When looking at someone you know well, have you ever felt like you were seeing the face of someone you didn't know? More confident, angrier, or, on the contrary, colder than usual - in any case, before this you knew someone completely different.
In situations that bring out the most unexpected in people, it is sometimes impossible to recognize even those closest to you. Perhaps you have sometimes said about yourself: “It’s not me, someone has definitely taken possession of me!” Well, then you can imagine in general terms the everyday emotions of people suffering from Capgras syndrome.
Story
The syndrome was first described by Joseph Capgras in 1923. He used the phrase “illusion of doubles” as a name, but it did not catch on because the word “illusion” in psychiatry had a different meaning. As a result, the disorder, in which patients mistook relatives and other people for doubles, received its name - “Capgras syndrome.”
It is more common in people with schizophrenia, head injuries, and in combination with various types of dementia. It may appear with age; there have been cases of Capgras syndrome in children. The disorder was once identified as a result of ketamine abuse. In a ratio of 3 to 2, it occurs more often in women than in men.
Treatment
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Doubles of spouses and a doctor with an army of clones
To give you a complete picture of the disease, we will present several clinical cases. The first good example was described by Julia Warnock and Kevin Pusser, MDs, in 1991. Then they encountered Mrs. "D." - an elderly housewife who mistook her husband for an impostor:
“She refused to sleep with the impostor, locked her bedroom and door at night, asked her son for a gun and finally got into a fight with the police when they tried to hospitalize her. Sometimes she believed that her husband was her long-dead father. She easily recognized other family members and was only mistaken about her husband.”
Or another case that does not concern relatives. A precedent in 2008 was described by psychiatrist Arthur Sinkman; a patient named Diana came to see him. She was diagnosed with her first psychosis at the age of 23. She was shy and reserved by nature, and after stopping taking antipsychotics, she began to suspect the doctor that he was allegedly making copies of people:
“When she was hospitalized eight months later, she was under the delusion that the man was making exact copies of people—“screens”—and that she personally had two “screens,” one evil and one good. Diagnosis: schizophrenia with Capgras delusion. She was disheveled and had a bald spot on her head from self-mutilation.”
Obviously, the girl was trying to cope with her “evil” copy. There were precedents when people mistook themselves for doubles. In such cases, patients tended to attribute their bad deeds to their counterparts.
Capgras syndrome can also occur as a result of a neurodegenerative disease. A similar case was described in 2007 by neurologists Lucelli and Spinler. 59-year-old Fred came to see them. The man had a secondary education and was the head of a small division in the energy sector. In his medical history, he had no cognitive or behavioral disorders, but with age he began to mistake his wife for a double:
“Fred’s wife reported that approximately 15 months after the onset of the disease, he began to see her as a “double” (her words). The first episode happened one day when, after returning home, Fred asked her where Wilma was. To her surprised response that she was there, he firmly denied it. By way of argument, he said that he “knew his Wilma very well as the mother of his sons,” and continued to directly comment that Wilma had probably left and would return later.”
Over time, Fred's cognitive problems only worsened. In addition to Capgras syndrome, he also had difficulties with communication. This later progressed to frontal lobe syndrome - when a person retains his knowledge, intelligence, but cannot use it in accordance with a conscious purpose. In other words, Fred lost his will and began to react arbitrarily to the environment.
This syndrome was first described by French psychiatrists J. Capgras and J. Reboul-Lachaux in 1923 under the name “illusion of doubles.” In 1929, at the suggestion of J. Levy-Valensi, in commemoration of the merits of J. Capgras, the syndrome was named after him. Initially, it was considered a manifestation of schizophrenia, but later it was described in organic pathology of the brain, primarily in elderly people suffering from dementia [1, 17].
Phenomenology
Capgras syndrome is a type of delusional disorder in which the patient is convinced that one or more of his loved ones have been replaced by doubles (imposters), outwardly indistinguishable from the original. As with any other delusional disorder, Capgras syndrome is characterized by persistence despite the presence of indisputable evidence that the beliefs are false. Most often, false beliefs arise in relation to people from close circles. One of the paradoxes of Capgras syndrome is that the object of delusional judgments, as a rule, becomes the relative with whom the patient has the most stable emotional connection and has much in common [23]. A classic example of Capgras syndrome is a patient's claim that his or her spouse has been replaced by an impostor [24].
