Today I had a patient with delusional misidentification syndrome. There are different types: Capgras syndrome, where someone familiar like a family member has been replaced by an nearly identical stranger; Fregoli syndrome, where someone thinks people they encounter throughout the day are actually the same person (often a enemy or persecutor) in disguise; phantom boarder syndrome, where a person believes that there is someone living in their house (but they never see this person). All of these sound like they would be very frightening to experience both as the patient and as a loved one. The patient I saw today had kinda a mix of Capgras and phantom boarder. She believed that her husband of 40 years was a family friend overstaying his welcome at her house. She claims she had been divorced for 10 years and this guy just showed up and refuses to leave. She has called the police multiple times to have him removed, but they aren’t able to do anything because according to his driver’s license, he lives there. It’s just a sad situation overall. For the wife because that must be so scary to think some strange man is invading your home. For this husband because this woman that he shared 40 years of his life with is acting like none of that existing and treating him like a stranger.
What’s even more heartbreaking is there isn’t really anything we can do to make the situation better. The patient’s condition is age related and there is no cure or super effective treatment for dementia so she will just continue to decline. The husband doesn’t want to send her away and he doesn’t want to cause her any torment, but he also shouldn’t have to move out of his own house.
One part of me says, it’s cases like this that make me not want to go into psychiatry. But at the same time I feel some guilt because I feel like then I’m running away from difficult situation, but the reality I’m not sure how much psychiatry is actually involved in cases like this besides “understanding” the pathology and etiology, maybe providing medications with limited efficacy to marginally help lessen the symptoms, and make recommendations to send the patient to a facility or consider home health depending on a variety of other circumstances and social factors.
Later in the day I was able to volunteer with Doctors Without Wall, this time at a park clinic. It was nice to be back and see the familiar faces. It was nice getting to hear about patients now with this new medical knowledge and actually have some thoughts on management in a setting where previously I played a very different role. Gets me a bit fired up.
TTITF: old friends, vegan donuts, extroverted strangers