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A new onset of Capgras syndrome, delusional misidentification, developed in an elderly gentleman. Treatment with the antidepressant mirtazapine led to the remission. Suggestions are made for both dynamic and medical bases for Capgras syndrome and possible antipsychotic effects of mirtazapine.
OBJECTIVE: Recent theoretical approaches emphasize a disorder of face processing in the pathogenesis of the Capgras syndrome. We report a patient with the Capgras syndrome developing in the physical absence of the person who is believed to be replaced and thus a limited role for a disorder of face processing. METHOD: The clinical phenomenology of a case of the Capgras syndrome is explored. RESULTS: A disorder of face processing might not be a sufficient explanation of the course of the disorder in this patient. CONCLUSION: Face processing accounts, of the Capgras delusion, have to be supplemented by additional assumptions.
Capgras syndrome in association with lithium toxicity is described in a 74-year-old woman. Lithium toxicity should be considered when new delusions occur during lithium therapy.
Capgras Syndrome or Illusion of the Doubles is studied from a personal case. Its clinical and organic cerebral aspects are emphasized. We think that the occurrence of Capgras Syndrome should incite the clinician to look for a cerebral lesion, even in a definite psychopathological situation.
Two cases of Capgras' syndrome are described in which patients committed serious acts of violence towards family members who had become the subject of delusional misidentification. The cases illustrate some typical features of Capgras' syndrome including its potential for dangerousness. Intoxication with alcohol is proposed as a precipitant for violence in these patients.
The author report a case of Capgras' syndrome in a 12-years-old girl, who had been hospitalized for attacks of abdominal pain. These symptoms had gone on for two years and led twice to surgical interventions which did not find any organic etiology. Interviews with the girl showed that the abdominal pains were related to symptoms of typical panic attacks which lasted about 20 minutes. In some on them, she experienced multiple autoscopy and the "illusion des sosies", described by Capgras. Long-term evolution showed that Capgras' syndrome disappeared with improvement of the panic attacks, but ten years later the patient is still suffering from generalized anxiety. To our knowledge, no case, even in adult patients, was previously described in the context of panic attacks. Furthermore, Capgras' syndrome is particularly rare at adolescence. Our review of literature exhibits only 19 cases under 18. Diagnosis was available in 16 cases, and consisted of schizophrenia or schizophreniform psychosis in 62.5% of the cases. The others involved acute psychosis (2 cases), post-partum psychosis (1 case), drug-induced-psychosis (1 case), psychotic major depression (1 case), and post-varicella encephalitis (1 case). The doubles (out of the 15 cases where relevant detail is available) included at least a parent in 92.9% of patients, a brother or sister in 35.7%, a member of the medical team in 21.4% and a grand-parent in 14.3%.
Capgras syndrome (CS) is characterized by the delusional belief that a person, usually very close to the patient, has been replaced by a double who is physically very similar to the original. CS is relatively rare, occurring predominantly in course of schizophrenia, particularly of the paranoid sub-type, and less frequently in association with schizoaffective and affective disorder. Recent years have witnessed a sharp increase in the number of published CS cases with an organic etiology; however, CS was considered to have its origins in psychodynamic conflict. We present a patient with the CS and brain SPECT findings whom without psychiatric disorder. As an evaluation of brain SPECT, there have been found a significantly decreased blood flow in bilateral parietal regions and slightly decreased blood flow in bilateral posterior frontal regions. Cerebral dysfunction is proposed to be a central role in CS development. Unilateral right hemisphere lesions occur more frequently than the left; however, the majority of CS cases show bilateral involvement. Pathology involves many parts of the brain, most notably frontal and parietal cortex. Our findings support that frontoparietal dysfunction could be important in the pathogenesis of CS. We reviewed the neurobiology of CS and discussed our findings in this article. CS studies will give a better understanding of the neurobiological basis of psychotic experiences and may contribute to develop a paradigm on researches about other psychotic disorders.
We herein report a case of Capgras' syndrome observed in interictal psychosis in which the single-photon emission computed tomography (SPECT) findings before and after the appearance of the psychotic symptoms differed. SPECT with 99mTc-hexamethyl propyleneamine oxine (HMPAO) revealed worsening of hypoperfusion in the entire right hemisphere after onset of the psychotic symptoms. The enhanced hypoperfusion demonstrated by SPECT in the present case seems to indicate a right interhemispheric disconnection resulting in the occurrence of Capgras' syndrome.
A variant of the Capgras syndrome is described in a 43-year-old woman who had vitiligo and multinodular goitre. The unusual feature of the case was that the patient not only misidentified members of her own family but also claimed that she herself had been replaced by a double.