Patients are often in “righteous” indignation due to the fact that their relatives have not only “disappeared”, but have also been replaced by complete strangers, although similar to them, people who pose as their relatives. Patients often look for a “real” relative and ask the person they are looking for about him. Usually, the “impostor,” according to the patient, is very similar to a loved one, but the patient tries to find and often finds differences from the original. This can provoke outbursts of aggression in the patient towards others [5] and is often accompanied by other delusional beliefs, such as delusions of relationship, persecution, jealousy, and threats to life. Cases have been described when, simultaneously with a close relative, the patient’s belongings became the object of delusional disorder. The patient claimed that his paintings had been replaced by reproductions or that his new things had been replaced by inferior copies [17].
In the context of organic brain pathology, Capgras syndrome is considered as a false delusional syndrome associated with an identification disorder, which in turn is caused by impaired cognitive processes [21].
Identification disorder syndromes
Capgras syndrome can occur either alone or in combination with other types of identification disorder or paranoid syndrome. Identification disorders can be divided according to the principle of insufficiency or excess of “related” feelings in relation to people or objects. Syndromes of lack of relatedness (emotionally negative) include Capgras syndrome, “mirror” syndrome (Foley syndrome), “topical variant of Capgras syndrome” [1, 10].
“Hyperidentification” (emotionally positive) syndromes include Fregoli syndrome, intermetamorphosis syndrome, “own double” syndrome, as well as reduplicative paramnesia described by A. Pick in 1928. In addition, there may be a feeling of the presence of strangers in the house (extracampal hallucinations, phantom neighborhood phenomenon).
Fregoli syndrome
represents a violation of identification with recognition of an unfamiliar person as a long-time acquaintance or relative. This syndrome is the exact opposite of Capgras syndrome. Patients ignore the appearance of the object and note its psychological “kinship”.
Intermetamorphosis syndrome
characterized by the belief of patients that this or that person is not only psychologically close, as happens with Fregoli syndrome, but also has an appearance similar to a loved one. Thus, patients suffering from this syndrome not only feel a kinship with a stranger, but also find familiar features in his appearance.
Doppelgänger Syndrome
It was identified as an independent variety quite recently, although the first description of the delusion of one’s own doubles belongs to J. Capgras and J. Reboul-Lachaux [cit. according to 18]. Its main feature is that the patient is convinced of the presence of his own doubles. It is customary to distinguish two types of the syndrome. In one of them - delusional - the patient is convinced that his invisible double is “acting” in the environment. Another type of this syndrome is autoscopic, or hallucinatory, in which the patient is able to see his own image outside.
Reduplication paramnesia syndrome
characterized by the statement of patients that they are simultaneously in different time dimensions or geographical places. The patient may agree with the objective signs of being in the hospital, but at the same time believes that he is at home. In contrast, with the “topical variant of Capgras syndrome” it is impossible to convince the patient that he is in a familiar environment; the patient believes that his house has been replaced or that this is scenery.
The simultaneous existence of several identification disorder syndromes or their combination with paranoid delusions (the exception is reduplicative paramnesia) can create a bizarre clinical picture. Examples of such combinations in patients with Capgras syndrome are the following observations described in the literature with the following statements from patients: “the daughter has been replaced by a deceased sister”, “the husband has become a woman or a stranger living in their house”, “several people with the name of the wife live in the house” , “two daughters and two sons who look identical live in the house,” “some homosexual is masquerading as his wife,” “there are two identical nurses” [10].
In some cases, Capgras syndrome may follow a disorder in recognizing one's reflection in a mirror (Foley's syndrome).
Foley syndrome
, or autoprosopagnosia, is the impairment of the patient’s recognition of his own face in the mirror while maintaining this ability in relation to other persons. Patients may mistake their reflection for a stranger, an interlocutor, and be afraid of his presence. In some cases, the “mirror” symptom is the only manifestation of the disease at an early stage, but its occurrence can serve as a predictor of progressive dementing disease [6]. Disturbances involve not only the recognition of one’s own reflection, but also sometimes the recognition of familiar faces or the interpretation of reflected space [1, 11, 18]. It is believed that the basis for impaired interpretation of reflections in the mirror is a cognitive deficit, including impaired perception, affective disturbances, and decreased ability to infer [6, 21].
