Síndrome de Capgras: una revision de la literatura / Capgras syndrome: a review of the literature

Los síndromes de falsa identificación delirante (DMS, por su sigla en inglés) son trastornos neuropsiquiátricos poco frecuentes que se caracterizan por tener ideas delirantes respecto a la propia identidad y la de otras personas, animales o lugares conocidos por el paciente. Los principales DMS son el Síndrome de Capgras (SC), el de Fregoli, el de doble subjetivo y el de intermetamorfosis. Se presentan en contexto tanto de enfermedades psiquiátricas como en cuadros orgánicos. Distintos modelos han tratado de encontrar una explicación a los DMS, con aportes tanto desde la psicología como de las neurociencias. Entre las causas están enfermedades neurodegenerativas, cuadros psiquiátricos, alteraciones estructurales, efecto de drogas, y alteraciones metabólicas. El manejo depende de la patología de base y las características clínicas específicas. Esta revisión se centra específicamente en el SC, ya que dentro de los DMS, es el más frecuente y estudiado

Delusional misidentification syndromes (DMS) are rare neuropsychiatric disorders that are characterized by having delirious ideas regarding one's and other people, animals or places identity known by the patient. The main DMS are the Capgras syndrome, the Fregoli syndrome, the subjective double syndrome and the intermetamorphosis syndrome. They appear in context of both psychiatric illnesses and organic disorders. Different models have tried to find an explanation to the DMS, with contributions from both psychology and neurosciences. Among the causes are neurodegenerative diseases, psychiatric symptoms, structural alterations, drug effects, and metabolic alterations. Management depends on the underlying pathology and the specific clinical characteristics. This review focuses specifically on the SC, since within the DMS, it is the most frequent and studied.

[Delusional misidentification syndromes: A factor associated with violence? Literature review of case reports]. / Les syndromes délirants d'identification : un facteur associé à la violence ? Revue de littérature à partir d'études de cas.

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.

Patologías psicóticas infrecuentes en psiquiatría geriátrica / No disponible

No disponible

Propuesta de una batería neuropsicológica para la exploración del síndrome de Capgras / Capgras syndrome: a proposal of neuropsychological battery for assessment

El síndrome de Capgras es el más frecuente de los síndromes de falsa identificación delirante. Se puede presentar tanto en enfermedades clásicamente psiquiátricas como en patología orgánica. Su estudio se ha planteado desde modelos cognitivistas y posteriormente neuropsiquiátricos, tanto de desconexión como de lateralización. Desde el punto de vista neuropsiquiátrico el síndrome de Capgras aparecería tras afectación bifrontal y de regiones temporales y límbicas derechas, produciéndose un fallo a la hora de conciliar la información sobre el reconocimiento y las emociones. Este fallo se debería a la alteración de las funciones de monitorización de la realidad, de la automonitorización, la memoria y la sensación de familiaridad. La preservación del hemisferio izquierdo sería necesaria para la producción de la respuesta delirante. No parece existir un patrón diferencial en función de la etiología, subyaciendo en todos los casos una alteración común neuropsiquiátrica. Partiendo de los modelos teóricos, y de los hallazgos clínicos en la valoración de casos, se propone una batería neuropsicológica que resulte sensible a los principales déficits esperables en el síndrome de Capgras(AU)

Capgras syndrome is the most prevalent of the delusional misidentification syndromes. It appears in both psychiatric illness and organic brain damage. Cognitive and neuropsychiatric models (lateralization and disconnection) have been proposed to explain the syndrome. From a neuropsychological point of view Capgras syndrome seems to be due to damage of bifrontal and right limbic and temporal regions. Memory, feeling of familiarity, monitoring of self and reality would be altered. All of these cause a failure to adequately integrate the information about emotions and facial recognition. Relative preservation of the left frontal lobe may be necessary for the development of delusional response. There does not seem to be a differential pattern as regards the aetiology, but there is a common underlying neuropsychiatric mechanism. Based on theoretic models, and clinics features, we propose a neuropsychological battery to assess the Capgras syndrome, that should be sensitive to the main expected deficits(AU)

¿Mental o físico? Trastorno de ideas delirantes secundario a pseudohipoparatiroidismo. A propósito de un caso / Mental or physical? A case of Capgras syndrome associated with pseudohypoparathyroidism

