RESUMEN
OBJECTIVES: This report discusses the emergence, clinical appearance, and treatment of the rare entity Capgras syndrome (CS) in an adolescent diagnosed with autism. METHODS: After a brief introduction to the CS, we conduct a detailed description of the case and review, after a search on the PubMed database, the known pathophysiology, psychiatric disorders associated with the onset of this syndrome, and the management of CS. RESULTS: Capgras syndrome generally emerges during the course of delusional disorder, schizophrenia, or mood disorders, and for reasons such as neurological, infectious, or endocrinological diseases, drug intoxications, or deprivation. We encountered no previous reports of CS developing during the course of autism. There are no prospective studies concerning the treatment of the syndrome. However, antipsychotic drug use is primarily recommended in treatment. Antipsychotic drug therapy was therefore planned for the treatment of delusion, a psychotic symptom, in this case. The atypical antipsychotic aripiprazole was used based on the presence of accompanying diagnosis of autism, and the patient's body mass index and age. A relatively high dose of aripiprazole was required for the first psychotic attack in our patient. However, a good level of response was achieved within the expected time frame. In addition, no marked adverse effects were observed. CONCLUSIONS: Aripiprazole seems to be an effective and well-tolerated antipsychotic drug in the treatment of CS accompanying autism.
Asunto(s)
Antipsicóticos , Trastorno Autístico , Síndrome de Capgras , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos , Trastornos Psicóticos , Adolescente , Humanos , Aripiprazol/uso terapéutico , Antipsicóticos/efectos adversos , Síndrome de Capgras/complicaciones , Síndrome de Capgras/tratamiento farmacológico , Trastorno Autístico/complicaciones , Trastorno Autístico/tratamiento farmacológico , Trastornos Psicóticos/tratamiento farmacológicoRESUMEN
Capgras syndrome (CS) is a delusional misidentification syndrome that is encountered in various pathologies. Here, we report the case of an 83-year-old woman affected by dementia with Lewy bodies who presented a CS during the disease. The neuropsychological assessment showed executive and face processing deficits. In this case, CS was characterized, in the beginning, by the duplication of a relative and then by its multiplication. To our knowledge, the description of the evolution of a CS in the course of a neurodegenerative disease is rare and we discuss this multiplication phenomenon in light of existing models of delusions.
Asunto(s)
Síndrome de Capgras , Enfermedades Neurodegenerativas , Anciano de 80 o más Años , Síndrome de Capgras/complicaciones , Deluciones/etiología , Femenino , Humanos , Enfermedades Neurodegenerativas/complicaciones , Pruebas NeuropsicológicasAsunto(s)
Síndrome de Capgras/diagnóstico , Síndrome de Capgras/terapia , Deluciones/diagnóstico , Deluciones/terapia , Síndrome de Capgras/complicaciones , Síndrome de Capgras/epidemiología , Comorbilidad , Deluciones/complicaciones , Deluciones/epidemiología , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Capgras symptom is characterized by the delusional belief that a person significant to the patient has been replaced by a 'double' or 'impostor'. Capgras symptom was discussed to be associated with violent behavior. We report here the cases of two male patients with schizophrenia paranoid type, where parricide was connected to Capgras delusion. It is important to emphasize that in our observed cases, non-adherence played an essential role in the development of violent behavior, parricide. Orv Hetil. 2019; 160(42): 1673-1676.
Asunto(s)
Síndrome de Capgras/complicaciones , Homicidio , Esquizofrenia Paranoide/etiología , Violencia/psicología , Adulto , Síndrome de Capgras/diagnóstico , Síndrome de Capgras/psicología , Deluciones/psicología , Padre , Humanos , Masculino , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologíaRESUMEN
Capgras syndrome (CS), also called imposter syndrome, is a rare psychiatric condition that is characterized by the delusion that a family relative or close friend has been replaced by an identical imposter. Here, we describe a 69-year-old man with CS who presented to the Kemal Arikan Psychiatry Clinic with an ongoing belief that his wife had been replaced by an identical imposter. MRI showed selective anterior left temporal lobe atrophy. Quantitative EEG showed bilateral frontal and temporal slowing. Neuropsychological profiling identified a broad range of deficits in the areas of naming, executive function, and long-term memory. On the basis of these findings, we diagnosed frontotemporal dementia. This case demonstrates that CS can clinically accompany frontotemporal dementia.
