Capgras Syndrome is one of the rarest and most intriguing in neurology. Even though

while dreaming we can have Capgras Syndrome like perceptions, the feature that sticks out the

most is that the patient, usually mentally together in other aspects, comes to view close friends or

family as imposters. They may say that the person in question is identical or looks like the

relative or friend but they really aren’t. It’s noted that a percentage of patients with Capgras

Syndrome have epilepsy or an odd looking temporal lobe. Over a third of diagnoses have

occurred with traumatic brain lesions, suggesting that Capgras is organic and functional based.

Note that Capgras should not be confused with prosopagnosia, which is characterized by

inability to recognize the faces of people and usually caused by bilateral lesions in the inferior

temporal lobes. There are two components to recognizing visually a familiar face, one being

responsible for conscious recognition of the face, where the other is in charge of the limbic-

mediated emotional arousal meaning the feeling of familiarity. A lack of association between the

two not only explains states like déjà vu but would explain why it’s possible to respond to skin

conductance even when failing to recognize a face.

There is no certain causes known for Capgras Syndrome, although research studies have

evolved several believable theories. One being from neurologist V.S. Ramachandran,

Ramachandran believes theres a malfunction between the brains visual cortex and the emotional

feeling of “familiarity” causing the patient to believe they are seeing a exact duplicate not the

actual person. Visually everything is correct but emotionally and familiarity wise they aren’t

present, conclusion being theres an exact imposter. A study done of 47 patients showed 81% had

a neurodegenerative disease, most commonly Lewy Body Disease. There are many features that

pertain to Capgras Syndrome such as the patient has a brain injury or disease, the patient realizes

that a person or place is just like the “real” one but insists it isn’t, the imposter is always

someone or somewhere the patient is familiar with, and it is a biological disorder. Again not to

be confused with Prosopagnosia which is a form of facial misidentification which is different

from Capgras in the fact that it causes a complete inability to recognize familiar faces. Capgras

has easy recognition of the face but doesn’t agree that’s the persons true identity. Patients are

often so disturbed by their reflection that they remove or cover mirrors in there home.

Treatments for Capgras Syndrome include individual therapy which may be best to treat

delusions. Persistence is key in establishing a therapeutic empathy without giving validation to

the delusional system of the patient or openly confronting the delusions. Some cognitive tests

may be used such as reality testing or reframing as well as prescribing antipsychotics or other

medications. In order to properly treat Capgras Syndrome you have to make sure its properly

diagnosed as it has similar symptoms as several other diagnoses such as schizophrenia,

alzheimer’s disease, huntington’s disease, multiple sclerosis, traumatic brain injury, substance

induced delusions, mood disorders with delusions, and dementia.

Although there is not much information on the dangers of people with Capgras

Syndrome, there are some reported cases where the patients suffering have become violent

leading to injury or death. The fact that there is very little research done on this subject and no

easy way to predict violence, amazingly, considering theres great hostility and resentment shown

by the patients towards the “imposters”. We should take into consideration if the “imposter” is

living with the patient or is easily accessable to the patient. If so things could easily escalate to a

violent level, but with the right care they can accept living with the “imposter”.

I chose Capgras Syndrome because my sister has this mental disorder. I personally have

seen the effects it can have on ones own relationship with the patient or even the patients

relationship with family or friends. As scary as this may seem to you, you have to take a moment

and think how this mentally effects the person with the syndrome, after all they are the ones they

don’t recognize their own mother, father, brother, sister or even their own children. If you know

anyone with this don’t judge rashly take time to educate yourself on the disability and how to

properly handle situations when they arise. My sister thanks me on a regular basis because she

can now recognize when shes suffering through an episode and she calls me to help bring her

back to “reality” as they say. Remember the first step to handling Capgras Syndrome is to

acknowledge something isn’t right and to seek therapy, guidance or help of any kind!