Abstract
Delusion of reduplication of body parts is a rare somatic delusion, and has been reported in association with delusional disorder, somatic type (DDST) [1], brain tumours, and head injuries [2]. We report a patient of Alzheimer's disease (AD) with delusion of reduplication of tongue accompanied by dangerous self-treatments.
The case was an 83 year old man. He and his family member gave consent for reporting his clinical course. His social and occupational histories were normal. Since 2006, he presented with progressive memory decline. Since 2008 he felt that the amount of saliva increased, and that the saliva solidified to form another tongue. At night, he spent some ten minutes in front of a mirror in gurgling, putting his tongue in a glass of water and rubbing it to dissolve the false tongue. From February of 2010 he felt that vinyl membranes were sticking to the tongue, gingival and oral cavity, and that small metal plates were coming out from the stomach and tongue and moving around in the mouth. In March, he began to spend about 5 h in a day on these ‘self-treatments’, while his food intake decreased with a weight loss from 62 kg to 53 kg. Finally, he was noticed by his family members to have a scissor or razor in his hands to cut off the false tongue or to scrape off the vinyl membranes and metal plates. Then he was taken to our outpatient clinic by his family members.
On examination, he had prominent somatic delusions. He also had memory difficulties, scoring 20/30 on mini mental state examination. He had no visual hallucinations, fluctuation of cognitive symptoms or Parkinsonism. Blood tests were all within normal limits. Magnetic resonance imaging revealed severe hippocampal atrophy with diffuse brain cortical atrophy. He was given a diagnosis of psychotic disorder due to AD, with delusions according to DSM-IV-TR [3]. Consent for paroxetine treatment was obtained from the patient and his family member, since we had experience of several patients with DDST responding to paroxetine monotherapy [4]. However, paroxetine 10–20 mg/day was ineffective, but the somatic delusions improved after addition of olanzapine 2.5 mg/day and donepezil 5 mg/day.
This is the first report to our knowledge of a delusion of reduplication of body parts in AD. It was critical in this instance because of the dangerous attempts to remedy the situation. We suggest this phenomenon warrants further investigation.