Importance of Capgras syndrome in shared psychotic disorder: a case report.

Shared psychotic disorder characterized by Capgras syndrome is an extremely rare condition. To our knowledge, there are only a few published papers on this condition. This paper presents a case of shared Capgras syndrome in two sisters. The inducer was a younger sister with schizophrenia, who passed on her Capgras delusion to her older sister after the death of their father. After committing a violent offense caused by Capgras delusion, a court ordered the sisters' involuntary admission to a psychiatric hospital. After being separated and receiving antipsychotic treatment, the sisters showed substantial improvement. However, shortly after hospital discharge, they stopped taking their medication and disappeared. After 15 years, their mother died and shortly afterwards, the sisters were re-admitted for forensic psychiatric evaluation after another violent crime caused by Capgras delusion. Timely recognition, adequate treatment and maintaining a therapeutic alliance could contribute to a better clinical course and outcome of this disorder, and reduce the risk of violent behavior.

Capgras Syndrome, Multiple Sclerosis, and COVID-19 Infection: A Case Report.

Capgras syndrome is a psychotic illness characterized by an unshaken false belief in having a close family member replaced by an imposter when there is no evidence of such. The patient described in this case report is a 68-year-old Caucasian female who presented with Capgras syndrome in the context of chronic progressive multiple sclerosis (MS) following an acute COVID-19 illness. She was treated with quetiapine with full resolution of symptoms.

Delusions of Vampirism in an Adolescent and Treatment With Clozapine: A Case Report.

This case describes delusions of vampirism among several other psychotic symptoms in a 15-year-old who has a diagnosis of schizophrenia, with these delusions first presenting when he was 13 years of age. Delusions of vampirism can be associated with a strong desire to suck human blood but these delusional beliefs were not acted upon here. This is the first report of delusions of vampirism in childhood to date. The introduction of the antipsychotic medication clozapine after failed treatment trials with two other antipsychotic agents has been associated with a significant amelioration in symptomatology and an improvement in functioning.

A Narrative Review of the Many Psychiatric Manifestations of Neurosyphilis: The Great Imitator.

Neurosyphilis is an infection of the central nervous system caused by the spirochete, Treponema pallidum. New syphilis infections have been increasing around the world each year. This disease was much of a concern in the pre-penicillin era, where when left untreated many cases progressed to tertiary syphilis which can commonly manifest as neurosyphilis. Of particular interest, neurosyphilis has been linked to masquerading itself as various psychiatric conditions. This narrative review focuses on exploring psychiatric manifestations of neurosyphilis as well as the importance of screening in psychiatric settings and clinicians maintaining high clinical suspicion of the disease. A systematic search was conducted for published articles from 2003 to 2023 using PubMed, EMBASE, and Google Scholar. A total of 66 articles met the criteria and were used for detailed analysis, where psychiatric manifestations and clinical progression of patients were discussed in detail. Psychiatric manifestations that were explored include dementia, delirium, depression, mania, personality changes, and psychosis. One of the most common manifestations of neurosyphilis appears to be severe neurocognitive impairment. There are also rare psychiatric conditions neurosyphilis mimics that have been described in literature such as Capgras syndrome and Geschwind syndrome. A narrative review of the literature revealed a low level of clinical awareness of neurosyphilis as a possible etiology of various psychiatric disorders. This resulted in delayed or inaccurate diagnosis and consequently delayed initiation of adequate treatment. Considering that many psychiatric manifestations of neurosyphilis are reversible with proper treatment, it is imperative to implement routine screening for syphilis among psychiatric patients.

A case with burning mouth syndrome followed by dementia with Lewy bodies: a case report.

