Generality
Capgras syndrome is a psychiatric disease characterized by the firm belief that one or more familiar persons have been replaced by strangers identical to them.
Those affected claim that those close to them - such as their spouse, friends, siblings, children or parents - have been replaced by doppelgangers, impostors or even aliens. In some cases, Capgras syndrome can also extend to pets or familiar places.
The exact causes are not yet fully known. However, Capgras syndrome has been shown to be related to brain injury, dementia or other organic brain disorder.
The recognition of this syndrome through an adequate diagnostic pathway is of primary importance. Capgras syndrome can be tackled with a therapy based on drugs (neuroleptic or other) associated with a psychotherapy course.
What's this
Capgras syndrome is a psychiatric illness, in which the subject is firmly convinced that a friend, spouse and other members of their family have been replaced by impostors or impersonators . In practice, the "copies" would have appropriated the identity of the people close to them, replacing them.
In Capgras syndrome, this delusional belief is constant and is maintained despite evidence to the contrary; the result is a feeling of strangeness towards other individuals.
One of the characteristics of this pathology is that the conviction of those suffering from Capgras syndrome is not based on false or incomplete information due to some error in sensory perception or to an illusion (unlike what happens, instead, in other disorders psychiatric).
Synonyms and some curiosity
- The syndrome is also known as " Capgras delirium ".
- The name of the syndrome is due to the French doctor Joseph Capgras, who first described it in 1923, taking the example of "Madame M.", a patient who claimed that her husband and other people known to her had been replaced by a double. The psychiatrist defined this pathological form as " illusion des sosies ", although it is not a true illusion, since the sensory perception is intact . Originally, Capgras argued that delirium was the consequence of feelings of strangeness experienced by the patient towards emotionally close people (in practice, instead of facing a possible conflict, the subject developed the symptoms associated with the pathology).
- In the past, Capgras syndrome was associated with hysteria, so it was considered a purely female psychiatric disorder. In 1980, the investigation of the possible causes at the origin of the pathology allowed to establish that the pathology derives mainly from organic or degenerative brain lesions . Today, therefore, Capgras syndrome is understood as a neurological disorder that can be concomitant with other psychiatric disorders, such as schizophrenia .
Causes and Risk Factors
What are the causes of Capgras syndrome?
The underlying causes of Capgras syndrome are not yet fully understood, but numerous hypotheses have been formulated. In particular, a close correlation between this manifestation and brain damage has been demonstrated, especially against the temporal and frontal lobe of the right hemisphere .
The Capgras syndrome has been identified, in particular, as a consequence of head trauma, cerebrovascular disorders, neurodegenerative pathologies (such as Alzheimer's) and various dementia forms.
Furthermore, it is not uncommon for patients suffering from this condition to experience other psychiatric disorders or organic brain disorders, such as, for example: schizophrenia, mood disorders, epilepsy, alcoholism, encephalitis and more.
Neurobiological hypotheses
In patients affected by Capgras syndrome, the sense of familiarity that accompanies the perception of a face is missing, which gives the conviction that people close to them, such as their spouse or child, have been replaced with other individuals .
Capgras syndrome is part of the so-called " false recognition syndromes " (in English " misidentification syndromes "). This category also includes the Fregoli syndrome, characterized by a clinical picture diametrically opposed to that of the pathology in question: the patient recognizes family members and friends in strangers.
With the modality still under study, it seems that, in the Capgras syndrome, in the dysfunctional mechanism of face recognition is implicated the limbic system, responsible for the emotions: whoever is affected recognizes the features and the face of their loved ones, but l is missing affective activation towards them ( model of disconnection ).
Another theory, on the other hand, holds that the main damage is on the right lobe and, in particular, a dysfunctional integration between the perceptual information and the feeling of familiarity normally attributed to them ( lateralization model ) would be created.