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Síndrome de Capgras/complicaciones , Síndrome de Capgras/diagnóstico por imagen , Demencia Frontotemporal/complicaciones , Demencia Frontotemporal/diagnóstico por imagen , Anciano , Síndrome de Capgras/psicología , Función Ejecutiva/fisiología , Demencia Frontotemporal/psicología , Humanos , Imagen por Resonancia Magnética/métodos , Masculino , Pruebas Neuropsicológicas , Lóbulo Temporal/diagnóstico por imagenRESUMEN
OBJECTIVES: Delusional misidentification syndromes (DMS) correspond to the delusional belief of misidentification of familiar persons, places or objects and to the conviction that they have been replaced or transformed. Several cases of patients who developed violent behavior while suffering from DMS have been published. This led some authors to consider patients with DMS at risk of violence. However, only a few studies have focused on the potential relationship between violence and DMS. The aim of our study was to explore this relationship with a literature review of published cases of patients having committed violent acts associated to DMS. METHODS: A systematic literature search was conducted on PubMed up to January 2017 using the following term combination "misidentification" and "violence" Fifteen cases of patients with DMS who had committed violent acts were identified. The data from these descriptions were analyzed and synthetized. RESULTS: Most of the patients were men with a diagnosis of schizophrenia and Capgras syndrome. Acts of violence were severe with a relatively high number of murders or attempted murders. For half of the patients these violent acts were perpetrated with weapons. Victims were regularly the patient's family members and the assaults were usually not planned. Delusional syndromes often progressed for several years. Importantly, substance abuse, which is known to increase the risk of violence in patients with schizophrenia, was only observed in two patients. CONCLUSION: DMS are associated with several risk factors of violence, such as a diagnosis of schizophrenia, specific delusions including megalomania, persecution, negative affects and identified targets. Despite this risk for severe violence, there are no existing guidelines on how to assess and treat DMS in schizophrenia. Accordingly, we propose (1) the establishment of formal diagnostic criteria, (2) the development of rigorous research on these syndromes and (3) the integration of DMS in assessment of violence risk in schizophrenic patients.
Asunto(s)
Síndrome de Capgras , Deluciones , Esquizofrenia Paranoide , Violencia/psicología , Síndrome de Capgras/complicaciones , Síndrome de Capgras/epidemiología , Síndrome de Capgras/psicología , Deluciones/epidemiología , Deluciones/psicología , Homicidio/psicología , Homicidio/estadística & datos numéricos , Humanos , Prevalencia , Factores de Riesgo , Esquizofrenia Paranoide/epidemiología , Esquizofrenia Paranoide/psicología , Síndrome , Violencia/estadística & datos numéricosRESUMEN
BACKGROUND: Dementia with Lewy bodies (DLB) is the second most frequent diagnosis of progressive degenerative dementia in older people. Delusions are common features in DLB and, among them, Capgras syndrome represents the most frequent disturbance, characterized by the recurrent and transient belief that a familiar person, often a close family member or caregiver, has been replaced by an identical-looking imposter. However, other delusional conditions near to misidentification syndromes can occur in DLB patients and may represent a major psychiatric disorder, although rarely studied systematically. CASE PRESENTATION: We reported on a female patient affected by DLB who presented with an unusual delusion of duplication. Referring to the female professional caregiver engaged by her relatives for her care, the patient constantly described the presence of two different female persons, with a disorder framed in the context of a delusion of duplication. A brain 99Tc-hexamethylpropyleneamineoxime SPECT was performed showing moderate hypoperfusion in both occipital lobes, and associated with marked decreased perfusion in parieto-fronto-temporal lobes bilaterally. CONCLUSIONS: An occipital hypoperfusion was identified, although in association with a marked global decrease of perfusion in the remaining lobes. The role of posterior lobes is certainly important in all misidentification syndromes where a natural dissociation between recognition and identification is present. Moreover, the concomitant presence of severe attentional and executive deficits evocative for a frontal syndrome and the marked global decrease of perfusion in the remaining lobes at the SPECT scan also suggest a possible dysfunction in an abnormal connectivity between anterior and posterior areas.
Asunto(s)
Síndrome de Capgras/complicaciones , Enfermedad por Cuerpos de Lewy/psicología , Anciano , Corteza Cerebral/irrigación sanguínea , Femenino , Humanos , Enfermedad por Cuerpos de Lewy/complicaciones , Neuroimagen , Oximas/metabolismo , Compuestos de Tecnecio/metabolismo , Tomografía Computarizada de Emisión de Fotón ÚnicoAsunto(s)
Síndrome de Capgras/complicaciones , Homicidio , Violencia/prevención & control , Adulto , Humanos , MasculinoRESUMEN
Delusional misidentification syndromes (DMSs) are persistent delusions of hyper- or hypofamiliarity for meaningful persons and places in one's environment. This study set to determine the clinical course, neuroanatomical localization, neuropsychological abnormalities, and delusional content in patients with DMSs occurring after focal neurological injuries. Sixty-one patients were identified: 28 with hypofamiliar delusions, 27 with hyperfamiliar delusions, and, most surprisingly, six patients with both hypo- and hyperfamiliar delusions. Recognition is often delayed by months from the time of injury, and the delusions are self-limited. Patients with DMSs had right hemisphere (92%) injuries (specifically right frontal injuries in 63%), prominent memory impairment (73%), and multiple concurrent DMSs (29%).