Causes of identification violation
Capgras syndrome has been described in a variety of neurological diseases: intracerebral hemorrhage, massive subarachnoid hemorrhage (associated with the administration of thromboplastin for the treatment of acute myocardial infarction), necrotizing encephalitis, multiple sclerosis, epilepsy, pituitary tumor [1, 2], severe traumatic brain injury, HIV -encephalopathy, alcoholic encephalopathy, lithium intoxication, methamphetamine intoxication, migraine. But most often in recent years, Capgras syndrome has been described in neurodegenerative pathology occurring with dementia syndrome - dementia with Lewy bodies (DLB), dementia in Parkinson's disease (PD), Alzheimer's disease (AD) [2-4, 7, 8, 15 , 18, 20, 26, 27].
The highest frequency of Capgras syndrome was noted in DLB - in 56-68% of cases [3, 16, 18]. Moreover, in those few cases of AD occurring with Capgras syndrome, when the diagnosis was verified pathomorphologically, Lewy bodies were found at autopsy, at least as a component of a mixed degenerative process. It should be noted that other syndromes of impaired identification in DLB are observed significantly more often than in other forms of dementia. Capgras syndrome is often observed in PD with dementia, typologically similar to DLB, usually with a long course of the disease. At the same time, Capgras syndrome has not been described in patients with pathomorphologically confirmed diagnoses of frontotemporal dementia, primary progressive aphasia, corticobasal degeneration, and progressive supranuclear palsy [3].
It should be noted that Capgras syndrome in almost 100% of cases occurs against the background of persistent visual hallucinations, which are also, as a rule, absent in the degenerative diseases listed above [17]. The clinical picture of Capgras syndrome in mental and neurological diseases is almost identical [18].
Pathogenesis
Identification of a person and, in particular, his face depends on two main mechanisms, one of which provides explicit (conscious) recognition, and the other - emotional recognition. Each of these mechanisms has its own neuroanatomical basis. The ventral visual pathway, running from the visual cortex to the temporal lobes, is responsible for explicit (conscious) recognition, while emotional perception of the face is provided by the dorsal visual pathway, which runs from the visual cortex through the inferior parietal lobe of the brain to the limbic system [14].
Normally, recognition occurs involuntarily and a mechanism is activated a second time, looking for factual or biographical confirmation of the acquaintance.
Damage to the ventral pathway leads to prosopagnosia. Prosopagnosia refers to the inability of patients to recognize previously familiar faces. In the table
A comparative description of Capgras syndrome and prosopagnosia is presented.
Prosopagnosia most often occurs with bilateral or right-sided lesions of the occipitotemporal region involving the fusiform gyrus [6, 9, 12, 13].
In case of damage to the dorsal pathway, a violation of the emotional identification of a familiar face occurs - due to the separation of the areas that provide the perception of visual information and the limbic structures responsible for the feeling of relatedness of a person, which leads to Capgras syndrome [12, 13, 18]. However, this is probably only one of the possible mechanisms of the pathogenesis of this syndrome, since damage to the dorsal pathway cannot explain all cases of Capgras syndrome. A necessary condition for the appearance of this syndrome is the loss of a sense of reality, which develops as a result of a psychotic disorder. J. Capgras himself explained the origin of the “illusion” he described by the emergence of a feeling of unfamiliarity, foreignness, combined with a paranoid tendency to mistrust. Interhemispheric asymmetry also plays a certain role in identification. The right hemisphere is responsible for a more quickly realized feeling of familiarity with a given person, the left hemisphere is responsible for searching for information that confirms this, which usually happens more slowly. K. Josephs [18] suggested that Capgras syndrome is associated with functional disconnection of the cerebral hemispheres, but this hypothesis was not confirmed by the results of a tachistoscopic study, which revealed that visual stimuli arriving unilaterally arrive faster than bilateral ones.
From a topical point of view, Capgras syndrome, like other identification disorder syndromes, can be most closely associated with pathology of the right hemisphere or with bilateral damage to the cerebral hemispheres. Focal processes (for example, stroke or trauma) accompanied by Capgras syndrome almost always involved the frontal lobe of the right hemisphere; in this case, the damage to the temporal and parietal lobes was optional. Not a single patient has been described with a clinical identification disorder whose frontal lobes were intact (according to neuroimaging or neuropsychological testing) [5, 16, 18].
