Capgras delusion

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Capgras delusion
Classification and external resources
DiseasesDB 32606
MeSH D002194

The Capgras delusion (or Capgras syndrome) is a rare disorder in which a person holds a delusional belief that an acquaintance, usually a spouse or other close family member, has been replaced by an identical-looking impostor. The Capgras delusion is classed as a delusional misidentification syndrome, a class of delusional beliefs that involves the misidentification of people, places or objects. It can occur in acute, transient, or chronic forms.

The delusion is most common in patients diagnosed with schizophrenia, although it can occur in connection with a number of conditions, including brain injury and dementia.[1] Although the Capgras delusion is commonly called a syndrome, because it can occur as part of, or alongside, various other disorders and conditions, some researchers have argued that it should be considered a symptom, rather than a syndrome or classification in its own right[citation needed].


[edit] History

The Capgras delusion is named after Joseph Capgras (1873-1950), a French psychiatrist who first described the disorder in a 1923 paper co-authored with Reboul-Lachaux.[2][3] They used the term l'illusion des sosies (the illusion of doubles) to describe the case of a French woman who complained that various "doubles" had taken the place of people she knew. However, the term illusion has a subtly different meaning from delusion in psychiatry, so the Capgras delusion has been adopted as the more accurate name.

[edit] Presentation

This case is taken from a 1991 report by Passer and Warnock:[4]

Mrs. D, a 74-year old married housewife, recently discharged from a local hospital after her first psychiatric admission, presented to our facility for a second opinion. At the time of her admission earlier in the year, she had received the diagnosis of atypical psychosis because of her belief that her husband had been replaced by another, unrelated man. She refused to sleep with the "imposter", locked her bedroom and door at night, asked her son for a gun, and finally fought with the police when attempts were made to hospitalize her. At times she believed her husband was her long deceased father. She easily recognized other family members and would misidentify her husband only.

[edit] Causes

Some of the first clues to the possible causes of the Capgras delusion were suggested by the study of brain-injured patients who had developed prosopagnosia. In this condition, patients are unable to recognize faces consciously, despite being able to recognize other types of visual objects. However, a 1984 study by Bauer showed that even though conscious face recognition was impaired, patients with the condition showed autonomic arousal (measured by a galvanic skin response measure) to familiar faces,[5] suggesting that there are two pathways to face recognition—one conscious and one unconscious.

In a 1990 paper published in the British Journal of Psychiatry, psychologists Hadyn Ellis and Andy Young hypothesized that patients with Capgras delusion may have a "mirror image" of prosopagnosia, in that their conscious ability to recognize faces was intact, but they might have damage to the system that produces the automatic emotional arousal to familiar faces.[6] This might lead to the experience of recognizing someone while feeling something was not "quite right" about them.

In 1997, Hadyn Ellis and his colleagues published a study of five patients with Capgras delusion (all diagnosed with schizophrenia) and confirmed that although they could consciously recognize the faces, they did not show the normal automatic emotional arousal response.[7]

In that same year, William Hirstein and Vilayanur S. Ramachandran reported similar findings in a paper published on a single case of a patient with Capgras delusion after brain injury.[8] Ramachandran also portrays this case in his book Phantoms in the Brain.[9] Since the patient was capable of feeling emotions and recognizing faces but could not feel emotions when recognizing familiar faces, Ramachandran hypothesizes that the origin of Capgras syndrome is a disconnection between the temporal cortex, where faces are usually recognized (see temporal lobe), and the limbic system, involved in emotions. Because the patient could not put together memories and feelings, he believed objects in a photograph were new on every viewing, even though they normally should have evoked feelings (e.g., a person close to him, a familiar object, or even himself). Ramachandran therefore believed there was a relationship between Capgras syndrome and a more general difficulty in linking successive episodic memories, since it is believed that emotion is critical for creating memories.