In summary, among the various hypotheses proposed so far to explain the etiology of Capgras syndrome are:
- Anatomo-functional alterations of the temporal and frontal lobe of the right hemisphere ;
- Dorsal segment lesions ;
- Disconnections between the limbic system and the cerebral cortex .
Other scientific studies, on the other hand, argue that the reason for Capgras syndrome is due to a dysfunction of the amygdala .
Capgras syndrome: risk factors
- Capgras syndrome is more common in women, but is also found among men (according to available epidemiological data, the ratio is 3: 2 ).
- The symptomatology of Capgras syndrome can appear in conjunction with stressful periods or occur in association with some organic pathologies .
- Capgras syndrome may represent a "collateral" manifestation of some psychiatric disorders (eg paranoid schizophrenia, psychotic depression, mood disorders, etc.).
Symptoms and Complications
The Capgras syndrome leads to the conviction of the existence of "duplicates" of significant people in the life of the patient: even if they appear identical in their eyes, they are completely different. This conviction remains constant all the time, although attempts are being made to prove otherwise by showing the evidence: the phenomenon consists in a " complicated form of misidentification ". If the subject is asked how the alleged impostor differs from the original, it often indicates aspects relating to physical appearance or behavior. In reality, these differences are non-existent and the details that justify his belief are mostly minor. For example, those suffering from Capras syndrome can claim that the partner has been replaced, since he is less affectionate, has a different way of speaking than the real one, or tied his shoes in another way, etc.
The disorder can also extend to pets and familiar places ; in rare cases, then, it is the patient himself who feels replaced.
In addition to these typical behaviors, the patient may experience depressive episodes, anxiety, melancholy and aggression towards others.
Mode of beginning and course
When Capgras syndrome results from a psychotic disorder it tends to arise at an early age; if the pathology results from organic causes, instead, it appears suddenly and abruptly coinciding with the damage suffered.
It should be emphasized that Capgras syndrome can occur intermittently, transient or chronic.
Capgras syndrome: how it occurs
The characteristic symptom of Capgras syndrome is the delusion that other people, emotionally significant for the patient (such as parents, partners, children or siblings), are no longer the real family members, but have been replaced with identical double, impostors or, indeed, aliens . Thus a "disavowal" of the known person is determined.
The patient's attitude towards these subjects can vary:
- In some cases, close people are seen in a positive way;
- Other times, the attitude towards the alleged impostors is negative, so it can go from a simple suspicion to a real paranoid behavior, which in some cases can lead to threats, hostility, persecutory delusions or physical aggression towards the substitute.
Diagnosis
When the first symptoms of Capgras syndrome appear, it is important to consult a doctor, usually a psychiatrist or neurologist, to establish the diagnosis.
To understand the extent of the disease and establish an appropriate treatment plan, the doctor organizes interviews with the patient and / or family members, in order to gather information on the syndromic picture and the level of general compromise. This evaluation also aims to find the links between the discomfort experienced by the patient and the factors that trigger or contribute to maintaining the disorder.
The diagnostic process of Capgras syndrome must always include a neurological examination, integrated with neuroimaging studies (such as MRI).
Treatment
The treatment of Capgras syndrome depends on the triggering causes and varies, therefore, from case to case.
Usually, the management of the condition involves the use with antipsychotic and antidepressant medicines, associated with psychotherapy sessions . In the treatment, the family tends to be involved, as the patient may not recognize his state in full autonomy, besides not realizing what factors are responsible for the development and maintenance of the disorder.
drugs
The drugs that are usually prescribed for the treatment of Capgras syndrome may include:
- Antipsychotics (also called neuroleptics) : drugs useful for the treatment of psychotic symptoms, such as delusions and hallucinations;
- Mood stabilizers ;
- Antidepressants : help manage feelings of sadness and despair.
Psychotherapy
Psychotherapeutic interventions are an important complement to the pharmacological treatment of Capgras syndrome, as they contribute to improving the prognosis of the disorder, taking into account the complexity of the pathology and the specific individuality of the subject.
