Horn M, Pins D, Vaiva G, Thomas P, Fovet T, Amad A
CHU Lille, pôle de psychiatrie, 59000 Lille, France; Univ. Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), 59000 Lille, France.
CHU Lille, pôle de psychiatrie, 59000 Lille, France; Univ. Lille, CNRS UMR 9193, laboratoire de sciences cognitives et sciences affectives (SCALab-PsyCHIC), 59000 Lille, France.
Encephale. 2018 Sep;44(4):372-378. doi: 10.1016/j.encep.2017.12.010. Epub 2018 Mar 24.
Delusional misidentification syndromes (DMS) correspond to the delusional belief of misidentification of familiar persons, places or objects and to the conviction that they have been replaced or transformed. Several cases of patients who developed violent behavior while suffering from DMS have been published. This led some authors to consider patients with DMS at risk of violence. However, only a few studies have focused on the potential relationship between violence and DMS. The aim of our study was to explore this relationship with a literature review of published cases of patients having committed violent acts associated to DMS.
A systematic literature search was conducted on PubMed up to January 2017 using the following term combination "misidentification" and "violence" Fifteen cases of patients with DMS who had committed violent acts were identified. The data from these descriptions were analyzed and synthetized.
Most of the patients were men with a diagnosis of schizophrenia and Capgras syndrome. Acts of violence were severe with a relatively high number of murders or attempted murders. For half of the patients these violent acts were perpetrated with weapons. Victims were regularly the patient's family members and the assaults were usually not planned. Delusional syndromes often progressed for several years. Importantly, substance abuse, which is known to increase the risk of violence in patients with schizophrenia, was only observed in two patients.
DMS are associated with several risk factors of violence, such as a diagnosis of schizophrenia, specific delusions including megalomania, persecution, negative affects and identified targets. Despite this risk for severe violence, there are no existing guidelines on how to assess and treat DMS in schizophrenia. Accordingly, we propose (1) the establishment of formal diagnostic criteria, (2) the development of rigorous research on these syndromes and (3) the integration of DMS in assessment of violence risk in schizophrenic patients.
妄想性错认综合征（DMS）表现为对熟悉的人、地点或物体产生错认的妄想信念，并坚信它们已被替换或改变。已有数例患有DMS的患者出现暴力行为的病例报道。这使得一些作者认为患有DMS的患者有暴力风险。然而，只有少数研究关注暴力与DMS之间的潜在关系。我们研究的目的是通过对已发表的与DMS相关的暴力行为患者病例进行文献综述来探讨这种关系。
截至2017年1月，在PubMed上进行了系统的文献检索，使用了以下术语组合“错认”和“暴力”。共识别出15例患有DMS且实施了暴力行为的患者。对这些描述中的数据进行了分析和综合。
大多数患者为男性，诊断为精神分裂症和卡普格拉综合征。暴力行为严重程度较高，谋杀或谋杀未遂的数量相对较多。一半的患者使用武器实施这些暴力行为。受害者通常是患者的家庭成员，袭击通常没有预谋。妄想综合征往往持续数年。重要的是，已知会增加精神分裂症患者暴力风险的药物滥用仅在两名患者中观察到。
DMS与多种暴力风险因素相关，如精神分裂症诊断、包括夸大狂、迫害妄想、负面影响及明确目标在内的特定妄想。尽管存在严重暴力风险，但目前尚无关于如何评估和治疗精神分裂症中DMS的指南。因此，我们建议：（1）建立正式的诊断标准；（2）对这些综合征开展严谨的研究；（3）将DMS纳入精神分裂症患者暴力风险评估中。
