CAPGRA SYNDROME

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

[1], [2], [3]

Causes of the cAPGRA SYNDROME

Until now, scientists can not come to a common opinion, which is the true root cause of the emergence of the syndrome Kapgra. There is a widespread hypothesis that the double replacement syndrome is due to a traumatic or organic lesion of the visual portion of the cerebral cortex responsible for facial recognition. To the violation of identification can result: a stroke, cerebral hematoma, TBI, cracks and ruptures of brain aneurysm, neurosurgical interventions, diagnosed schizophrenia with manic and paranoid components, deep alcoholism, senile dementia.

Not having an unambiguous explanation about the process of the Cappra syndrome.

Many scientists do not believe that Kapgra's delirium is a separate diagnosis, but are inclined to claim that a combination of characteristic symptoms of a mental disorder is a subspecies of schizophrenia.

[4], [5], [6]

Pathogenesis

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

• I autoscopism - perverted perception of others (relatives or completely outsiders).
• II the dual perception of oneself, or the illusory-delusional perception of one's twin.

[7], [8], [9], [10], [11], [12], [13]

Symptoms of the cAPGRA SYNDROME

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

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

I type - a false-perverted form of recognition of a group of persons. It is divided into positive and negative recognition of twins. False perception extends not to one person, but to a group of people.

With a negative perception of twins, the patient claims that all the relatives around him are replaced by completely different personalities, skillfully disguised as relatives. The relatives were replaced by robots or aliens, only external similarity remained. This is constantly sought confirmation and proof (drawing a make-up, similar clothes). Patients constantly find facts that distinguish true relatives, familiar from twins: facial features, gait, eye color, etc.

Unshakable belief in the existence of doubles makes the patient suspicious and aggressive. It seems to him that twins are a threat, they want to harm or kill him. The patient's aggression is explained by the constant psychological stress and anticipation of the danger coming from all sides.

Perverted positive recognition can concern completely unfamiliar strangers. The patient claims that for a very long time they know, they are disguised as familiar friends and relatives.

In the illusory-delirious form of false recognition, patients become aggressive and dangerous. Perceiving wary "doubles" they may want to change places "replaced" with "right" people. Aggressive behavior is based on the desire to put an end to the understudy by killing them. Patients are difficult to remain calm when the danger is on all sides.

II type is an illusory-delusional form of not perceiving oneself, and the lack of self-identification of one's personality. As well as type I has a negative and positive options. The patient proves to others that all his actions and unseemly acts are not committed by himself, but by his double or "duplicating twin." The patient himself has no relation to any events that occurred - in all his fault is the exact copy.

Such a state of mind as the Kapra syndrome lasts from a few hours to a week or more.

[14], [15]

First signs

One of the most significant provoking factors is a burdened history of anamnesis (childhood spent in a troubled family, past traumas of the head). The prerequisites for the emergence of the Kapgra syndrome are: diagnosis of schizophrenia, TBI, female alcoholism, alcohol delirium, brain surgery, senile dementia, twilight consciousness. The patient begins to express his own assumptions and suspicions about the substitution of a group of persons or himself. An unnerving suspicion, inability to identify familiar and unfamiliar faces, delusions about substitutions of people should serve as alarming moments.

[16], [17], [18], [19], [20], [21]

Forms

Kapgra syndrome is classified depending on the patient's claims:

• delusional recognition of negative twins (his relatives, friends and acquaintances replaced replicas - doubles);
• delusional recognition of positive twins (in completely foreign and unfamiliar people relatives and friends are recognized).

There are types of Kapgra syndrome depending on whether one sees a double patient or not:

• I autoscopic type - the patient sees and perceives a double;
• II type - the understudy remains "invisible".

Psychiatrists argue that the ability to distinguish faces with Kapgra's syndrome remains good, although not fully preserved.

[22], [23], [24], [25], [26]

Complications and consequences

In schizophrenia with Kapgra's syndrome, there is a clear tendency to change some types of recognition of "twins" by others. The clinical situation is complicated as a result of the progression of the psychiatric disorder.

The Kapgra syndrome is often wavy, with a gradual transformation of illusory recognition and simultaneous increase in delirium. This is a reflection of the aggravation of the disease. Patients with Kapgra syndrome usually are, aggressive and easily fall into a rage. The feelings of fear and threat of aggression are a form of protection for patients. They are dangerous for society, because they can attack for the purpose of murder. For themselves, they are dangerous for the possibility of suicide.

[27], [28], [29]

Diagnostics of the cAPGRA SYNDROME

It is carried out by specialists in stationary conditions. Diagnosis is based on behavioral characteristics and illusory-delusional recognition of people. The syndrome of Kapra differs in that individuals are usually accurately identified. The signs by which the person is identified are not called, and this fact is only ascertained by the patient. Great importance in diagnosis is given to the presence of one of the factors that provoke a delusional state (a burdened anamnesis).

[30], [31]

Differential diagnosis

Some mental disorders have similar abnormalities. For the diagnosis, the psychiatrist excludes the following violations:

• schizophrenic disorders;
• Alzheimer's disease;
• Huntington's disease;
• multiple sclerosis;
• craniocerebral trauma;
• delirium caused by the use of drugs and alcohol, overdose of medicines with an adverse hallucinatory effect;
• dementia, proceeding according to the depressive-manic type.

Treatment of the cAPGRA SYNDROME

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

Cognitive methods of treatment, including reframing and testing of reality turned out to be effective.

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

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

Prevention

Preventive measures include:

• psychotherapist's help,
• avoidance of stress or an adequate response to them,
• refusal of pre-alcohol,
• preventive measures for atherosclerosis,
• if the diagnosis of "Kapgra syndrome" has already sounded, then it is necessary to carefully communicate with the patient during the interictal period, to avoid unnecessary stressful situations for him, and at the slightest change of behavioral reactions to consult a specialist.

[32], [33], [34], [35], [36], [37], [38]

Forecast

The manifestation of Kapgra's syndrome in manifestations of obscuration of consciousness indicates the severity of the underlying disease (delirium).

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

With schizophrenia, the presence of Kapgra syndrome confirms the progression of the disease.

[39], [40], [41], [42], [43], [44], [45]