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Capgras Syndrome: A Rare Psychotic Disorder

Capgras syndrome, also termed as 'Capgras delusion' is a psychiatric disorder in which a person starts believing that an individual (considerably their loved one) or a group of people have been replaced by lookalike imposters or doubles.

This form of delusional misidentification syndromes is very rare and can be associated with some pre-existing psychiatric and neurological conditions such as Lewy body dementia, cerebrovascular events or use of illicit drugs. [1]

Capgras syndrome is named so as it was first described by Joseph Capgras. Also, the condition is prevalent over many first-episode psychotic disorders. A study has shown that Capgras syndrome is mostly found in women, blacks and schizophrenics. [2]

In this article, we will discuss details on Capgras syndrome, its causes and treatments. Take a look.

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Causes Of Capgras Syndrome: Case Studies

1. A case study talks about a 69-year-old widow with Capgras syndrome. One week after returning from a holiday, she barricaded herself in her apartment as she had become suspicious of people around her. The woman had set a small fire in her house and refused to allow the firemen saying that they are not real ones, but an imposter.

Then, one day she poured a bucket of water on a group of elderly women, claiming that they too are not her real neighbours. When she was diagnosed, it was found that she had an old tuberculosis arthrodesis on her left knee. The irony was that her mental health conditions like memory and cognition were normal. She was then treated with neuroleptic medications and has recovered well. [3]

2. Another case study talks about a 74-year-old woman who was on insulin control due to diabetes mellitus. Due to excess insulin in her body, her blood sugar had dropped too low causing several hypoglycemic episodes.

Fifteen months before the examination of the syndrome, she had her first episode in which she failed to recognise her husband. The frequency of the episodes increased gradually after some months, followed by a decrease in her memory.

She had started misplacing things, leaving the cookers burning and forgetting to switch off the taps. After diagnosis, she was found with short-term memory impairment, judgement and abstract thinking. Also, there was mild atrophy (loss of neurons) and microvascular change (changes in small blood vessels in the brain) that had caused the sudden onset of Capgras syndrome.

Proper treatment, routine examination and management of her diabetes have improved the condition. However, after three years of the onset, she had developed severe dementia.

3. Other causes of Capgras syndrome may include auditory hallucinations, formal thought disorder, memory and visual-spatial impairments,[4] Lewy body dementia and visual hallucinations and anxiety. [5]

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Capgras Syndrome And Violence

People with primary Capgras syndrome (mean age 32 years) often get more furious or violent towards the imposter because of suspiciousness and paranoia. A study says that the risk of violence is much higher in males with the condition, considering the fact that Capgras syndrome is more prevalent in women.

The study also says that people who have demonstrated the act of violence, have also demonstrated self-isolation and social withdrawal prior to the act.

A case series based on eight patients mention their violent behaviours such as killing, threatening with scissors, holding a knife on the throat, injuring with an axe, stabbing, burning and other life-threatening physical harms. This suggests that early identification and treatment of the condition is very important. [6]

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Treatment Of Capgras Syndrome

Capgras syndrome is mainly treated with neurological or psychiatric medications as most of the cases of Capgras syndrome are associated with some kind of underlying mental health disorders.

Therefore, a proper diagnosis (both physically and mentally) is carried out to know the exact cause and accordingly, medications are prescribed.

A study talks about the treatment of schizophrenia patients with clozapine, who also had symptoms of Capgras delusion.

If the cause of the condition is some psychotic illness, antipsychotic drugs or antidepressants or mood-stabiliser are given for a certain period and then, the results are evaluated. [7]

People with Capgras syndrome due to substance use, acute alcohol or drug intoxication are given combination medications such as Aripiprazole and Escitalopram to resolve symptoms such as anxiety. [8]

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Common FAQs

1. Is Capgras syndrome in the DSM 5?

No, though the Capgras syndrome has multiple causes and a wide range range of symptoms from physical to psychological conditions, it is not particularly described in DSM 5. However, as it is a kind of delusional disorder, it can be identified as a symptom for the condition.

2. Can Capgras be cured?

Capgras delusion is mainly due to some underlying mental health condition. Timely diagnosis, treatment and management of the condition can lower the episodes of Capgras and help improve the quality of life.

3. What are the symptoms of Capgras syndrome?

Some of the symptoms of Capgras syndrome include olfactory hallucinations, psychotic symptoms and somatic hallucinations.

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