We report the occurrence of Capgras' syndrome, or the delusion of doubles, in a patient with dementia with Lewy bodies. The patient believed that several similar-looking impostors had replaced his wife of over 50 years. Uncharacteristically, he adopted a friendly attitude with these impostors. This unusual convivial reaction to the impostors may result from differential involvement of the dual visual pathways processing facial recognition and emotional responses to faces. The delusion resolved spontaneously, coincident with worsening of the dementia. In a retrospective chart review of 18 autopsy-confirmed cases of dementia with Lewy bodies, delusions were reported in 5 subjects (27.8%), of whom 1 had misidentification delusions much like Capgras' syndrome.
PURPOSE: To describe periictal Capgras syndrome as a result of rapid, successive bouts of ictal fear. METHODS: This periictal psychotic state was documented by depth EEG recordings. RESULTS: Episodes of paroxysmal fear, experienced as a vivid sensation of someone being nearby, corresponded with unilateral left limbic ictal discharge. CONCLUSIONS: Depersonalization, regardless of organic or functional origin, is an important contributor to the genesis of Capgras syndrome.
In a previous paper, the author has argued that what actually changes in the person whom the Capgras patient has chosen as his/her target of delusion is non-attribute such as having only "haecceity." At the same time, the author has pointed out that such ever-identical is also the target of the indication for the rigid designator as proposed by S. Kripke. Such problems with indication and identity, however, are closely associated with ontology presented by possible worlds semantics, an analytic philosophy that was much debated during the latter half of the 20th century. The purpose of this paper is to try to define the essence of Capgras syndrome from the viewpoint of possible worlds semantics. If Capgras syndrome is taken as suggested by the patient's statement that "a real person has been replaced by an imposter," it is though that this statement refers to metaphysics with regard to the number of individuals who exist in the world. This is because the appearance of the imposter means the generation of a new individual who had not been in existence until that time. The creation of the new individual not only demands the existence of plural worlds as addressed by possible worlds semantics, but also provides a clue to solving problems with places where the real person and its imposter exist. If the number of individuals existing in the world is taken into account, it is difficult to spatio-temporally comprehend the places in which the real person and its imposter exist. Inevitably, the real person and its imposter have to be in mutually different possible worlds as defined by possible worlds semantics. This leads into the conclusion that after the onset of Capgras syndrome, the patient and the imposter are in a possible world that is different from the possible world to which the real person belongs. In the case presented herein, the patient repeatedly talked about how difficult it was to get access to the real person. If the patient was separated by space and time from the real person, his difficulty in getting access should have been only a matter of relativity. On the contrary, it is quite likely that what the patient really wanted to express is the fundamental impossibility of access that exists between two individuals who belong to mutually different possible worlds.
In a case of Capgras' syndrome the primary double is usually the spouse. In the described case, the patient chose as a double her pregnant 15-year-old daughter even though her spouse and four other children lived with her. A psychodynamic explanation for this choice is offered within the mechanism of the "ambivalence theory."
The author describes a young woman with both Capgras syndrome and Huntington's Disease. The possible pathophysiology of Capgras syndrome is briefly reviewed in the context of the neuropathology of Huntington's Disease.
A case of Capgras' Syndrome secondary to an Organic Mental Disorder associated with metrizamide myelography is presented. The relationship of Capgras' symptom to reduplicative paramnesia and prosopagnosia is discussed.
A case of an 84-year-old woman with Capgras' syndrome is presented, and questions on diagnostic consequences and treatment are answered after reviewing the literature. There appears to no syndrome, but a symptom, that is associated with many psychiatric diagnoses, for instance psychosis, acute confusional state, affective psychosis and dementia with delusions. The mainly casuistic literature furthermore reveals that treating the 'syndrome of Capgras' consists of a symptomatic treatment of the underlying psychiatric disturbance. These case descriptions mention a variety of somatic illnesses that occur amongst elderly with the symptom of Capgras. Therefore many authors advocate exhaustive diagnostic procedures to find these illnesses. However, from our review it is clear that almost all these diagnoses have already been made before the symptom of Capgras appears. Moreover, these diagnoses vary so much that in the individual case a specific diagnostic procedure is impossible. We therefore conclude that diagnostic procedures and treatment of elderly persons with the symptom of Capgras do not differ from that of other elderly persons with psychiatric symptoms.
A 37-year-old female with Capgras syndrome was assessed on psychometric and neuropsychological measures. Significant neuropsychological deficits suggesting a frontal-temporal cerebral dysfunction were observed. The results demonstrate that the Capgras delusion involves more than an inability to recognize faces, although this deficit is one manifestation of the disorder.