“A Case of Mirror Image Agnosia and Mirrored Self-Misidentification Syndrome in Schizophrenia without Dementia or Structural Abnormalities”, 2020-07-29 ():
Delusional misidentification syndrome (DMS) is an umbrella term encompassing a variety of disorders. One rare form of DMS is the delusional misidentification of one’s own reflection, known as “mirrored self-misidentification syndrome”. In “mirror image agnosia”, the ability to identify the image of self and/or others in the mirror is lost, while the ability to identify the mirror itself is preserved.
To our knowledge, mirror image agnosia has never been described in a patient with schizophrenia.
Herein we present a case of a patient with schizophrenia with severe delusions of both mirrored self-misidentification and mirror image agnosia without any structural abnormalities or dementia.
[Keywords: mirror agnosia, mirror image agnosia, delusional misidentification syndrome, schizophrenia, psychosis]
…However, she presented to us under a different name; she believed she was a “baby” and was unaware of her age or date of birth. On our mental status exam, she demonstrated euthymic [normal] mood with irritable affect, grandiose thought content and endorsing symptoms of auditory hallucinations, paranoid delusions, as well as believing she was pregnant. The patient was started on haloperidol 5 mg PO BID for symptoms of psychosis, and diphenhydramine 25 mg PO BID for EPS prophylaxis. On day 4 of hospitalization, the patient was found to have delusions of misidentification and mirrored self-misidentification that was not noted on any of her previous admissions. She stated spontaneously that she saw someone in the mirror but did not think that was her. She identified them as wearing the same clothes as her but she called them by a different name. However when she was asked to identify another person that wasn’t her in the mirror, she stated correctly that she was seeing a double of that person…interestingly, the patient was also noted to be talking and arguing with her own self-reflection. The patient was able to identify other individuals’ reflections in the same mirror. When the patient was asked to grab a pen, she grabbed the real one and did not look for reflected images inside the mirror. When the patient was asked to localize the pen, which was outside of her line of sight, she was able to localize all the directions of the moving object.
…On her 14th day of admission, she was discharged with substantial improvements in her psychotic symptoms. However, she still remained with the delusions of misidentification and mirrored self-identification.