Capgras' syndrome: a synthesis of various viewpoints.
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Biomedical subjects
Publications and source records attributed to S F Signer.
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A woman with Capgras and de Clérambault's syndromes transmitted persecutory, erotic, and somatic delusions to her son in a folie à deux. Capgras and de Clérambault's syndromes appear together more commonly than is apparent in the literature. Review of these cases shows a strong association with severe affective disorder.
Two patients with erotomania (de Clérambault's syndrome) associated with epilepsy and head trauma are presented. The delusion appeared during periods of mania or hypomania and partially remitted during depression or euthymia. Erotomania may be seen in a wide variety of psychotic conditions, including those that are organically based.
Two female patients with longstanding bipolar affective disorder demonstrated de Clérambault's paradigm of erotomania during the euthymic phase of their illness. Although a diagnosis of schizophrenia or paranoid disorder is often given, a review of the literature shows that many cases have features of a major affective disorder, probably bipolar affective disorder and its spectrum.
The English and French literature on Capgras' syndrome yielded 315 patients, 212 of whom provided the basis for review. Forty-six percent presented with an affective disturbance. Seven variant forms of a unified delusion of substitution are described: Capgras; subjective doubles, Capgras type; Fregoli; intermetamorphosis; subjective doubles, autoscopic type; "reverse" subjective doubles; and "reverse" Fregoli. Classes of single and multiple forms of the delusion with either functional or organic etiology were compared. Multiple form classes had a greater diversity of variant forms.
Two individuals with well-defined seizure problems developed dual personalities. One personality was irritable and hostile, the other placid; in each case, a major seizure preceded the shift from the former to the latter. Each personality was amnesic for the other. The incidence of seizures in patients with multiple personality disorder is higher than expected, and these cases demonstrate a direct relationship.
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Amoxapine, a member of the dibenzoxazepine drugs which includes loxapine, has recently been introduced for the treatment of depression. We present five cases of amoxapine failure after an initial good response, which showed severe deterioration with an increase in dosage. The dopamine-blocking effects of amoxapine metabolites are discussed. The mechanism of failure may be related to either the appearance of akinetic depression or a strong neuroleptic effect.
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