Burning mouth syndrome (BMS) is characterized by persistent oral burning sensations without corresponding organic findings. Dementia with Lewy bodies (DLB) is a common type of dementia and generally presents visual hallucination and parkinsonism as motor dysfunction besides cognitive decline. In this case report, we present a case in which DLB emerged during the treatment for BMS, with a relatively positive outcome for BMS. A 74 years-old female complained of burning pain in her mouth and a subsequent decrease in food intake. Following a diagnosis of BMS, pharmacotherapy was initiated. BMS was much improved with mirtazapine 15 mg and aripiprazole 1.0 mg, leading to the restoration of her food intake by day 180. However, BMS flared up again triggered by deteriorating physical condition of herself and that of her husband. With aripiprazole 1.5 mg and amitriptyline 25 mg, her BMS gradually improved by day 482. However, by day 510, an increase in anxiety was noted, accompanied by the occasionally misidentification of her husband on day 566. Her cognitive impairment and disorientation were also reported by her husband on the day 572, she was then immediately referred to a neurologist specialized dementia and diagnosed with DLB on the day 583. Her treatment was adjusted to include the prescription of rivastigmine which was titrated up to 9.0 mg. Considering the potential impact of amitriptyline on cognitive function, it was reduced and switched to mirtazapine; however, her oral sensations slightly got worse. Following the consultation with her neurologist, amitriptyline 10 mg was reintroduced and aripiprazole was discontinued on day 755. Remarkably, BMS gradually improved without deteriorating DLB. This case indicated the reaffirmed necessity of careful interviews for changes in daily life not only with the patients but also with their families through the medical assessments. It highlights the vigilance regarding potential cognitive decline underlying or induced as an adverse event especially when treating elderly patients with BMS. While the interaction between BMS and DLB remains unclear, this case underscores the importance of prudent diagnosis and constructing collaboration with specialists in managing BMS with the early phase of DLB.

Capgras Syndrome as the Core Manifestation of Early-Onset Alzheimer's Disease.

Capgras syndrome (CS) was usually considered a symptom of a functional disorder in the young, most commonly schizophrenia, or an organic disorder in the elderly. The occurrence of CS among early-onset Alzheimer's disease (EOAD) is extremely rare. We describe a case in which the unrecognition of CS as part of EOAD resulted in a wrong psychiatric diagnosis and inappropriate treatment. This paper aims to acknowledge CS as an early or core manifestation and highlight EOAD as a differential diagnosis of mental disorders in young people, even without a remarkable family history.

Capgras Syndrome Due to Cannabinoids Use: A Case Report With Radiological Findings.

Capgras syndrome is a part of the delusional misidentification syndromes. In this condition, the patient believes that identical individuals have impersonated the people close to them, leading to aggression or even homicide of their relatives. The following article describes the case of a 28-year-old patient with a history of cannabis consumption who arrived at the emergency department due to an unsuccessful murder attempt against his neighbor. At the mental examination, the patient believed their parents were killed some time ago, and impostors were replacing them; laboratory tests showed tetrahydrocannabinol in the urine sample. Therefore, the diagnosis of Capgras syndrome due to cannabis consumption was performed, and treatment was established with two antipsychotics and one mood stabilizer drug, showing satisfactory results after two months.

THE LOSS OF FAMILIARITY: A CASE STUDY OF THE COMORBIDITIES OF CAPGRAS AND FREGOLI.

This case study describes the coexistence of Capgras and Fregoli-type delusions in a 51-year-old woman. The patient reported that her children were kidnapped and replaced with doubles. She claims that several customers at her shop are her real children. Neuropsychological assessment revealed severe defects in social cognition and an increased number of perseveration responses in the self-directed signaling task. We propose that the latter finding is a measure of the familiarity phenomenon and may be associated with hypofunction in the left retrosplenial region. SPECT-CT confirmed a pattern of hypoperfusion in the retrosplenial, posterior cingulate, and prefrontal cortex.

Delusional misidentification syndrome and criminal acting out: A case report of maternal filicide.

Delusional misidentification syndromes are associated with danger and may lead to homicide. Early assessment of the danger is a key part of the psychiatric examination. Compliance to treatment in psychosis is important to avoid the devastating consequences, for the perpetrator, the victim, and the community.

Epileptic Capgras-Like Delusions in a Patient with Right Frontal Meningioma: Case Report.

Capgras syndrome is a condition characterized by the belief that a relative has been replaced by an almost identical imposter. The disorder has been reported in several neurological diseases. We describe the uncommon case of a transient Capgras syndrome manifesting as focal temporal seizures in a woman with a right frontal meningioma. Our patient represents an exceptional case of Capgras syndrome for several reasons, namely, the association with meningioma, very rarely reported before, the transient manifestation of symptoms, and, most importantly, the epileptic etiology of reduplicative paramnesias. Lastly, our report also confirms the importance of frontal and right hemisphere dysfunction in generating Capgras syndrome-like delusions.

Capgras syndrome and confabulation unfurling anti NMDAR encephalitis with classical papillary thyroid carcinoma: First reported case.

Anti NMDA Receptor encephalitis (ANMDARE) is an immune mediated disease of the central nervous system, caused by circulating antibodies against the NMDA receptor present on neuronal surface. It is known to cause a spectrum of disease ranging from mild behavioral and psychiatric manifestations to full blown seizures, dyskinesias and altered sensorium. It can also be paraneoplastic presentation of a hidden tumor, most commonly ovarian teratoma. Here we present a case of ANMDARE with intriguing presentation of Capgras syndrome and confabulations, who was found to have a malignant papillary thyroid carcinoma, which has been rarely reported.

