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A case of Capgras syndrome in a 67-year-old man who failed to improve on haloperidol, but responded to pimozide, is described. The patient's paranoid delusions abated with 8 mg per day of pimozide. We believe pimozide's established benefit in the treatment of delusional disorders warrants its consideration in alleviating other delusions, including "the delusion of doubles."
The Capgras' syndrome is the delusional belief that a person or object has been replaced by an identical duplicate, usually with evil intent. A clinical, psychometric and electroencephalographic study of 9 patients afflicted with this syndrome and its variants was performed. The clinical course and the therapeutic response were assessed during the follow up that run between 2 and 11 years. The aim of this paper is to discuss the etiologically relevant psychodynamic, organic and mythological issues and to postulate an explanatory model that integrates limbic mechanisms, affect recognition processes, psychodynamic factors and anthropological aspects.
Case report of an adolescent with Capgras Syndrome in the absence of organic brain syndrome is presented. Four cardinal features associated with Capgras Syndrome--(1) moderate-to-severe anxiety or stress, (2) ambivalent love-hate relationships with important love objects, (3) body image distortion, and (4) rejection-abandonment phenomena--were developed vis-a-vis the developmental tasks of adolescence. The literature consisting of 75 case reports is reviewed from the standpoint of differential diagnosis especially with respect to organic brain syndromes and schizophrenia.
Patients with Capgras syndrome regard people whom they know well such as their parents or siblings as imposters. Here we describe a case (DS) of this syndrome who presents several novel features. DS was unusual in that his delusion was modality-specific: he claimed that his parents were imposters when he was looking at them but not when speaking to them on the telephone. Unlike normals, DS's skin conductance responses to photographs of familiar people, including his parents, were not larger in magnitude than his responses to photographs of unfamiliar people. We suggest that in this patient connections from face-processing areas in the temporal lobe to the limbic system have been damaged, a loss which may explain why he calls his parents imposters. In addition, DS was very poor at judging gaze direction. Finally, when presented with a sequence of photographs of the same model's face looking in different directions, DS asserted that they were "different women who looked just like each other'. In the absence of limbic activation, DS creates separate memory "files' of the same person, apparently because he is unable to extract and link the common denominator of successive episodic memories. Thus, far from being a medical curiosity. Capgras syndrome may help us to explore the formation of new memories caught in flagrante delicto.
A case of Capgras syndrome in a black Zimbabwean patient is described. The syndrome occurs in the setting of a schizophrenic illness, but psychodynamic factors are readily identified despite the patient's different cultural background.
A patient recovering from a severe head injury developed a prolonged Capgras syndrome in which he believed his wife and five children had been replaced by nearly identical substitutes. Although this phenomenon is considered a functional disorder in the psychiatric literature, recent reports postulate an organic basis. Recent studies of the comparable neurologic disorder, reduplicative paramnesia, have stressed the importance of bilateral frontal and right hemisphere pathology. Neuropsychologic and neuroradiologic data in our patient revealed this combination, suggesting that the Capgras syndrome may be a form of reduplicative paramnesia with the same pathologic substrate.
A case of secondary erotomania co-existent with Capgras' syndrome presented with features that have not been reported before. The case is suggested to be a variant of de Clérambault's syndrome. The role of cultural factors in altering the clinical picture is insignificant.
Words such as 'consciousness' and 'self' actually encompass a number of distinct phenomena that are loosely lumped together. The study of neurological syndromes allows us to explore the neural mechanisms that might underlie different aspects of self, such as body image and emotional responses to sensory stimuli, and perhaps even laughter and humour. Mapping the 'functional logic' of the many different attributes of human nature on to specific neural circuits in the brain offers the best hope of understanding how the activity of neurons gives rise to conscious experience. We consider three neurological syndromes (phantom limbs, Capgras delusion and pain asymbolia) to illustrate this idea.
The study of a case of Capgras syndrome with striking clinical features illuminates the reality elements, affective conflicts, and cognitive processes that go into forming this specific delusion; and raises questions about the nosologic uniqueness of the entity. The meaning of the syndrome as a communication about an altered reality is highlighted.
In a 40-yr.-old man a variant of Capgras syndrome called reverse subjective doubles is described. The unusual feature of the case was the presence of a delusion that the patient had been transformed into someone else.
Two additional cases of Capgras syndrome were reported. In these schizophrenic patients, the abrupt hatred against family members seemed to contribute largely to the genesis of the syndrome in addition to delusional background. At the same time, the importance of delusional retrospective interpretation in these patients as well as in the previously reported case was discussed.
A case of so-called Capgras' syndrome occurring in an elderly woman showing several degenerative conditions is presented as a basis for questioning the value of preserving this diagnostic term. It is pointed out that the concept of the changeling has ancient provenance in man's thought down the ages, and that its occurrence in psychosis does not justify its ascription as a syndrome. 'Changeling' or 'imposture' are terms which describe this kind of delusion usually occurring in underlying schizophrenic, affective and organic syndromes.
Capgras syndrome is an unfrequent delusional disorder based on the patient's belief that a significant person for him or her, mainly the spouse, becomes a "double", undistinguishable from the real one, but threatening in some way. There are about two hundred reports of the syndrome in international psychiatric literature. This paper describes a new case in a woman aged 68, diagnosed of Major Affective Disorder, without signs of any other organic mental disease. The authors review some ethiological theories in relation with the disorder, which are contrasted with the characteristics of the new case.
In the Capgras syndrome (CS) there is a natural dissociation between recognition and identification and it deserves to be designated as an agnosia of identification. Joseph Capgras who first introduced this concept of agnosia, also suggested that the syndrome might be studied within the framework of 'méconnaissance systématique' (translated here as systématic unawareness), thus anticipating a type of interpretation in which the basis of CS (and other delusional misidentification syndromes) would be a lack of corporeal and/or egocentric space awareness. From two examples, it is suggested that the basic phenomenon of unawareness may be due to sensory deprivation. A particular process of awareness concerning personal objects is hypothesized which would explain the specific delusion of reduplication that occurs when these objects are misidentified.
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.
A case of Capgras syndrome associated with extreme violent behaviour is described. The patient's psychodynamics support the belief that the Capgras delusion initially arises from an altered affective response towards one or more others and proceeds to intolerable ambivalent feelings. This ambivalence is neutralised through the imagined existence of doubles.
An unusual and rare variant of Capgras syndrome is reported in which a patient with depressive illness became preoccupied with doubles of inanimate objects. The patient responded to antidepressant therapy.
Ischaemic cerebral accidents are frequent following extracorporeal membrane oxygenation (ECMO), especially after fixing the reinjection cannula in the right primitive carotid artery, which leads to an interruption in downstream flow. We describe a rare and unusual symptom of cerebral ischaemic accident that is known as Capgras syndrome. This feature is interesting because it may be documented by computed tomography (CT) scan and particular electroencephalography signals. It appears that our observation represents the first documented case of Capgras syndrome complicating ECMO. This incident emphasizes the potential hazards associated with right common artery ligature for venoarterial extracorporeal membrane oxygenation (VAECMO). In addition, it shows that this psychiatric symptom (that has been interpreted psychodynamically for many years) can have an organic basis, which should be studied.