Positron emission tomography (PET) in AD patients with Capgras syndrome and other delusional syndromes revealed a decrease in metabolism in the paralimbic structures (orbitofrontal and cingulate cortex) bilaterally, as well as in the medial part of the left temporal lobe - with normal function of the sensory associative cortex (superior the temporal lobe and the inferior parietal lobe) [22].
According to neuropsychological testing, Capgras syndrome is predominantly correlated with dysfunction of the right frontotemporal region [8, 13, 16]. At the same time, isolated cases of Capgras syndrome with damage to the left hemisphere have been described, possibly associated with a change in the dominance of the hemispheres in left-handers.
Identification disorders are also often associated with the phenomena of derealization and depersonalization, indicating bilateral dysfunction of the orbitofrontal zone [12]. Short-term schizophrenia-like postictal psychoses, including elements of Capgras syndrome, were observed in patients with epilepsy with generalized convulsive seizures and epileptogenic activity in the right hemisphere of the brain [18]. Summarizing the results of numerous studies, we can conclude that Capgras syndrome may be based on disruptions in connections between multimodal associative fields involved in formal recognition of faces, limbic and paralimbic structures that provide the affective component of the identification process, and the prefrontal parts of the frontal cortex that control the connection of identification with social cognitive processes (“theory of mind”) [12, 17, 18, 25].
Capgras syndrome often occurs at a certain stage of the disease, when there is a disconnect between relatively more intact explicit and impaired emotional recognition. For the formation, structuring and fixation of a complex delusional syndrome, a certain residual level of intelligence turns out to be necessary [18].
The neurochemical mechanisms of the syndrome remain poorly understood. As with other psychotic disorders, an imbalance between the insufficiency of the cholinergic and the relatively more active dopaminergic and serotonergic systems may play some role in DLB. This is supported by cases of Capgras syndrome and other identification disorder syndromes in patients with PD during therapy with levodopa, bromocriptine and trihexyphenidyl. Increased dopaminergic stimulation of the mesolimbic system may be the cause of both visual hallucinations and paranoid disorders in patients with PD during treatment with dopamine receptor agonists and levodopa. At the same time, in PD with fluctuations during long-term levodopa therapy, cases of transient Capgras syndrome in the “off” period (i.e., on a hypodopaminergic background) have been described, which disappeared with the onset of the next dose of levodopa [3].
Treatment
Treatment for Capgras syndrome remains poorly developed and is often ineffective. For schizophrenia, the mainstay of treatment is antipsychotics. In case of DLB, due to hypersensitivity to neuroleptics with the risk of developing severe extrapyramidal syndrome and death, even atypical neuroleptics should, if possible, be limited to situations requiring rapid correction of agitation and aggression, when there is a danger to the patient himself or others. Cholinesterase inhibitors are the drugs of choice that provide a slower antipsychotic effect, but their effectiveness in Capgras syndrome has not yet been determined. An alternative or complement to cholinesterase inhibitors can be a NMDA glutamate receptor modulator, such as memantine [3]. Although controlled studies have shown its beneficial effect on behavioral disorders, whether it has a beneficial effect in Capgras syndrome remains unknown.
Psychotherapeutic work with the patient’s loved ones, who bear the brunt of the psychological blow, is important. Since the most common object of delusional interpretation is one of the spouses, such a situation is truly dramatic. Close relatives experience a wide range of feelings, most often negatively colored. At first it may be a feeling of confusion, misunderstanding, grief, resentment, annoyance. For some time, relatives cannot accept the patient’s changed attitude towards themselves, they try to persistently convince him, show the evidence of the “mistake,” and prove the opposite. All these attempts often provoke aggression from the patient [23]. In the future, the patience of relatives is exhausted and they often allow outbursts of anger towards the patient.
The role of the doctor in this situation is to normalize relationships in the patient’s family. The doctor is a third, independent party, who in most cases is listened to by both the patient’s relatives and the patient himself. A possible way out of this situation may be to explain to relatives that the patient does not intentionally not recognize them, that this is a natural manifestation of his painful condition. Relatives should be explained that there is no need to harshly, causing confrontation, to insist on the true state of affairs. At the same time, in a conversation with the patient, it is necessary to emphasize the positive aspects of the “new” person, his care and attention to the patient.
