Delusional Misidentification and Posttraumatic Brain Injury

腦傷後的錯認症狀

10.6550/ACP.200406_1(1).0009

王佳玉(Chia-Yu Wang)；花茂棽(Mau-Sun Hua)；葉炳強(Ping-Keung Yip)；張玉玲(Yu-Ling Chang)

錯認 ； 腦傷 ； Misidentification ； Traumatic Brain Injury

臨床心理學刊

1卷1期（2004 / 06 / 30）

76 - 84

英文

目的：「對於時間與地點的錯認」已被認為是腦傷患者的一個重要的特徵。至於「對於人物的錯認」，例如Capgras症狀或Fregoli症狀，這些過去被認為是精神科疾病的表現，現在也被認為與神經科的疾病有關。在這個研究，我們報告一位車禍後出現錯認症狀，卻沒有「複製(duplication)」現象的病患。我們評估她的神經心理功能，並且嘗試探討與錯認現象相關的神經心理機制。 方法：這是一位37歲，慣用手為右利的女性已婚病患。她曾經接受14年的教育（師專），在學校的成績表現在中等以上，職業是鋼琴老師。病患過去沒有任何精神科或神經科病史。這次車禍主要造成她腦部損傷的位置在兩側額葉與前顳葉。我們評估她的神經心理功能，其中也包括了情緒狀態與半結構神經行為標準晤談量表的施測。 結果：神經心理檢查的結果顯示，病患呈現多重認知功能缺損，其中包括失憶、視空間知覺與執行功能缺損。病患的錯認症狀，包括了對於時間、地點、人物與事件的錯認。此外，病患還呈現易怒、愛開玩笑、幼稚、編故事(confabulation)與缺乏病識感(awareness)等明顯的心理病理症狀。 結論：這位病患呈現多種層面的錯認症狀，這些症狀可能與病患的時間順序記憶、視空間知覺、執行功能與缺乏病識感等，多重認知功能缺損有關。

Objective: Misidentifications of place and time have been recognized as an important feature of organic mental syndromes. Likewise, a misidentification of persons, such as the Capgras and the Fregoli syndrome has also been acknowledged to be associated with neurological diseases though it has traditionally been related to psychiatric illness. In the present study, we made an attempt to explore possible underlying neuropsychological mechanisms for a post-traumatic brain injury patient who manifested misidentification problems. Method: The patient was a 37-year-old, right-handed, married woman. She obtained a 14th grade education with an above average performance record, and was a piano tutor. She did not have any prior history of psychiatric and neurological deficits. She suffered from a traumatic brain injury, and the lesion areas mainly involved bilateral frontal and anterior temporal structures. She received a battery of neuropsychological tests including measures of emotional status, and semistructured Neurobehavioral Standard Interview. Results: The patient evidenced multiple cognitive impairments, mainly including amnesia, executive dysfunction, and visual perceptual difficulty. Misidentifications of time, place, person, and event, as well as remarkably psychopathological manifestations including irritability, jocularity, childishness, confabulation, and a loss of awareness were noted. Conclusion: Our patient evidenced a wide range of misidentification problems which mainly consisted of misidentifying place, person, and event, and these problems seem to be associated with deficits of temporal sequencing of memory, visual-spatial and visual perception, executive function, and awareness.