Evolution of Capgras syndrome in neurodegenerative disease: the multiplication phenomenon.

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.

Patricide and overkill: a review of the literature and case report of a murder with Capgras delusion.

Despite being an infrequent crime, parental homicide has been associated with schizophrenia spectrum disorders in adult perpetrators and a history of child abuse and family violence in adolescent perpetrators. Among severe psychiatric disorders there is initial evidence that delusional misidentification might also play a role in parricide. Parricides are often committed with undue violence and may result in overkill. The authors present the case of an adult male affected by schizoaffective disorder and Capgras syndrome who committed patricide. Forensic pathologists classify such cases as overkill by multiple fatal means comprising stabbing, blunt trauma and choking. Accurate crime scene investigations coupled with psychiatric examinations of perpetrator allow reconstruction of the murder stages. This overkill case is discussed in the context of a broad review of the literature.

A Rare Case of Capgras Syndrome in Moyamoya Disease.

Moyamoya disease is a rare cerebrovascular disorder with unknown etiology and psychiatric symptoms occasionally manifest initially. Capgras syndrome is a unique neuropsychiatric symptom that is a delusional misidentification of a familiar person replaced by an identical imposter. We report the case of a 51-year-old woman with frontal lobe ischemic stroke caused by moyamoya disease, presenting with Capgras syndrome. Dysfunction of frontal areas may be attributable to development of Capgras syndrome.

Catching the imposter in the brain: The case of Capgras delusion.

Here we describe a rare case of Capgras delusion - a misidentification syndrome characterized by the belief that a person has been replaced by an imposter - in a patient without evident neurological or psychiatric symptoms. Intriguingly, delusional belief was selective for both person and modality, as the patient believed that his son - not his daughter or other relatives - was substituted with an imposter only while being in presence of him and looking at his face, but not when merely listening to his voice. A neuroanatomical reconstruction obtained integrating morphological and functional patient's neuroimaging data highlighted two main peculiarities: a compression of the rostral portion of right temporal lobe due to a large arachnoid cyst, and a bilaterally reduced metabolism of frontal areas. Autonomic data obtained from thermal infra-red camera and skin conductance recordings showed that a higher sympathetic activation was evoked by the observation of daughter's face, relative to the observation of the son's face as well as of not-familiar faces; conversely, daughter and son voices elicited a similar sympathetic activation, higher relative to not-familiar voices, indicating a modality-dependent dissociation consistent with the delusional behavior. Our case supports the "two-hit hypothesis" about Capgras delusion etiopathogenesis: here, the first hit is represented by the right-temporal lesion impairing the association between familiar faces and emotional values, the second one is the frontal bilateral hypometabolism favoring delusional behavior. The selective occurrence of "imposter" delusion for a particular subject and for a specific perceptual modality suggests the involvement of modality-specific interactions in the retrieval of affective properties during familiar people recognition.

Capgras and Fregoli syndromes: delusion and misidentification.

Capgras and Fregoli syndromes are two psychotic and complex conditions also known as Delusional Misidentification Syndromes (DMSs). Their description dates back to the beginning of XX century, and many explanatory models have been formulated through myths, psychoanalytical and psychological hypotheses, as well as neurobiological proposals. Even if DMSs are not fully considered in the modern diagnostic manuals, they still remain intriguing phenomena to be clinically observed and explained. Also, the employment of psychotropics and physical techniques in the treatment of such conditions is not supported by robust evidences and this may encourage further studies. We conclude that it would be of great interest to brush up the neglected MDSs in order to improve our knowledge on the underlying mechanisms of delusion and brain functioning.

Prevalence of Capgras syndrome in Alzheimer's patients: A systematic review and meta-analysis.

The association between Capgras syndrome and Alzheimer's disease has been reported in several studies, but its prevalence varies considerably in the literature, making it difficult to measure and manage this condition. OBJECTIVE: This study aims to estimate the prevalence of Capgras syndrome in patients with Alzheimer's disease through a systematic review, and to review etiological and pathophysiological aspects related to the syndrome. METHODS: A systematic review was conducted using the Medline, ISI, Cochrane, Scielo, Lilacs, and Embase databases. Two independent researchers carried out study selection, data extraction, and qualitative analysis by strictly following the same methodology. Disagreements were resolved by consensus. The meta-analysis was performed using the random effect model. RESULTS: 40 studies were identified, 8 of which were included in the present review. Overall, a total of 1,977 patients with Alzheimer's disease were analyzed, and the prevalence of Capgras syndrome in this group was 6% (CI: 95% I² 54% 4.0-8.0). CONCLUSION: The study found a significant prevalence of Capgras syndrome in patients with Alzheimer's disease. These findings point to the need for more studies on the topic to improve the management of these patients.

