To be or not to be at home? A neuropsychological approach to delusion for place.

A woman, LB, while in recovery from a viral encephalitis, exhibited a delusion for place, which led her to insist that she was at home, in spite of compelling evidence to the contrary. Later, she developed a Capgras syndrome, that is, another misidentification syndrome. The patient was given a detailed neuropsychological evaluation to shed light on the mechanisms underlying her delusional misbelief. Two main deficits were in evidence: (1) a severe visual-spatial impairment, giving the patient a distorted perception of her surroundings; and (2) frontal lobe dysfunction, which played a critical role in her impulsive responses and lack of self-awareness. The pathogenesis of delusion for place and persons if discussed in light of these observations.