Asunto(s)
Encéfalo/patología , Síndrome de Capgras/complicaciones , Síndrome de Capgras/patología , Deluciones/complicaciones , Deluciones/patología , Encéfalo/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neuroimagen , Pruebas Neuropsicológicas , PubMed/estadística & datos numéricosRESUMEN
BACKGROUND: Capgras delusion (CD) has multiple etiologies including neurodegenerative disorders and can be associated with violent behavior. CD is a common complication of Alzheimer dementia (AD); however, CD with violent behavior is uncommon in AD. We report escalating violent behavior by a patient with advanced AD and CD who presented to the emergency department (ED) and required admission to an academic medical center. METHODS: Case analysis with PubMed literature review. RESULTS: A 75-year-old male with a 13-year history of progressive AD, asymptomatic bipolar disorder, chronic kidney disease, hypertension, hyperlipidemia, and benign prostatic hypertrophy presented to the ED with recurrent/escalating violence toward his wife, whom he considered an impostor. His psychotropic regimen included potentially inappropriate medications (PIMs) for geriatric/AD patients-topiramate/amitriptyline/chlordiazepoxide/olanzapine-that are associated with delirium, cognitive decline, dementia, and mortality. Renal dosing for topiramate, reduction in PIMs/anticholinergic burden, and substituting haloperidol for olanzapine resolved his violent behavior and CD. CONCLUSIONS: CD in AD is a risk factor for violent behavior. As the geriatric population in the United States grows, CD in patients with AD may present more frequently in the ED, requiring proper treatment. Pharmacovigilance is necessary to minimize PIMs in geriatric/AD patients. Clinicians and other caregivers require further education to appropriately address CD in AD.
Asunto(s)
Enfermedad de Alzheimer/psicología , Trastorno Bipolar/psicología , Síndrome de Capgras/psicología , Lista de Medicamentos Potencialmente Inapropiados , Violencia/psicología , Anciano , Agresión/psicología , Enfermedad de Alzheimer/complicaciones , Amitriptilina/efectos adversos , Anticonvulsivantes/efectos adversos , Antidepresivos Tricíclicos/efectos adversos , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Benzodiazepinas/efectos adversos , Trastorno Bipolar/complicaciones , Trastorno Bipolar/tratamiento farmacológico , Síndrome de Capgras/inducido químicamente , Síndrome de Capgras/complicaciones , Clordiazepóxido/efectos adversos , Fructosa/efectos adversos , Fructosa/análogos & derivados , Haloperidol/uso terapéutico , Humanos , Hipnóticos y Sedantes/efectos adversos , Masculino , Olanzapina , Insuficiencia Renal Crónica/complicaciones , TopiramatoRESUMEN
BACKGROUND: Misidentification phenomena, including the delusion of 'imposters' named after Joseph Capgras, occur in various major psychiatric and neurological disorders but have rarely been studied systematically in broad samples of modern patients. This study investigated the prevalence and correlated clinical factors of Capgras' phenomenon in a broad sample of patient-subjects with first-lifetime episodes of psychotic affective and nonaffective disorders. METHODS: We evaluated 517 initially hospitalized, first-episode psychotic-disorder patients for the prevalence of Capgras' phenomenon and its association with DSM-IV-TR diagnoses including schizophreniform, brief psychotic, unspecified psychotic, delusional, and schizoaffective disorders, schizophrenia, bipolar-I disorder and major depression with psychotic features, and with characteristics of interest including antecedent psychiatric and neurological morbidity, onset type and presenting psychopathological phenomena, using standard bivariate and multivariate statistical methods. RESULTS: Capgras' syndrome was identified in 73/517 (14.1%) patients (8.2-50% across diagnoses). Risk was greatest with acute or brief psychotic disorders (schizophreniform psychoses 50%, brief psychoses 34.8%, or unspecified psychoses 23.9%), intermediate in major depression (15%), schizophrenia (11.4%) and delusional disorder (11.1%), and lowest in bipolar-I (10.3%) and schizoaffective disorders (8.2%). Associated were somatosensory, olfactory and tactile hallucinations, Schneiderian (especially delusional perception), and cycloid features including polymorphous psychotic phenomena, rapidly shifting psychomotor and affective symptoms, pananxiety, ecstasy, overconcern with death, and perplexity or confusion, as well as rapid onset, but not sex, age, abuse history, dissociative features, or indications of neurological disorders. CONCLUSIONS: Capgras' syndrome was prevalent across a broad spectrum of first-episode psychotic disorders, most often in acute psychoses of rapid onset.
