October 1, 2019 e-Pearl of the Week: Capgras syndrome

Capgras Syndrome

Capgras syndrome is a form of delusional misidentification characterized by the belief that a familiar person has been replaced by an imposter.1,2 Its exact pathophysiology is unknown, although disruption between areas of facial recognition and the limbic system has been postulated.2 It is associated with Lewy body dementia, occipital lobe epilepsy,1 bilateral ischemic stroke,2 traumatic brain injuries, schizophrenia, and Alzheimer disease.3 Symptoms may improve with treatment of the underlying cause—however, persistence of the delusion may benefit from initiation of an SSRI, atypical antipsychotic, or acetylcholinesterase inhibitor such as donepezil.4

References

  1. Lilly B, Maynard E, Melvin K, Holroyd S. "Capgras" Delusions Involving Belongings, Not People, and Evolving Visual Hallucinations Associated with Occipital Lobe Seizures. Case Rep Psychiatry 2018 Epub Mar 7.
  2. Garcha, M, Sivakumar K, Leary M, Yacoub H. (2018). Transient Capgras Syndrome Secondary to Bilateral Ischemic Stroke: A Case Report. Cogn Behav Neurol 2018;31:96–98.
  3. Fischer C, Keeler A, Fornazzari L, et al. A rare
    variant of Capgras syndrome in Alzheimer's disease. Can J Neurol Sci 2009;36:509–11.
  4. Reimers K, Emmert N, Shah H, Benedict RH, Szigeti K. Capgras-like visual decomposition in Lewy body dementia with therapeutic response to donepezil. Neurol Clin Pract 2014;4:467–469.

Submitted by Naveed Ahmad, MBBS, Research Associate, Sugar Land Neurology and Sleep and Faisal Khan M.D, DABSM, Consultant Neurologist, Sugar Land Neurology and Sleep.

Naveed Ahmad and Faisal Khan report no disclosures.