A associação da síndrome de Capgras com a doença de Alzheimer é relatada em diversos estudos, porém a sua prevalência varia consideravelmente entre bibliografias, dificultando a real mensuração e manejo desta patologia. OBJETIVO: O objetivo deste estudo foi estimar, através de uma revisão sistemática, a prevalência da síndrome de Capgras em pacientes com a doença de Alzheimer, bem como revisar os aspectos etiológicos e fisiopatológicos relacionados à síndrome. MÉTODOS: Uma revisão sistemática foi realizada utilizando-se as seguintes bases de dados: Medline, ISI, Cochrane, Scielo, Lilacs e Embase. A seleção dos estudos, extração de dados e análise qualitativa foi feita por dois pesquisadores de forma independente e seguindo rigorosamente a mesma metodologia, sendo as discordâncias resolvidas por consenso. A metanálise foi calculada utilizando-se modelo de efeito randômico. RESULTADOS: Foram recuperados 40 estudos, dos quais 8 foram incluídos na presente revisão. Considerando todos os estudos incluídos, 1977 pacientes com doença de Alzheimer foram analisados, sendo encontrada a prevalência da síndrome de Capgras dentre esses pacientes de 6% (IC: 95% I² 54% 4,0-8,0). CONCLUSÃO: A presente revisão encontrou uma prevalência significativa da síndrome de Capgras nos pacientes com doença de Alzheimer. Tal achado implica na necessidade de mais estudos visando melhorar o manejo desses pacientes.

Prevalence of Capgras syndrome in Alzheimer's patients: A systematic review and meta-analysis / Prevalência da síndrome de capgras em pacientes com doença de alzheimer: uma revisão sistemática e metanálise

ABSTRACT The association between Capgras syndrome and Alzheimer's disease has been reported in several studies, but its prevalence varies considerably in the literature, making it difficult to measure and manage this condition. Objective: This study aims to estimate the prevalence of Capgras syndrome in patients with Alzheimer's disease through a systematic review, and to review etiological and pathophysiological aspects related to the syndrome. Methods: A systematic review was conducted using the Medline, ISI, Cochrane, Scielo, Lilacs, and Embase databases. Two independent researchers carried out study selection, data extraction, and qualitative analysis by strictly following the same methodology. Disagreements were resolved by consensus. The meta-analysis was performed using the random effect model. Results: 40 studies were identified, 8 of which were included in the present review. Overall, a total of 1,977 patients with Alzheimer's disease were analyzed, and the prevalence of Capgras syndrome in this group was 6% (CI: 95% I² 54% 4.0-8.0). Conclusion: The study found a significant prevalence of Capgras syndrome in patients with Alzheimer's disease. These findings point to the need for more studies on the topic to improve the management of these patients.

RESUMO A associação da síndrome de Capgras com a doença de Alzheimer é relatada em diversos estudos, porém a sua prevalência varia consideravelmente entre bibliografias, dificultando a real mensuração e manejo desta patologia. Objetivo: O objetivo deste estudo foi estimar, através de uma revisão sistemática, a prevalência da síndrome de Capgras em pacientes com a doença de Alzheimer, bem como revisar os aspectos etiológicos e fisiopatológicos relacionados à síndrome. Métodos: Uma revisão sistemática foi realizada utilizando-se as seguintes bases de dados: Medline, ISI, Cochrane, Scielo, Lilacs e Embase. A seleção dos estudos, extração de dados e análise qualitativa foi feita por dois pesquisadores de forma independente e seguindo rigorosamente a mesma metodologia, sendo as discordâncias resolvidas por consenso. A metanálise foi calculada utilizando-se modelo de efeito randômico. Resultados: Foram recuperados 40 estudos, dos quais 8 foram incluídos na presente revisão. Considerando todos os estudos incluídos, 1977 pacientes com doença de Alzheimer foram analisados, sendo encontrada a prevalência da síndrome de Capgras dentre esses pacientes de 6% (IC: 95% I² 54% 4,0-8,0). Conclusão: A presente revisão encontrou uma prevalência significativa da síndrome de Capgras nos pacientes com doença de Alzheimer. Tal achado implica na necessidade de mais estudos visando melhorar o manejo desses pacientes.