Asunto(s)
Síndrome de Capgras/diagnóstico , Síndrome de Capgras/psicología , Trastornos Psicóticos/diagnóstico , Trastornos Psicóticos/psicología , Adulto , Síndrome de Capgras/complicaciones , Síndrome de Capgras/terapia , Deluciones/complicaciones , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Alucinaciones/complicaciones , Hospitalización , Humanos , Masculino , Psicopatología , Trastornos Psicóticos/complicaciones , Trastornos Psicóticos/terapia , Adulto JovenAsunto(s)
Lesiones Encefálicas/complicaciones , Síndrome de Capgras/complicaciones , Lateralidad Funcional/fisiología , Anciano , Lesiones Encefálicas/diagnóstico , Síndrome de Capgras/diagnóstico , Femenino , Humanos , Tomografía Computarizada de Emisión de Fotón Único , Tomografía Computarizada por Rayos XRESUMEN
The Capgras syndrome is one of delusional-like misidentification syndrome in which a person holds a delusion that one or several his/her friends or relatives have been replaced by an identical-looking impostor. As any other delusional disorder, the Capgras syndrome is characterized by stability despite the indisputable arguments against fault views. Initially, this syndrome was considered as a presentation of schizophrenia but later it has been described in brain organic disorders, primarily in elderly patients with dementia.
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Síndrome de Capgras , Demencia/etiología , Esquizofrenia Paranoide/etiología , Síndrome de Capgras/complicaciones , Síndrome de Capgras/diagnóstico , Síndrome de Capgras/psicología , Demencia/diagnóstico , Demencia/psicología , Diagnóstico Diferencial , Humanos , Esquizofrenia Paranoide/diagnóstico , Esquizofrenia Paranoide/psicologíaRESUMEN
BACKGROUND: Unusual delusional syndromes are rare protean diseases with speculative etiopathogenic mechanisms. METHODS: Seven consecutive patients with advanced PD were evaluated over a 15-year period at the Movement Disorders Unit in the Neurology Service, Hospital de Clínicas, Federal University of Paraná, and the Paraná State Parkinson's Patients Association. RESULTS: We describe advanced Parkinson's disease patients presenting with unusual delusional syndromes, including cases of Ekbom, Othello, Capgras' and Diogenes syndromes, reduplicative paramnesia and mirrored-self misidentification. CONCLUSION: There are a few isolated reports of unusual neuropsychiatric disorders in patients with PD. We believe that these syndromes associated with advanced PD in elderly patients presenting with cognitive impairment and polypharmacy are probably often underestimated. Neurologists should be aware for these rare and treatable conditions.
Asunto(s)
Deluciones/complicaciones , Deluciones/diagnóstico , Progresión de la Enfermedad , Enfermedad de Parkinson/complicaciones , Enfermedad de Parkinson/diagnóstico , Anciano , Anciano de 80 o más Años , Síndrome de Capgras/complicaciones , Síndrome de Capgras/diagnóstico , Síndrome de Capgras/psicología , Delirio de Parasitosis/complicaciones , Delirio de Parasitosis/diagnóstico , Delirio de Parasitosis/psicología , Deluciones/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad de Parkinson/psicología , SíndromeRESUMEN
BACKGROUND: Capgras syndrome is characterized by the recurrent, transient belief that a person has been replaced by an identical imposter. We reviewed clinical characteristics of Dementia with Lewy Bodies (DLB) patients with Capgras syndrome compared to those without Capgras. METHODS: We identified 55 consecutive DLB patients (11 cases with Capgras syndrome (DLB-C) and 44 cases without evidence of Capgras (DLB). Semi-structured interviews with the patient and an informant, neurological exams, and neuropsychological testing were performed. Caregivers were assessed for caregiver burden and depression. Primary comparisons were made between DLB-C and DLB. Exploratory analyses using stepwise logistic regression and bootstrap analyses were performed to determine clinical features associated with Capgras. RESULTS: DLB-C patients experienced more visual hallucinations and self-reported anxiety, had higher scores on the Neuropsychiatric Inventory, and were less likely to be treated with cholinesterase inhibitors at time of initial evaluation. Extrapyramidal symptoms and depression were not associated with Capgras. Caregivers of DLB-C patients had higher caregiver burden. DLB-C was associated with self-reported anxiety (OR = 10.9; 95% CI = 2.6-47.6). In a bootstrap analysis, clinical findings that were predictors of Capgras included visual hallucinations (log(OR) = 18.3; 95% CI = 17.9-19.3) and anxiety (log(OR) = 2.9; 95% CI = 0.31-20.2). CONCLUSIONS: Our study suggests that Capgras syndrome is common in DLB and usually occurs in the presence of anxiety and visual hallucinations, suggesting related etiopathogenesis. Early appreciation of Capgras syndrome may afford the opportunity to alleviate caregiver burden and improve patient and caregiver outcomes.