Thus, the doctor’s task, in addition to prescribing medication, is to work explanatory work with the patient’s relatives to create a favorable psychological atmosphere in the patient’s environment, diverting his attention to other activities and events. A positive effect is noted from listening to classical music, caring for pets (feeding cats, fish), etc. The proposed activities should be simple, not pose a potential danger to the patient and others, and take into account the severely limited physical and mental capabilities of the patient [18, 19].
We provide a description of a clinical case of Capgras syndrome.
Patient Z.
, 80 years old, higher education, physicist. According to her husband, she has been ill for 2 years, the onset of the disease is associated with an operation (appendectomy) performed under anesthesia, after which she began to experience nausea, loss of appetite, severe weakness, increased sleepiness during the day, and she had great difficulty moving around the apartment.
Due to severe loss of body weight, she underwent an oncological examination, but no pathology was detected. 4 months after the onset of the disease, communication with relatives was reduced to monosyllabic answers, she became apathetic, showed no interest in food, stopped asking about work (before the operation she worked at a research institute), and preferred to lie down. Difficulties arose when dressing - she could not determine the sequence of actions, she was lost within her apartment. Fears appeared - she constantly looked around and asked her husband to look at some object with her, actively expressed dissatisfaction when trying to feed her, shouted at her husband. Brief visual hallucinations in the form of clear images of pets and strangers were occasionally observed. Gradually, the patient's step became short, her gait was shuffling, and the patient had difficulty turning and sitting down on a chair. The posture became bent over.
Examination revealed a moderate akinetic-rigid syndrome with some predominance in the left extremities, severe postural instability, microbasia, paresis of upward gaze, postural myoclonus in the fingers of outstretched arms.
The score on the III (motor) part of the UPDRS (Unified Parkinson's Disease Scale) was 24 points. Neuropsychological testing revealed severe disturbances in attention, regulatory and visual-spatial functions, and moderate mnestic disorders, predominantly of the frontal type. At the same time, attention was paid to impaired orientation in time and space, a few false recognitions in the test for difficulties in selecting words and single paraphasias. The Mini Mental State Examination (MMSE) score was 12 points.
MRI of the brain: relatively symmetrical diffuse cerebral atrophy with minimally expressed periventricular leukoaraiosis in the form of a thin strip around the dilated lateral ventricles.
Somatic and laboratory examination revealed no pathology. Thyroid function, vitamin B12 level in the blood are within normal limits.
Taking into account clinical and neuropsychological data and nonspecific changes on MRI, DLB was diagnosed. Prescription of levodopa at a dose of up to 300 mg/day did not lead to an improvement in motor functions. To correct cognitive and behavioral disorders, rivastigmine was prescribed with a gradual titration of the dose to 6 mg/day; after 3 months, due to insufficient effect, memantine was added with a gradual increase in the dose to 20 mg/day.
Against the background of combination therapy, a significant improvement was initially noted: the patient began to eat, find her way around the apartment with help, talked to her family on the phone, easily recognized them by voice, adequately answered simple questions, talked about everyday problems, and the events of the day. Under supervision and with corrective prompts, she could wash the dishes, water the flowers, feed the cat, read a note in an article, and guess simple words in crossword puzzles. But over time, the condition worsened: visual hallucinations became more persistent and formed into the image of a middle-aged woman coming to the apartment. The patient's attitude towards hallucinations began to be alarming and frightening. In the evening, the patient might not recognize or confuse her sons standing silently, but she quickly corrected herself if they spoke to her. The symptoms of parkinsonism were moderate and did not progress, but signs of frequent urination with episodic urinary incontinence and orthostatic hypotension appeared. Despite the therapy, the condition continued to worsen, and hallucinations and delusions became more pronounced at night. The patient began to get ready to go to another city, hide from someone, asked to be escorted to the station, cried, said that she needed to meet someone or deliver a parcel. I began to often ask who she was, where she was, who was nearby. Additionally, quetiapine was prescribed at a dose of 25 mg at night, which brought a positive effect.
