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Conference Poster The Neuropsychiatric Features of Fregoli Syndrome: A Case-Level Meta-Analysis Maria Teixeira-Dias, Amber Kaur Dadwal & Dr Graham Blackman King’s College London [email protected] Introduction Results § Fregoli syndrome: Delusion of misidentification § A sample of 67 patients was obtained from 59 eligible characterised by the false belief that people in the studies. environment are other people of closer emotional link § Primary psychosis Fregoli patients: n = 47 in disguise (Langdon et al., 2014). § Secondary psychosis Fregoli patients: n = 20 § There is lack of comprehensive understanding of the characteristics of Fregoli syndrome in both patients § First-episode psychosis was significantly more likely in with primary or secondary psychosis. patients with Fregoli syndrome in the secondary psychosis § This has posed challenges to mental health group (OR = 7.04, 95% CI [1.07, 60.49]). professionals and a lack of efficacy in assessment, § Neuroimaging abnormalities were also significantly more diagnoses and treatment of such syndrome (Atta et likely in secondary psychosis patients with Fregoli al., 2016). syndrome (OR = 10.66, 95% CI [1.51, 108.87]). § Brain lesions were seen predominantly on the right Study Aim hemisphere (n = 8; 67%) § To compile existent evidence and investigate the § The temporal (n = 6; 50%) and frontal (n = 5; 42%) lobes differences in the neuropsychiatric features of Fregoli were the most affected areas in patients with Fregoli syndrome in patients with primary and secondary syndrome (Figure 2). psychosis. Primary Outcomes Cognitive Co-occurring Co-occurring Depression and Methods Records identified Impairment Delusions Hallucinations Anxiety § 5 electronic through database search First-Episode Multiple Fregoli Neuroimaging databases were (n = 9888) Records identified Lack of insight through other Psychosis Delusions Abnormalities searched. sources § Methodological quality Records after (n = 4) Restlessness EEG Persecutory and Response to of case studies was duplicates removed Abnormalities Features treatment assessed (Murad et (n = 4656) Agitation al., 2018). Thought Violent Sleep Problems Disorder Behaviour § Odds ratios (OR) and Records screened Records excluded 95% confidence (n = 561) (n = 427) Figure 1. Primary outcomes in this meta-analysis intervals (CI) were Lesion Location in Fregoli syndrome computed to examine Full-text articles (n = 12) Full-text articles assessed for the differences in excluded 60% eligibility (n = 75) Fregoli syndrome (n = 134) 50% between primary and 50% secondary psychosis. Studies included in 42% § Secondary analyses quantitative 40% analysis (meta- addressed the analysis) 33% 33% contents of delusion, (n = 59) 30% types of cognitive Table 1. PRISMA Study Search Flowchart Diagram impairment and types 20% of co-occurring delusions, as well as different treatment modalities. 10% § The location of neuroimaging abnormalities was assessed through the analysis of frequencies and percentages. 0% § Sensitivity analyses were run to assess robustness of Temporal Lobe Frontal Lobe Medial Lobe Parietal Lobe results. Figure 2. Lesion location in Fregoli syndrome patients with both primary (n = 3) and secondary psychosis (n = 9). Conclusions § Fregoli syndrome as a first-episode psychosis may point to a secondary underlying illness. § Neuroimaging abnormalities are more prevalent in secondary psychosis patients, trending to be on the right hemisphere. References: Atta, K., Forlenza, N., Gujski, M., Hashmi, S., & Isaac, G. (2006). Delusional Misidentification Syndromes: Separate Disorders or Unusual Presentations of Existing DSM-IV Categories? Psychiatry, 3(9), 56–61. Langdon, R., Connaughton, E., & Coltheart, M. (2014). The Fregoli delusion: a disorder of person identification and tracking. Topics in Cognitive Science, 6(4), 615–631. Murad, M. H., Sultan, S., Haffar, S., & Bazerbachi, F. (2018). Methodological quality and synthesis of case series and case reports. Evidence-Based Medicine, 23(2), 60–63. https://doi.org/10.1136/bmjebm- 2017-110853.
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