It is likely that more than an impairment of the automatic emotional arousal response is necessary to form Capgras delusion, as the same pattern has been reported in patients showing no signs of delusions.[10] Ellis and colleagues suggested that a second factor explains why this unusual experience is transformed into a delusional belief; this second factor is thought to be an impairment in reasoning, although no definitive impairment has been found to explain all cases.[11]

[edit] In popular culture

  • The concept of the Changeling in myth and folklore is an example of this delusion.
  • The narrator of Rivka Galchen's 2008 novel Atmospheric Disturbances, a psychologist, believes his wife has been replaced by a "simulacrum" or "impostress".
  • Jack Finney's 1955 science fiction novel The Body Snatchers begins with several people going to the town doctor, convinced that their loved ones have been replaced with exact replicas.
  • The Capgras delusion plays an important part in Richard Powers's 2006 novel The Echo Maker, winner of the National Book Award.
  • In Shirley Jackson's short story "The Beautiful Stranger", the protagonist begins with the delusion that her husband has been replaced and is ultimately unable to recognize her own house.
  • An explanation of the Capgras delusion serves as an important plot turn in Neil Gaiman's short story "Foreign Parts", found in the Smoke and Mirrors collection.
  • The character of Debbie in Kate Atkinson's novel Human Croquet may suffer from this, and the syndrome is mentioned about halfway through the book.
  • An example of the Capgras delusion (and possibly a parody of the latter genre) occurs in John Wyndham's 1959 science fiction novel The Outward Urge, where an astronaut develops the delusion that his colleague is a Martian.
  • In the 2005 film Empire of the Wolves, the female lead initially appears to suffer from Capgras delusion when she fails to recognise her husband and later suspects he might have undergone cosmetic surgery.
  • In the 2008 film Synecdoche, New York the character Caden Cotard works as a cleaning woman in what he believes is his absent wife Adele's apartment, which she is subletting from Capgras.
  • In the 2008 film The Broken, the first sentence of this article is quoted nearly verbatim by a trauma counselor to his patient.
  • A Capgras delusion was used as the reason for a murder in the plot of an episode of the American television crime drama CSI:NY.
  • In the 8th season of the television series Scrubs in the episode titled "My Full Moon", one of the patients was diagnosed with Capgras syndrome.
  • The role-playing game Exquisite Replicas deals with things and people being replaced by identical copies, a phenomenon that only a few people can perceive. This may be a reference to the Capgras delusion.

[edit] See also

[edit] Notes

  1. ^ Forstl, H.; Almeida, O.P.; Owen, A.M.; Burns, A.; & Howard, R. (1991). Psychiatric, neurological and medical aspects of misidentification syndromes: a review of 260 cases. Psychological Medicine 21 (4) 905–910.[1]
  2. ^ Capgras, J. & Reboul-Lachaux, J. (1923). Illusion des sosies dans un délire systématisé chronique. Bulletin de la Société Clinique de Médicine Mentale 2 6–16.
  3. ^ Ellis, H.D.; Whitley, J.; & Luaute, J.P. (1994). Delusional misidentification. The three original papers on the Capgras, Frégoli and intermetamorphosis delusions (Classic Text No. 17). History of Psychiatry 5 (17) 117–146.[2]
  4. ^ Passer, K.M. & Warnock, J.K. (1991). Pimozide in the treatment of Capgras' syndrome. A case report. Psychosomatics 32 (4) 446–448.[3]
  5. ^ Bauer, R.M. (1984) Autonomic recognition of names and faces in prosopagnosia: a neuropsychological application of the guilty knowledge test. Neuropsychologia 22, 457–469.
  6. ^ Ellis, H. D., & Young, A. W. (1990) Accounting for delusional misidentifications. Br J Psychiatry, 157, 239-248.
  7. ^ Ellis, H. D., Young, A. W., Quayle, A. H., & De Pauw, K. W. (1997) Reduced autonomic responses to faces in Capgras delusion. Proc R Soc Lond B Biol Sci, 264, 1085-1092.
  8. ^ Hirstein, W., & Ramachandran, V. S. (1997) Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons. Proc R Soc Lond B Biol Sci, 264, 437-444."
  9. ^ Ramachandran, V. S; Blakeslee S. (1998). Phantoms in the Brain. Great Britain: Harper Perennial. ISBN 10-1-85702-895-3. 
  10. ^ Tranel D, Damasio H, Damasio A (1995) Double dissociation between overt and covert face recognition. Journal of Cognitive Neuroscience, 7, 425-432.
  11. ^ Davies, M., Coltheart, M., Langdon, R., & Breen, N. (2001) Monothematic delusions: Towards a two-factor account. Philosophy, Psychiatry, and Psychology, 8, 133-158.

[edit] External links

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