Capgras Syndrome

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Capgras Syndrome

Definition

Capgras syndrome (CS) is a relatively rare delusion of negative identification in which the patient believes that an individual or individuals well-known to him or her is an almost identical physiological double.

Description

Named for the French psychiatrist Jean Capgras in 1923, CS is also known as the “illusion of doubles” and the “illusion of false recognition.” Although the object of the delusion is typically a person with whom the patient is either particularly familiar or has an emotional tie, cases have been reported of the delusion being extended to pets and even inanimate objects, such as letters or a teacup. The term “syndrome”—a group of symptoms characterizing a disorder—as applied to CS is misleading; CS is more accurately described as a symptom associated with multiple physiological and psychological disorders.

Demographics

Reported cases of CS have focused on adults, although a few cases have been reported with younger adults. It was once thought that CS is a disorder occurring only in women. However, cases have also been reported in men.

CS is related to numerous underlying causes including central nervous system disorders, dementia , and psychosis . The demographics of CS vary with the underlying cause.

Causes and Symptoms

The literature is divided as to whether CS is psychological or physiological in nature. Historically, CS

was thought to be a purely psychological condition. More recently, however, the focus has shifted, and CS is now considered by many clinicians to be a disorder of the central nervous system. It is estimated that between 21% and 40% of CS cases stem from physiological disorders including dementia, head trauma, epilepsy, and cerebrovascular disease. Neuroimaging data suggest a link between CS and abnormalities of the right hemisphere of the brain . In fact, the literature supports the conclusion that CS can be a symptom of virtually any central nervous system disorder.

CS has been observed in association with various systemic illnesses including vitamin B-12 deficiency, chicken encephalitis, and diseases of the thyroid, parathyroid, and liver. CS has also been found associated with the use of various drugs, including morphine and diazepam (Valium). CS has been observed following transient physiological disturbances such as pneumo-cystis pneumonia in an HIV-positive patient, migraine headache, overdose of a bronchial dilator containing adrenaline and adropinemethonitrate, and interictal psychosis of epilepsy.

Diagnosis

Most clinicians regard CS as a symptom associated with numerous underlying causes rather than a syndrome in the classical sense of the term. Diagnosis should be based on psychological and personality testing as well as neuroradiological testing to determine the underlying cause rather than relying purely on behavioral descriptions.

CS can occur at any time during a psychosis and is not currently considered to be an essential element of any psychological disorder. It is impossible to predict the occurrence of CS based on the course of the overall psychopathology.

Treatments

CS is typically treated with a combination of anti-psychotic medication and supportive psychological therapy in which stronger areas of mental and behavioral processes are used to overcome weaker areas of functioning. Patients presenting with CS stemming from psychosis have been found to improve on pimozide even when nonresponsive to haloperidol . CS stemming from physiological causes is best treated by treating the underlying disorder.

Prognosis

The symptoms of CShave been found in most, but not all, cases to clear shortly after the remission of the psychosis. In the case of depression , however, the

KEY TERMS

Central nervous system —The brain and spinal cord.

Delusion —A false idea held despite all evidence to the contrary.

Dementia —Deterioration of intellect, reasoning ability, memory, and will resulting from organic brain disease.

Interictal —Occurring between seizures.

Psychosis —A mental illness that markedly interferes with the patient’s ability to deal with the demands of everyday life. Psychosis is characterized by loss of contact with reality, often accompanied by delusions and hallucinations.

symptoms of CS persist longer than those of other syndromes of doubles (syndrome of Frégoli, syndrome of intermetamorphosis, syndrome of subjective doubles). The symptoms of CS invariably recur when there is a relapse of the basic psychotic condition with which they were associated.

Prevention

CS is an uncommon occurrence associated with a range of disorders both psychological and physiological in nature. Prevention of CS is actually a question of preventing the underlying disorder resulting in CS. There are no investigations under way concerning the prevention of CS.

Resources

BOOKS

Fewtrell, David, and Kieron O’Connor. “Capgras syndrome and delusions of misidentification.” in Clinical Phenomenology and Cognitive Psychology. New York: Routledge, 1995.