El término «trastorno mental» implica erróneamente una distinción entre los trastornos mentales y los trastornos físicos. Esto supone un anacronismo reductor de la separación mente-cuerpo. Existe una importante bibliografía que demuestra que hay mucho de físico en los trastornos mentales y mucho de mental en los trastornos físicos. En relación a un caso de pseudohipoparatiroidismo y síndrome de Capgras se realizará una breve descripción de todos los trastornos psiquiátricos relacionados con dicha patología lo cual vuelve a poner en entredicho la dualidad mente-cuerpo (AU)

The term "mental disorder" erroneously implies a distinction between physical and mental disorders. This is a reductionist anachronism concerning the mind-body split. There is a wealth of information showing that there is a lot of physical in mental disorders and a lot of mental in physical disorders. With the aid of a clinical case of a patient with pseudo-hypoparathyroidism and Capgras syndrome, a brief review of all the psychiatric disorders related with the aforementioned illness is presented, which in turn question the mind-body duality (AU)

The prevalence of misidentification syndromes in neurodegenerative diseases.

Although misidentification syndromes (MISs) have been often described in Alzheimer disease (AD), the prevalence of these phenomena in different neurodegenerative diseases has not been systematically studied. Three hundred ninety-two individuals with probable AD, 119 patients with the behavioral variety of frontotemporal dementia (FTD-bv), 101 patients with primary progressive aphasia, 24 subjects with semantic dementia, 18 subjects with corticobasal degeneration, 8 patients with progressive supranuclear palsy, 36 individuals with probable Lewy body dementia (DLB), and 26 subjects with Parkinson disease (PD) were the participants of this study. On the basis of a semistructured interview with both patients and their reliable caregivers, MIS was identified in 15.8% of cases with AD, 16.6% of patients with DLB, and in 8.3% of individuals with semantic dementia. The most frequent form of MIS was Capgras delusions, often accompanied by reduplication of place, phantom border phenomenon, or both. Although MIS typically appears in later stages of the disease, it can also occur surprisingly early in patients with AD. None of the patients with FTD-bv, primary progressive aphasia, corticobasal degeneration/supranuclear palsy, or PD developed MIS. Thus, our findings suggest that MISs are characteristic of AD and DLB, and tend to exclude FTD/Pick complex and PD.

Capgras syndrome and its relationship to neurodegenerative disease.

BACKGROUND: Capgras syndrome is characterized by a delusional belief that a person has been replaced by an imposter. It has been described in psychiatric and neurological (neurodegenerative and nonneurodegenerative) diseases. OBJECTIVES: To determine whether the clinical and demographic features of subjects with Capgras syndrome differ when the syndrome is associated with neurodegenerative compared with nonneurodegenerative diseases, and whether features differ across different neurodegenerative diseases. DESIGN: Retrospective study. SETTING: Tertiary care medical center. Patients Forty-seven subjects with Capgras syndrome. RESULTS: Thirty-eight of the subjects with Capgras syndrome (81%) had a neurodegenerative disease, most commonly Lewy body disease. Capgras syndrome occurred at a younger age of onset in those with a nonneurodegenerative disease (51 vs 72 years) (P < .001) co-occurring with paranoid schizophrenia, schizoaffective disorder, and methamphetamine abuse and immediately after cerebrovascular events. Of those with Capgras syndrome and Lewy body disease, 100% had visual hallucinations compared with only one of those with Alzheimer disease (14%). CONCLUSIONS: Capgras syndrome is more commonly associated with neurodegenerative diseases, especially Lewy body disease, where visual hallucinations always coexist. In the absence of a neurodegenerative disease, the onset of Capgras syndrome occurs at a significantly younger age and can be associated with psychiatric disease, cerebrovascular events, and illicit drug use.

Classification of psychotic symptoms in dementia with Lewy bodies.

