M6, T3, cognitive neuropsychology and delusions of reduplication

Question 1

Reduplicative paramnesia of person, DB patient example

Answer 1

• Breen et al (2000) patient DB, 76 year old female
• No history of psychiatric illness, dementia or amnesia
• Had right hemisphere damage
• Right parietal stroke -> RP
• She was disoriented for time and place
• Husband died 4 years ago and was cremated
• She also believed that he was a patient in the same hospital as her

Question 2

Other reduplications from patient DB

Answer 2

• Acknowledge husband had passed away
• In same conversation reported he was a patient in the hospital
• Reduplicated other family members -> daughters, grandson
• All family members worked or were patients at hospital
• 19 months later while in a nursing home she still insisted her husband was alive
• Reduplicated places – nursing home taken over her house

Question 3

Reduplicative paramnesia of person, explained by Coltheart’s Two Factor Theory

Answer 3

1. Right parietal regions stroke she was disoriented for time and place (first factor/deficit)
2. Right hemisphere damage in frontal region [Right lateral prefrontal cortex] = weakened belief evaluation system (second factor/deficit)

Question 4

Place reduplication

Answer 4

• Delusional Misidentification Syndrome
• Environmental reduplicative paramnesia
• Subjective belief that a place has been duplicated and the places exists in at least two locations simultaneously
• Cause mainly neurological
  -> Possibly the first case: Bonnet (1788) patient who believed they were dead and that her current location was in another place

Question 5

Place reduplication patient example, Prof Pick

Answer 5

• Pick (1903) – patient with belief that there are two or more places with the same name
• 67 year old woman with possible neurodegenerative disease
• Claimed there were two clinics each headed by Professor Pick
• Two clinics one in Prague and another in her home town
• Patient claimed to be located/treated in the replica clinic in her home town
• Patient resisted all attempts to explain that belief was not correct

Question 6

Three variations of place reduplication

Answer 6

1. Place Reduplication – Place duplicated and exists simultaneously (and identical in both cases) in two or more locations that are geographically separated
2. Chimeric Assimilation – Two places become combined
3. Extravagant Spatial Localisation – Patient believes that the current location they are in is actually somewhere else

Question 7

Place reduplication, causes and criteria

Answer 7

• Patient little concern for their condition and decreased foresight
• Patient may initially display confabulation which resolves shortly after injury
• Typically organic cause not psychiatric
  -> Head trauma, cerebral infarction
  -> Patient does not have paranoia
• Delusion must persist after injury to be Place Reduplication
• Must be resistant to reason

Question 8

Three clusters of cog deficits for place reduplication

Answer 8

• Memory deficits
• Impaired geographical/visuospatial skills
• Executive skill dysfunctions

Question 9

Place reduplication, neural stuff

Answer 9

• Right hemisphere and/or bi-frontal injury, supported by imaging and CT scans
• Right hemisphere damage impairs visuospatial perception and visual memory
• Damage to the Right Hemisphere frontal lobe –> difficult to inhibit the false impressions related to disorientation
• Also some evidence of parietal and temporal damage

-> Loss of self-related function monitoring of reality, familiarity and memories OR
-> Overactivity of the left hemisphere due to right hemisphere deficit

Question 10

Moving forward with place reduplication

Answer 10

• May resolve after period of time
• Medications might be of use
• May co-occur with deficits in Memory, Executive functions, Attention, Visuospatial and topographic functions
• But these deficit occur without Place Reduplication so why does Place Reduplication?
  -> Patient has a false familiarity with place – mistaken for somewhere more familiar

Question 11

Coltheart (2007, 2010, 2011) Two Factor Theory and place reduplication

Answer 11

(1) Neurological damage that causes first factor/deficit
1. Memory deficits
2. Impaired geographical/visuospatial skills
-> Patient can recognise familiar landmarks and places but have issues orienting themselves in relation to these landmarks
3.False familiarity with place – mistaken for somewhere more familiar

(2) Right hemisphere frontal lobe damage [Right lateral prefrontal cortex] -> weakens belief evaluations system which causes difficulty in inhibiting the false impressions related to disorientation (second factor/deficit)

Question 12

Invisible doppelganger

Answer 12

Person believes that
- They have a clone of their real self OR
- They are the clone of their real self

• Neurological cause (exact location unknown) but it might be linked with the experience of owning one’s own body.
• Might be within the thalamocortical and limbic loops (widely distributed throughout the brain)
• DTI study showed small lesion fronto-opercular region in otherwise healthy male

Question 13

Coltheart (2007, 2010, 2011) Two Factor Theory and invisible doppelganger

Answer 13

1. Neurological cause associated with the thalamocortical and limbic loops that affects ownership of one’s body (first factor/deficit)
2. Right hemisphere damage in fronto-opercular region [Right lateral prefrontal cortex] = weakened belief evaluation system (second factor/deficit)