Delusional misidentification syndrome and confabulation in schizophrenia: a case report with rare symptoms

Confabulation is the unintentional production of false or distorted memories. Delusional Misidentification Syndromes (DMS) are psychopathological phenomena in which familiar people or places are believed to have been altered or replaced. Both are rare but clinically significant, and they may co-occur in schizophrenia. We present the case of a 27-year-old male with treatment-resistant schizophrenia who exhibited both confabulation and Fregoli syndrome. The patient produced shifting autobiographical narratives, including multiple identities, invented family members, and fantastical life events, alongside delusions that his father was an impostor in disguise. Neuropsychological testing revealed attentional and memory impairments with signs of frontal lobe involvement. Despite high-dose clozapine and amisulpride treatment, only partial improvement was achieved, and electroconvulsive therapy contributed to further symptom reduction. The patient’s PANSS score decreased from 119 to 76 after electroconvulsive therapy, indicating a marked clinical improvement. This case highlights the complex interplay between cognitive deficits, confabulation, and delusional misidentification in schizophrenia, emphasizing the importance of comprehensive assessment and individualized treatment approaches in managing rare psychopathological presentations.