Clinical features and imaging findings in a case of Capgras syndrome

Neuropsychiatric Disease and Treatment Dovepress open access to scientific and medical research C a s e R e p o rt Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Open Access Full Text Article Clinical features and imaging findings in a case of Capgras syndrome This article was published in the following Dove Press journal: Neuropsychiatric Disease and Treatment 5 August 2013 Number of times this article has been viewed Maria Luca 1 Andrea Bordone 1 Antonina Luca 2 Andrea Patti 1 Giuseppe Sortino 3 Carmela Calandra 1 Department of Medical and Surgery Specialties, Psychiatry Unit, 2 Department GF Ingrassia, Section of Neuroscience, 3Department of Diagnostic Imaging, Radiology Unit, University Hospital PoliclinicoVittorio Emanuele, Catania, Sicily, Italy 1 Introduction Correspondence: Carmela Calandra Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital Policlinico-Vittorio Emanuele, Via S Sofia 78, Catania, Sicily 95100, Italy Tel +39 09 5378 2636 Fax +39 09 5378 2636 Email Delusional misidentification syndromes are characterized by an interesting psychopathologic phenomenon in which patients misidentify familiar persons, objects, or themselves, believing that they have been replaced or transformed.1,2 The correct classification of these diseases is still unclear; within the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV),3 they could be included among the broader category of delusional disorders but, as reported in the literature, there is not always a concordance between the symptoms presented by the patients and the rigid diagnostic categories.4 Delusional misidentification syndromes can occur in the case of idiopathic psychiatric illness as well as in the case of diffuse or focal brain damage, and are characterized by a pattern of neuropsychologic impairments (particularly affecting memory and perception) which are not indicators of the selectivity of these delusional phenomena. In fact, other variables, such as premorbid psychopathology and motivation, may be important in determining which patients are more vulnerable to developing delusional misidentification syndromes.5 1095 submit your manuscript | www.dovepress.com Neuropsychiatric Disease and Treatment 2013:9 1095–1099 Dovepress © 2013 Luca et al. This work is published by Dove Medical Press Ltd, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at http://creativecommons.org/licenses/by-nc/3.0/. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Ltd, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Ltd. Information on how to request permission may be found at: http://www.dovepress.com/permissions.php http://dx.doi.org/10.2147/NDT.S47293 Powered by TCPDF (www.tcpdf.org) Abstract: Capgras syndrome consists of the delusional belief that a person or persons have been replaced by doubles or impostors. It can occur in the context of both psychiatric and organic illness, and seems to be related to lesions of the bifrontal and right limbic and temporal regions. Indeed, magnetic resonance imaging has revealed brain lesions in patients suffering from Capgras syndrome. This case study reports the findings of a thorough diagnostic evaluation in a woman suffering from Capgras syndrome and presenting with the following clinical peculiarities: obsessive modality of presentation of the delusional ideation, intrusiveness of such ideation (that even disturbed her sleep), as well as a sense of alienation and utter disgust towards the double. These characteristics bring to mind the typical aspects of obsessive-compulsive disorder. Neuroanatomic investigation, through magnetic resonance imaging, performed on this patient showed alteration of the bilateral semioval centers, which are brain regions associated with the emotion of disgust and often show alterations in subjects suffering from obsessive-compulsive disorder. Hence, neuroimaging allows researchers to put forward the hypothesis of a common neuroanatomic basis for Capgras syndrome and obsessive-compulsive disorder, at least for cases in which the delusional ideation is associated with deep feelings of disgust and presents with a certain pervasiveness. Keywords: Capgras syndrome, magnetic resonance imaging, electroencephalography, obsessive-compulsive disorder, semioval centers Dovepress Neuropsychiatric Disease and Treatment downloaded from https://www.dovepress.com/ by 37.59.46.207 on 12-Jul-2018 For personal use only. Luca et al Among the delusional misidentification syndromes, Capgras syndrome is the most common and consists of the delusional belief that a person or persons have been replaced by doubles or impostors.6 In 1923, this syndrome was described by Capgras and Reboul-Lachaux, and was originally termed “illusion des sosies”.7 The Capgras delusion can be considered a symptom occurring in adults and in children8 in the context of both psychiatric and organic illness.9,10 As a matter of fact, it can be associated with other psychiatric conditions, especially schizophrenia.11 It can present as a complication of neurodegenerative disorders (such as multiple sclerosis and Alzheimer’s disease)12,13 and infective conditions,10 or can even be a manifestation of drug toxicity.14 Moreover, it seems to be related to lesions of bifrontal and right limbic and temporal regions.9 Indeed, magnetic resonance imaging has revealed brain lesions in patients suffering from Capgras syndrome affecting in particular the frontal and subcortical regions.15,16 This delusion could also be due to a disconnection between the frontal lobes and right temporolimbic regions. Hence, it is impossible to link information regarding identification of the person and the emotions arising from such identification.6 Psychodynamic explanations for the occurrence of such a particular delusion have been provided by some authors,17,18 even though these explanations have been regarded as insufficient.19 From a psychodynamic point of view, the Capgras delusion arises from an altered affective response and leads to intolerable ambivalent feelings which are neutralized by “creation” of doubles.17,18 This case study reports the findings of thorough diagnostic evaluation in a woman suffering from Capgras syndrome. Case report A 53-year-old Caucasian woman was referred to our Psychiatry Unit for hospitalization by her general practitioner. Anamnestic data collection revealed that the patient had had a difficult adolescence, due to the fact that her father had had a mistress and suffered from pathologic gambling. Notwithstanding, she had not experienced any previous psychopathologic problems in the past. She was a housewife with two d (...truncated)