OBJECTIVE: The aim of this study is to determine empirically a possible classification of psychotic symptoms, and identify the frequency of such symptoms in dementia with Lewy bodies (DLB). METHODS: This was a clinical study of prospectively observed patients from the memory clinic at Shiga Medical Center. The authors conducted a factor analysis of psychotic symptoms in 96 probable DLB and 4 possible DLB patients, clinically diagnosed according to the consensus criteria, were included. RESULTS: Four factors were obtained. Factor 1 was closely akin to misidentifications, including Capgras syndrome, phantom boarder, and reduplication of people and places. Factor 2 consisted of reduplication of people, the belief that deceased relatives are still alive, and the belief that absent relatives are in the house, which was classified as a type of misidentification or paramnesia. Factor 3 was akin to visual hallucinations of nonhuman objects, and factor 4 mirrored the hallucination of people and feeling of presence. Delusions were independent of these factors. Following the results of factor analysis, the rates of each symptom group were identified. Hallucinations were the most frequent psychotic symptom in DLB (78%), followed by misidentifications (56%) and delusions (25%). CONCLUSION: This study suggested that hallucinations, misidentifications, and delusions should be separately considered in understanding of underlying pathophysiology or psychopathology of DLB.

Phenomenology and clinical correlates of delusions in Alzheimer disease.

OBJECTIVES: The objectives of this study were to determine whether anosognosia, depression, and elevated mood are associated with delusions in Alzheimer disease (AD), and to examine the validity of standardized diagnostic criteria for psychosis of dementia. METHOD: The authors assessed a consecutive series of 771 patients with AD attending a dementia clinic with a comprehensive neuropsychologic and psychiatric evaluation that included specific measures of delusions, hallucinations, anosognosia, depression, and elevated mood. RESULTS: Delusions were found in one-third of the patients and hallucinations in 7%. Most patients with hallucinations also had delusions. A principal component analysis of the Psychosis Dementia Scale, which rates the presence and severity of delusions, produced the factors of paranoid misidentification and expansive delusions. Paranoid, but not expansive, delusions increased across the stages of the illness. Anosognosia and depression were significantly and independently associated with the presence of delusions, whereas elevated mood was significantly associated with expansive, but not paranoid, delusions. A multiple logistic regression analysis demonstrated that delusions in AD were significantly associated with depression, anosognosia, overt aggression, and agitation. CONCLUSIONS: Anosognosia, depression, global cognitive deficits, and elevated mood are the main psychiatric correlates of paranoid misidentification and expansive delusions in AD, whereas overt aggression and agitation are the most frequent behavioral concomitants of psychosis in AD.

[Identification errors and delusions of false identification in Alzheimer's disease: a regional survey]. / Troubles de l'identification et délires d'identité dans la maladie d'Alzheimer: une enquête régionale.

INTRODUCTION: Misidentification syndromes are the main symptoms in Alzheimer's disease. Underlain by complex cognitive, agnosic, and amnesic disturbances of degenerative etiology, they can be expressed by misidentification delusions, as in psychoses. To date, research has focused on identification disturbances of persons selected according to various definitions. OBJECTIVE: Our main objective was to evaluate the frequency of identification disturbances among patients suffering from Alzheimer's disease within the current conditions of diagnosis and treatment. The secondary objective aimed to establish a detailed analysis of symptoms and clinical correlations, and evaluate the effects of the troubles on the caregiver. METHODS: We conducted a regional survey using a questionnaire designed for the caregiver, proposed to the 60 geriatric doctors and neurologists in the Poitou-Charentes region of France, for all patients suffering from Alzheimer's disease (defined according to DSM IV criteria) seen between June 1st and August 31st of 2003. Statview software was used for statistical analysis. RESULTS: The survey was completed for 104 patients: 69.5 percent women and 30.5 percent men, with a mean age of 79 years. The majority of the patients were seen by a neurologist and presented an average cognitive deficiency (MMS ranging from 11 to 20). An identification disturbance, whether or not it was delusional, all domains included, was found in 81.6 percent of the patients and was related to a more severe cognitive deficiency and greater hardship on the part of the caregiver. DISCUSSION: We observed a high prevalence of identification disturbance, which can be explained by the systematic and exhaustive search for identification disturbance. The most frequent disturbance concerned the identification of places, whereas self-identification was less often affected; the authentic Capgras delusion was found less often. CONCLUSION: The study of identification disturbances in Alzheimer's disease can contribute to a better understanding of the cognitive, psychopathological, and physiopathological aspects of the disease as well as to a better knowledge and better care for the patient.

Delusional misidentification.

