Capgras syndrome

Capgras syndrome (Capgras delusion) – refers to a group of rare psychiatric disorders associated with a violation of the identification of individuals from the environment (relatives, acquaintances, friends) or the perception of oneself. The syndrome received its name in honor of the psychiatrist Jean Marie Joseph Capgras, who first described the characteristic signs of the disease in 1923.

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Causes Capgras syndrome

Until now, scientists have not been able to come to a consensus on what is the true root cause of Capgras syndrome. There is a widespread hypothesis that the syndrome of double substitution occurs due to traumatic or organic damage to the visual part of the cerebral cortex responsible for facial recognition. Identification disorders can be caused by: stroke, cerebral hematoma, traumatic brain injury, cracks and ruptures of an aneurysm of the brain, neurosurgical interventions, diagnosed schizophrenia with manic and paranoid components, severe alcoholism, senile dementia.

Without a clear explanation of the process by which Capgras syndrome occurs.

Many scientists do not believe that Capgras delusion is a separate diagnosis, but are inclined to believe that the combination of characteristic symptoms of mental disorder is a subtype of schizophrenia.

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Pathogenesis

Since the mechanism of the development of Capgras syndrome has not been thoroughly studied, psychiatrists have to identify and diagnose sufficiently developed and manifested signs of the disease. The differential classification of Capgras delusions is reduced to two main types:

• I autoscopism is a distorted perception of others (relatives or complete strangers).
• II dual perception of oneself, or illusory-delusional perception of one’s twin.

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Symptoms Capgras syndrome

Among patients with Capgras syndrome, two main types of false-delusional recognition are recorded: some claim that the double is next to them (they see it, it is tangible), while others claim that their double is invisible (they record only the consequences of the actions allegedly committed by it). Such substitutions can even concern their pets (cats, dogs).

Patients may claim that the replacement concerns their pet (cat).

Type I – a false-distorted form of recognition of a group of people. Divided into positive and negative recognition of doubles. False perception extends not to one person, but to a group of people.

With a negative perception of doubles, the patient claims that all the relatives around him have been replaced by completely different personalities, skillfully disguising themselves as loved ones. Relatives have been replaced by robots or aliens, only external similarities remain. Confirmation and proof of this are constantly sought (applying makeup, similar clothes). Patients constantly find facts that distinguish true relatives, acquaintances from doubles: facial features, gait, eye color, etc.

The unshakable belief in the existence of doubles makes the patient suspicious and aggressive. It seems to him that the doubles pose a threat, want to harm or kill him. The patient's aggression is explained by constant psychological tension and the expectation of danger coming from all sides.

Perverted positive recognition may concern completely unfamiliar strangers. The patient claims that he has known them for a long time, they disguise themselves as well-known friends and relatives.

In the illusory-delusional form of false recognition, patients become aggressive and dangerous. Perceiving "understudies" with caution, they may want to swap the "replaced" with the "correct" people. Aggressive behavior is based on the desire to finish off the understudies by killing them. It is difficult for patients to remain calm when danger is creeping up on them from all sides.

Type II is an illusory-delusional form of non-perception of oneself and lack of self-identification of one's personality. Just like type I, it has negative and positive variants. The patient proves to others that all his actions and unseemly deeds were committed not by him, but by his double or "duplicate twin". The patient himself has nothing to do with any events that have occurred - his exact copy is to blame for everything.

A mental state such as Capgras syndrome lasts from several hours to a week or more.

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First signs

One of the most significant provoking factors is a burdened life history (childhood spent in a problematic family, previous head injuries). Prerequisites for the development of Capgras syndrome are: a diagnosis of schizophrenia, TBI, female alcoholism, alcoholic delirium, brain surgery, senile dementia, twilight consciousness. The patient begins to express his assumptions and suspicions about the substitution of a group of people or himself. Alarming moments should be excessive suspiciousness, the inability to identify familiar and unfamiliar faces, delusional statements about the substitution of people.

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Forms

Capgras syndrome is classified depending on the patient's statements:

• delusional recognition of negative doubles (his relatives, friends and acquaintances were replaced by exact copies - doubles);
• delusional recognition of positive doubles (relatives and friends are recognized in complete strangers and unfamiliar people).

There are different types of Capgras syndrome depending on whether the patient sees a double or not:

• I autoscopic type – the patient sees and touches the double;
• Type II – the understudy remains “invisible”.

Psychiatrists claim that the ability to distinguish faces in Capgras syndrome remains good, although not fully preserved.

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Complications and consequences

In schizophrenia with Capgras syndrome, there is a clear desire to replace some types of recognition of "doubles" with others. The clinical situation is complicated by the progression of the mental disorder.

Capgras syndrome often proceeds in waves with a gradual transformation of illusory recognition and a simultaneous increase in delusion. This is a reflection of the aggravation of the disease. Patients with Capgras syndrome are usually aggressive and easily enraged. Aggression caused by feelings of fear and threat is a form of defense for patients. They are dangerous to society, as they can attack with the intent to kill. They are dangerous to themselves due to the possibility of suicide.

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Diagnostics Capgras syndrome

It is performed by specialists in hospital conditions. Diagnostics is based on behavioral characteristics and illusory-delusional recognition of people. Capgras syndrome is characterized by the fact that faces are usually accurately identified. The signs by which the face is recognized are not named, and this fact is only stated by the patient. Great importance in diagnostics is given to the presence of one of the factors provoking a delusional state (burdened anamnesis).

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Differential diagnosis

Some mental disorders have similar disorders. To make a diagnosis, a psychiatrist excludes the following disorders:

• schizophrenic disorders;
• Alzheimer's disease;
• Huntington's disease;
• multiple sclerosis;
• traumatic brain injury;
• delirium caused by the use of drugs and alcohol, an overdose of medications with a side hallucinatory effect;
• dementia occurring according to the depressive-manic type.

Treatment Capgras syndrome

Capgras syndrome is treatable. The course of therapy is long with an individual approach. It is aimed at the main cause that caused the syndrome. The use of antipsychotic drugs did not always give the expected result. Control of lability of consciousness is carried out with the help of strong psychotropic drugs and all manipulations aimed at restoring the normal functions of the damaged areas of the central nervous system.

Cognitive treatments, including reframing and reality testing, have proven effective.

Antiepileptic therapy (from 10 weeks to several years) helps to get rid of delusional illusory recognition. The use of third-generation antidepressants for the treatment of depression or anxiety disorders (SSRIs).

The course of the syndrome is wave-like, so in the interictal period, patients can completely control their actions. But at what point in the psyche a new emotional outburst will occur and what will serve as its stimulus is unknown.

Prevention

Preventive measures include:

• help of a psychotherapist,
• avoiding stress or responding appropriately to it,
• refusal of pre-alcohol,
• preventive measures for atherosclerosis,
• If the diagnosis of "Capgras syndrome" has already been made, then one should carefully communicate with the patient during the interictal period, avoid unnecessary stressful situations for him, and at the slightest change in behavioral reactions, contact a specialist.

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Forecast

The manifestation of Capgras syndrome with manifestations of clouding of consciousness indicates the severity of the underlying disease (delirium).

The presence of the syndrome in overt dementia and alcoholic psychoses indicates their complexity and the presence of a large number of cognitive disorders.

In schizophrenia, the presence of Capgras syndrome confirms the progression of the disease.

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