When trying to increase the dose of memantine to 25 mg/day, psychotic symptoms increased and the patient was transferred to the previous dose of the drug. The dose of quetiapine was increased to 50 mg/day. By the beginning of the 3rd year from the appearance of obvious signs of the disease, signs of Capgras syndrome were first noted. The patient began to claim that the husband living with her was not her husband, but “Vanya,” while her husband’s name was Ivan Petrovich. She persistently asked where her “real” husband was, when he would return, why “Vanya” was here with her, where she would now live, where her children were. She put forward versions that everyone had died and they were hiding it from her. When trying to explain to the patient that “Vanya” was her husband, she reacted extremely negatively, screamed, and showed aggression.
Persistent hallucinations appeared in the form of a small child standing outside the door who urgently needed to be picked up. Over time, against the background of further cognitive decline, a slight weakening of the persistence of beliefs in the substitution of a spouse was noted. The patient began to agree that this was her husband, because she said that she recognized him by his voice: “As soon as he speaks, he’s already a husband.” Significant fluctuations in attention and activity gradually increased during the day, apathy increased, and attacks of suffocation appeared during sleep while lying on the back. The patient could not answer a question that did not contain the beginning of the answer in its structure. After another month, the patient stopped getting out of bed. She was in a state close to oneiroid. She responded to examination by briefly opening her eyes without fixing her gaze, opened her mouth when feeding, swallowed carefully pureed food in small portions, and often choked. She refused to eat with sounds and a minimal turn of her head. The neurological status showed pronounced axial rigidity and myoclonus of the fingers of the left hand. At the 4th year from the onset of the first signs of the disease, the patient died.
No pathological study was carried out, however, given the typical clinical picture with characteristic mental and neurological disorders and their natural progression, there was no doubt about the diagnosis of DLB, which in this case was the cause of Capgras syndrome.
How to identify
There is no point in treating Capgras syndrome on your own. At a minimum, because people susceptible to the disorder cannot understand that they are sick. They are characterized by a deep conviction that the person standing in front of them is none other than a double. If you notice a person with Capgras syndrome and, God forbid, he is your relative, then the first thing to do is take him to the doctor.
The first bell is health problems: either physical or mental. The main characteristic of the disorder is the mistaking other people for doubles.
Negative double
Another famous case involved an elderly Frenchman who complained for several days that there was a stranger in his house. According to him, the uninvited guest was hiding in the mirror and looked exactly like himself.
In addition to the symptoms of a negative twin, there is another type of Capgras syndrome - the so-called positive twin symptom. It is diagnosed in patients who begin to recognize strangers as their acquaintances or family members.
How to treat
There is currently no specific treatment plan for Capgras syndrome. As a rule, correction is aimed at the root cause of the disease. For example, a person may have schizophrenia, and a syndrome has arisen against it. Treatment for schizophrenia can correct the disorder and relieve symptoms. But when Capgras syndrome occurs in the context of Alzheimer's, treatment options are limited.
The most effective approach is to create a comfortable environment for the patient, where he will feel safe. For example, some institutions use validation therapy, where the patient's misconceptions are supported rather than refuted. This reduces his anxiety and panic in a delirious state. Hence the conclusion follows: under no circumstances should you convince a person of the falsity of his illusions. The consequences are unpredictable, especially if you are a double whom he does not recognize. In this case, you should give the person for examination to specialists, and leave him alone until the symptoms subside. In fact, the doctors’ recommendations in this case apply to any communication. You need to understand the person, not argue with him when this is not necessary, and acknowledge his feelings.
Types of Capgras syndrome
Capgras syndrome includes delusions of intermetamorphosis, delusions of negative/positive double and Fregoli syndrome [7].
- Delusion of intermetamorphosis (or “metabolic delirium”) is a person’s pathological belief that certain persons change their appearance and/or internal essence so that he does not recognize them. This is accompanied by confidence in the evil intentions of these people [4]. Sometimes it is combined with delusions of staging - the perception of a real situation as being played out specifically for the patient (as in the film “The Truman Show”).
- The delusion of a negative double is a person’s belief that his loved ones (and sometimes himself) have been replaced by a double or someone similar, disguised and made up. The patient is sure that his loved ones were killed or kidnapped, but so that no one would guess, they found replacement people. Usually it is this branch that is called Capgras syndrome itself.
- Delusion of a positive double is a person’s false recognition of people they know or are close to him in strangers.