The Capgras syndrome and other forms of delusional misidentification may be encountered frequently in neuropsychiatric settings. DMS can occur in the presence of idiopathic psychiatric illness, in diffuse brain illness such as dementia, and in focal neurologic disease. In patients who have focal lesions, there is evidence that right hemisphere damage is necessary for the production of DMS. Although DMS is associated with a pattern of neuropsychologic impairments in the domains of memory, perception, and executive function, these impairments alone do not account for the selectivity and delusional nature of DMS. Therefore, other factors such as premorbid psychopathology, motivation, and loss of ego functions may be important in determining which vulnerable patients develop DMS and which do not.

Capgras syndrome: possibly more common among the Maori of New Zealand.

OBJECTIVE: The report describes an apparently greater incidence of Capgras syndrome among the Maori population compared with the European population, in the most easterly catchment area served by Tauranga Hospital in New Zealand's Bay of Plenty. METHOD: Over the last year we have become aware of five cases of Capgras syndrome in our catchment area. This area (population nearly 21,000) consists of a rapidly expanding new suburb of the city of Tauranga and a rural area extending 55 km east of the city. These figures were compared with those of the westerly catchment area served by Tauranga Hospital, where the psychiatric team is not aware of any examples of Capgras syndrome among their population. The 1996 census figures were obtained in order to calculate a population ethnicity breakdown. RESULTS: Five cases of Capgras syndrome were identified in the most easterly catchment area where 19% of the population identified as Maori, 75% as European and 6% as other or non-specified. All of the cases occurred in Maori patients. This compares with no identified cases of Capgras syndrome in the most westerly catchment area where 12% of the population identified as Maori, 87% as European and 1% as other or non-specified. Four out of five cases were female. Two cases had a history of cannabis use. Three cases had exhibited dangerous behaviour towards family members. CONCLUSIONS: There is an apparently greater incidence of Capgras syndrome among the New Zealand Maori population compared with the European population in the most easterly catchment area served by Tauranga Hospital. In our population Capgras syndrome is a common, not rare, feature of psychotic illness, and the cases support a previously reported association of this syndrome with dangerousness.

Capgras syndrome: analysis of nine cases.

Three hundred and sixty-four patients, 158 males and 206 females, were admitted to an acute psychiatric ward between November 1994 and October 1995, and only 9 patients (2 males and 7 females) fulfilled the clinical criteria for Capgras syndrome. The crude prevalence of Capgras syndrome in the acute psychiatric ward was 2.5% (1.3% for men and 3.4% for women), which is not uncommon. Medical records and laboratory examinations, including brain images and electroencephalographic examinations (EEG), were reviewed in the nine patients with Capgras syndrome. Four cases were proven to have apparently abnormal anatomical lesions on EEG, brain computed tomography, magnetic resonance imaging or single photon emission computed tomography (99mTc-HMPAO) examinations and five cases were associated with major physical illness. These findings support that organic factors could be important in the pathogenesis of Capgras syndrome.

Prevalence and correlates of Capgras syndrome in Alzheimer's disease.

OBJECTIVES: This study examined the prevalence and clinical correlates of Capgras syndrome (CS) in Alzheimer's disease. DESIGN: Cross-sectional study of elderly patients evaluated at an outpatient memory disorders clinic classified according to the presence or absence of CS. SUBJECTS: One hundred and fifty-one consecutive patients diagnosed with probable (N=110) or possible (N=48) Alzheimer's disease (AD) utilizing NINCDS-ADRDA diagnostic criteria. MATERIALS: The Behavioral Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Mini-Mental State Examination (MMSE) and Blessed Dementia Scale (BDS). RESULTS: CS was observed in 10% of the sample (N=16). Associated factors included other delusions, lower MMSE scores and higher BDS scores. The relation between CS and both cognitive and functional status remained significant after controlling for other delusions. CONCLUSION: CS was prevalent in approximately 10% of our community-dwelling AD sample. This syndrome was more common at the later stages of the illness and showed relations with increased functional impairment and other psychotic symptomatology.

Three cases of Capgras' syndrome.

Three cases of Capgras' syndrome were identified in one psychiatric hospital within a 1-year period. These are presented and their psychopathology discussed. The traditional assumption that this is a rare syndrome is challenged.