Abstract Title: A case report on mirrored self-misidentification syndrome.

INTRODUCTION: Delusion of misidentifications are characterized by delusional belief that familiar person, objects, or self have been replaced or transformed. There are four common types like Capgras syndrome, Fregoli syndrome, Syndrome of subjective doubles and syndrome of intermetamorphosis. Another type of delusion of misidentification is mirrored self- misidentification, where the delusional belief is that one’s reflection in the mirror is misidentified as a stranger. CASE REPORT: A 83 years old male patient Mr. X, graduate, married, retired from his job, belonging to middle socio-economic status, hailing from urban background was accompanied to the OPD by his daughter. Informant had complaints of suspiciousness, abusing family members, abnormal behavior, and memory impairment since 6 months. Patient started suspecting that there is stranger whenever he looked into the mirrored or any other reflecting surfaces. Later he started suspecting that stranger was coming to meet his wife. Apart from this he also had memory disturbances. All the investigations were normal and he was started on Tab. Quetiapine -25mg and Tab. Donepezil -5mg. DISCUSSION: The ability to recognize oneself in the mirror has a potential way of testing self-awareness, but it is not clearly known how the brain does it. Mirrored-self misidentification has rarely been described in the literature. Most of the reported patients have global dementia of the Alzheimer type, making it difficult to infer the anatomical basis of this disorder. CONCLUSION: The loss of the ability to recognize oneself in the mirror is evidence of a fundamental change in the sense of self and this may cause interpersonal problems as well. Managing such cases may be difficult and challenging.