. Illusion des sosies dans un delire systematise chronique. Bulletin de la societe clinique de medicine mentale 1923;2:6–16.
21.
Capgras J, Carette P. Illusion des sories et complexe d'Oedipe. Ann Medico-Psychologiques 1924;12:48.
22.
Förstl H, Almeida OP, Owen AM, Burns A, Howard R. Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases. Psychol Med 1991;21:905905–910.
23.
Breen N, Caine D, Coltheart M. Mirrored-self misidentification: two cases of focal onset dementia. Neurocase 2001;7:239–254.
24.
Postal KS. The mirror sign delusional misidentification symptom. In: Feinberg TE, Keenan JP. The Lost Self: Pathologies of the Brain and Identity. New York: Oxford University Press; 2005:131–146.
25.
Kapur N, Coughlan AK. Confabulation and frontal lobe dysfunction. J Neurol Neurosurg Psychiatry 1980;43: 461–463.
26.
Fisher CM. Disorientation for place. Arch Neurol 1982;39:33–36.
27.
Pick A. Clinical studies. Brain 1903;26:242–267.
28.
Joseph AB, O'Leary DH, Kurland R, Ellis HD. Bilateral anterior cortical atrophy and subcortical atrophy in reduplicative paramnesia: a case-control study of computed tomography in 10 patients. Can J Psychiatry 1999;44:685–689.
29.
Benson DF, Gardner H, Meadows JC. Reduplicative paramnesia. Neurology 1976;26:147–151.
30.
de Pauw KW, Szulecka TK, Poltock TL. Frégoli syndrome after cerebral infarction. J Nerv Ment Dis 1987;175:433–438.
31.
Narumoto J, Nakamura K, Kitabayashi Y, Fukui K. Othello syndrome secondary to right orbitofrontal lobe excision. J Neuropsychiatry Clin Neurosci 2006;18:560–561.
32.
El Gaddal YY. De Clerambault's syndrome (erotomania) in organic delusional syndrome. Br J Psychiatry 1980;154:714–716.
33.
Turnbull OH, Berry H, Evans CE. A positive emotional bias in confabulatory false beliefs about place. Brain Cogn 2004;55:490–494.
34.
Ruff RL, Volpe BT. Environmental reduplication associated with right frontal and parietal lobe injury. J Neurol Neurosurg Psychiatry 1981;44:382–386.
35.
Ellis HD, Young AW, Quayle AH, de Pauw KW. Reduced autonomic responses to faces in Capgras delusion. Proc Biol Sci 1997;264:1085–1092.
36.
Hirstein W, Ramachandran VS. Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons. Proc Biol Sci 1997;264:437–444.
37.
Alexander MP, Stuss DT, Benson DF. Capgras syndrome: a reduplicative phenomenon. Neurology 1979;29:334–339.
38.
Levine DN, Grek A. The anatomic basis of delusions after right cerebral infraction. Neurology 1984;34:577–582.
39.
Feinberg TE, Shapiro RM. Misidentification-reduplication and the right hemisphere. Neuropsychiatry Neuropsychol Behav Neurol 1989;2:39–48.
40.
Sultzer DL, Brown CV, Mandelkern MA, et al. Delusional thoughts and regional frontal/temporal cortex metabolism in Alzheimer's disease. Am J Psychiatry 2003;160:341–349.
41.
Nakano S, Yamashita F, Matsuda H, Kodama C, Yamada T. Relationship between delusions and regional cerebral blood flow in Alzheimer's disease. Dement Geriatr Cogn Disord 2006;21:16–21.
42.
von Gunten A, Miklossy J, Suvà ML, Hof PR, Glannakopoulos P. Environmental reduplicative paramnesia in a case of atypical Alzheimer's disease. Neurocase 2005;11:216–226.
43.
Harding AJ, Broe GA, Halliday GM. Visual hallucinations in Lewy body disease relate to Lewy bodies in the temporal lobe. Brain 2002;125:391–403.
44.
McKeith IG, Perry RH, Fairbairn AF, Jabeen S, Perry EK. Operational criteria for senile dementia of Lewy body type (SDLT). Psychol Med 1992;22:911–922.
45.
Corlett PR, Murray GK, Honey GD, et al. Disrupted prediction-error signal in psychosis: evidence for an associative account of delusions. Brain 2007;130:2387–2400.
46.
Kunert HJ, Norra C, Hoff P. Theories of delusional disorders. Psychopathology 2007;40:191–202.
47.
Maher BA. Anomalous experience and delusional thinking: The logic of explanations. In: Oltmanns TF, Maher BA, eds. Delusional Beliefs. New York: Wiley; 1988: 15–33.
48.
Gainotti G. Face familiarity feelings, the right temporal lobe and the possible underlying neural mechanisms. Brain Res Rev 2007;56:214–235.
49.
Bowles B, Crupi C, Mirsattari SM, et al. Impaired familiarity with preserved recollection after anterior temporal-lobe resection that spares the hippocampus. Proc Natl Acad Sci 2007;104:16382–16387.
50.
Vignal J-P, Maillard L, McGonigal A, Chauvel P. The dreamy state: hallucinations of autobiographic memory evoked by temporal lobe stimulations and seizures. Brain 2007;130:88–89.
51.
Mullan S, Penfield W. Illusions of comparative interpretation and emotion. Arch Neurol Psychiatry 1959;81:269–284.
52.
Vuilleumier P, Mohr C, Valenza N, Wetzel C, Landis T. Hyperfamiliarity for unknown faces after left lateral temporo-occipital venous infarction: a double dissociation with prosopagnosia. Brain 2003;126:889–907.
53.
Nente F, Carrillo-Mezo R, Mendez MF, Ramirez-Bermudez J. Pathological hyperfamiliarity for others from a left anterior cingulate lesion. J Neuropsychiatry Clin Neurosci 2007;19:345–346.
54.
Keenan JP, Wheeler M, Platek SM, Lardi G, Lassonde M. Self-face processing in a callosotomy patient. Eur J Neurosci 2003;18:2391–2395.
55.
Bogousslavsky J, Regli F. Response-to-next-patient-stimulation: a right hemisphere syndrome. Neurology 1988;38:1225–1227.
56.
Jackson JH. Evolution and dissolution of the nervous system. In: Taylor J, ed. Selected Writings of John Hughlings Jackson, Volume 2. New York: Basic Books; 1884/1958:45–75.
57.
Sperry RW, Zaidel E, Zaidel D. Self recognition and social awareness in the deconnected minor hemisphere. Neuropsychologia 1979;17:153–166.
58.
Gazzaniga MS. Cerebral specialization and interhemispheric communication. Brain 2000;123:1296–1326.
59.
Gazzaniga MS. The split brain revisited. Sci Am 1998;279:50–55.
60.
Brown HD, Kosslyn SM. Cerebral lateralization. Curr Opin Neurobiol 1993;3:183–186.
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Published online: January 2, 2009
Published in print: January 6, 2009
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