Capgras Syndrome,
named for its discoverer, the French psychiatrist Jean Marie Joseph
Capgras. The person's primary delusion is that a close relative or
friend has been replaced by an impostor, an exact double, despite
recognition of familiarity in appearance and behavior. The patient
may also see himself as his own double. Also know as Delusional misidentification,
illusion of doubles, illusion of negative doubles, misidentification
syndrome, nonrecognition syndrome, phantom double syndrome, subjective
doubles syndrome.
Delusions are
false beliefs, sometimes with bizarre content, that are held with
strong conviction even in the presence of contrary evidence. For persons
suffering from Capgras Syndrome they typically believe they exist
in a world of impersonators. This feeling in a delusional world of
doubles can be so alarming that it drives the Capgras sufferer to
psychotic behavior. The syndrome typically has the following characteristics:
The person is convinced that one or several persons known by the sufferer
have been replaced by a double, an identical looking imposter.
The patient sees true and double persons.
It can may extend to animals and objects.
The person is conscious of the abnormality of these perceptions. There
is no hallucination.
The double is usually a key figure for the person at the time of onset
of symptoms. If married, always the husband or wife accordingly.
Associated
Features:
Cerebral lesions
caused by head injury, which are often located in the posterior
area of the right hemisphere, where face recognition is performed.
Schizophrenic
diseased conditions (paranoid-hallucinatory schizophrenia), but
also in affective and organic-psychic disturbances.
Affects both
sexes, but prevalent in women.
Differential
Diagnosis:
Some disorders have similar symptoms. The clinician, therefore, in
his diagnostic attempt, has to differentiate against the following
disorders which need to be ruled out to establish a precise diagnosis.
Schizophrenia
Alzheimer's Disease
Huntington's Disease
Multiple Sclerosis
Traumatic Brain Injury
Substance-Induced Delusional Disorders - hallucinogens and alcohol
Mood Disorders with Delusions - manic and depressive types
Dementia
Cause:
It has been reported
that the Capgras Syndrome and related substitution delusions, that
35% have an organic etiology. Some researchers believe that Capgras'
syndrome can be blamed on a relatively simple failure of normal recognition
processes following brain damage from a stroke, drug overdose, or
some other cause. This disorder can also follow after accidents that
cause damage to the right side of the brain. Therefore, controversies
exist about the etiology of Capgras Syndrome, some researchers explain
it with organic factors, others with psychodynamic factors, or a combination
of the two,
Treatment:
Individual therapy may be best
suited to treat the persons delusions. Persistence is needed in establishing
a therapeutic empathy without validating the person’s delusional
system or overtly confronting the system. Cognitive techniques that
include reality testing and reframing can be used. Antipsychotics
and other drugs have been used with some success.
Counseling
and Psychotherapy [ See
Therapy Section ]:
Cognitive-Behavioural
therapy, for treating delusions that is based on persistent gentle
discussions about evidence for the belief, might help overcome the
problem the person has with believing this substitution al delusion
against the available evidence.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
A reasonable pharmacological
treatment approach for the person with delusional disorder is a standard
trial of an antipsychotic or SSRI at starting doses commonly used
to treat psychotic or mood disorders.
Antipsychotics
(typical and atypical)
Pimozide
Risperidone
Clozapine
