Late Onset First Episode Psychosis Emerging as Delusional Misidentification of Familiar Sacred Places During a Holy Pilgrimage: A Case Report and Literature Review

Background

The delusional misidentification syndromes (DMS) include a myriad of discrete but related syndromes, which have wide spectrum anomalies of familiarity. Several misidentification syndromes have been described in the psychiatric literature, the most common of these delusions are: the Capgras syndrome; the Fregoli syndrome; the syndrome of inter-metamorphosis; reduplicative paramnesia; and environmental reduplication.

Case Presentation

The reported case highlights the emergence of late onset first episode psychosis in a Middle Eastern 65-year-old female who has no previous psychiatric history. The nature of psychosis was mainly delusions of misidentification and persecution.

Discussion

DMS are relatively rare and occur predominantly in association with schizophrenia and affective psychosis. Between 25 and 40% are associated with organic conditions such as dementia, head injuries, brain tumors, and epilepsy. Only three cases of misidentification of sacred places have been reported previously in the literature. This case report is the first to present a DMS, emerging as a late onset first episode psychosis during the sacred journey of Hajj.

Clinical Implications

The reported case highlights the importance of early recognition and treatment of mental health conditions that may appear de novo during the Hajj sacred journey. Readily available psychiatric resources, psychotropic medications, and psycho-education may be pivotal in ensuring mental well-being of pilgrims, which is fundamental to maintain the mental capacity required for completing these journeys.

     

Reactionary Deconversion from Mormonism: Polarization of Ideological and Behavioral Religiosity Among Active and Former Mormons

In contrast to a growing body of literature examining the experiences and trends of those who leave their faith tradition—particularly among Christian denominations—relatively little is known about those who specifically disaffiliate from Mormonism, although some evidence suggests that former Mormons may be especially likely to embrace secularity or irreligion rather than other religious beliefs and practices. Pursuant to empirically investigating this reactionary dynamic, the current study compared the relative religiosity and secularity of an online sample of active Mormons (n?=?194) and former Mormons (n?=?109) using the Abbreviated Religiousness Measure (ARM), an updated questionnaire of multidimensional religiosity. Results supported the ARM’s improved psychometrics and its hypothesized three-factor structure with both subsamples. Additionally, multivariate and univariate results indicated that active and former Mormon participants from our sample, significantly polarized in their self-reported level of religious beliefs, rituals, and influence on daily behaviors, with active Mormon reporting high religiosity and former Mormons reporting low religiosity or high secularity. Although these results comport with reactionary deconversion dynamics found in other high cost religions, limits to generalizability are discussed. Reasons for and implications of this reactionary phenomenon are also posited.