- Fregoli syndrome is a reverse delirium of intermetamorphosis. The patient is firmly convinced that all strangers are “played” by the same person familiar to him and pursues him, taking on the appearance of other people [5].
Causes of the disease
Even competent and qualified doctors cannot yet come to a consensus about the root causes of the described illness. At the same time, the most likely hypothesis was put forward, which is traumatic damage to the visual cortex of the brain, which identifies other faces. Sometimes recognition disorder appears after a serious stroke, brain injury, neurosurgery, schizophrenia with manic elements, alcohol dependence and senility.
Those scientists who have not yet formed a clear idea of the occurrence of the syndrome described above do not believe that this is some kind of illness. They claim the following: the symptoms characteristic of this syndrome are just another subtype of schizophrenia.
Psychologists H. Ellis and E. Youngs suggested that patients who suffer from the syndrome form a “mirror image” due to severe damage to certain parts of the nervous system. Many other researchers have reached a similar conclusion after analyzing the symptoms of patients who have suffered brain injuries.
There are also psychiatrists who claim that it is as a result of the devaluation of the unconscious emotional response of excitation that the formation of the above-described syndrome occurs. However, an identical picture in specific patients is not accompanied by delusional manifestations. Therefore, it has been suggested that there is an additional factor involved in the development of delusional thoughts. This factor is the devaluation of judgments.
As exciting as it is terrifying?
This can be said about Capgras syndrome, which is very cinematic in its description. This theme has been repeatedly embodied in films and books. There are many famous masterpieces of literature and cinema that take up this topic.
Capgras Syndrome has also been featured in Criminal Minds, The Stepford Wives and many others - a clear indication of the disorder's appeal, which is certainly due to the fact that it affects people in general, generating great interest in it. . After all, many are concerned about the question of how real the surrounding reality is.
Clinical picture
Capgras syndrome is a paranoid obsessive disorder. It comes in two types:
- The man is sure that in front of him is a double. He sees him, talks to him, argues with his opponent, can touch him, and so on. He shows it to the doctor, that is, the object is visible to everyone without exception.
- The patient does not physically see the twin. But at the same time she constantly feels his presence nearby. In this case, the double remains invisible not only to him, but also to society.
What is most interesting: the patient’s suspicion can fall not only on a specific person, but also on an animal or object. Hallucinations are not observed in a person suffering from a personality disorder. Often a person even realizes that he is sick and his perception of reality is abnormal and false. Doctors have noticed that women are more susceptible to the disease. Sometimes it is accompanied by schizophrenia or injury to the posterior region of the right hemisphere of the brain, which is responsible for recognizing people's faces and inanimate objects.
Symptoms
Capgras syndrome begins to progress after the age of 30. Before this, it may be in a sleeping, or latent, state. Although science knows cases where teenagers or even children fell ill. For example, a case was described in psychiatry where the first signs of the disease appeared in a 15-year-old girl. She was sitting with her brother and father in a cafe and suddenly suddenly announced that drugs were being slipped into her food. Already in the medical institution, she mistook her mother for an impostor, and called the night orderly her father, who came only to cause her physical and mental suffering.
From this we can conclude that absolutely unexpectedly a person develops Capgras syndrome. Symptoms, in addition to confusion between people and doubles, also manifest themselves in the form of aggressive behavior. Firstly, a person gets angry because they don’t believe him. Secondly, he becomes enraged at the perceived threat. Being afraid of someone or something, he can also become neurasthenic, intimidated, cautious, depressed and apathetic. Thirdly, the patient begins to use violence against close relatives. Sometimes it even comes to the murder of entire relatives and subsequent suicide.
Modern diagnostic methods
A person with such symptoms requires hospitalization - only in an inpatient setting, with constant monitoring, a psychiatrist can make the correct diagnosis. A distinctive feature of this syndrome is that the patient accurately identifies people’s faces (the results, naturally, do not coincide with reality), names them, but cannot tell by what criteria he recognized this or that person.
Of course, some examinations are also carried out that help supplement the collected anamnesis and determine the possible cause of the development of the disorder. For example, tests are needed to determine the content of alcohol and drugs in the body. Tomography, encephalography and other studies may be performed to help determine the presence of organic lesions in the brain.
