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Psychotic symptoms such as hallucinations and delusions are common in Alzheimer's disease (AD). Misidentification syndromes such as Capgras are more rare. In Capgras syndrome, patients develop the delusion that important persons such as a spouse or a child have been replaced by a 'bad' impostor. AD patients have also been shown to misidentify their own mirror reflections. Two cases are presented, in which AD patients were able to identify their mirror images, but felt their reflections included a second person with a separate identity. The first patient was a 61-year-old married white woman who had been diagnosed with AD three years earlier. At the mirror, she would see two women reflected - herself and another. She believed the other woman wanted to replace her. The second patient was a 55-year-old black man with an AD diagnosis of about 18 months. Sometimes he would become angry at his mirror image. At other times, he would laugh with it. He could recognize his own reflection, but often saw another man who was 'bad.' Both patients improved with structured care and support. In the first case, the woman's moods were related to her delusions. When she was feeling isolated, criticized and depressed, she often saw the bad woman. In the second case, the patient's reactions and moods fluctuated between friendly and hostile. The psychodynamic implications of these good versus bad mirror images are typically discussed in terms of 'splitting,' a phenomenon in which unwanted parts of the self are split off, denied, and projected outward. However, neurological examinations of both patients revealed deficits of the frontal and temporal lobes. It is thought that such cases point to the need to view certain psychoses as both biological and psychological in nature. (Consumer Summary produced by Reliance Medical Information, Inc.)

In Capgras syndrome, the patient believes that a person, usually a relative or close friend, has been replaced by a double or an imposter. The syndrome is usually a manifestation of schizophrenia or is associated with affective (mood) disorders. A small number of cases involving the delusion that inanimate objects have been replaced by duplicates have also been reported. The case of a 55-year-old married woman with the delusion that several inanimate objects had been replaced with doubles is reported. Several weeks before being admitted to a psychiatric ward, she had become increasingly argumentative and hostile. She believed that her clothing, crockery, washing machine, a picture in her living room, and a road sign outside her home had been replaced by identical duplicates. She had no history of alcohol or drug abuse or psychosis. After being admitted, she was suspicious of staff, patients and relatives, and believed her husband knew about the replacements. She was very angry, but demonstrated no evidence of depression or mania. Cognitive, neurological and physiological examinations were normal. Two weeks after admission, and after being treated with an antipsychotic medication, her symptoms began to subside. Her case is unusual in that the delusional misidentification of inanimate objects was not related to schizophrenia, affective disorder or organic disease. The cause of this episode of Capgras syndrome remains unexplained. (Consumer Summary produced by Reliance Medical Information, Inc.)

There are two psychiatric syndromes in which a patient believes he has been replaced by a double or an imposter. In one such delusion, the syndrome of subjective doubles, the patient believes that he has a double. In Capgras syndrome, the belief in a self-double is fairly rare, but this condition is always accompanied by the belief that other people and places have been replaced. A comprehensive literature review is presented of all 20 published cases since 1900 in which patients believed that a double of the self existed. These cases are listed in tabular form, giving the reference, a brief description of the delusion, and the diagnosis. Also, the most recent case is reported in detail. A 50-year-old wife and mother believed that a double of herself existed and this double had become the object of her husband's affections. The patient maintained that this could be proven by the fact that her husband had lost interest in sex with her. The woman said she had seen her double and that the imposter had stolen her fingerprints. As an inpatient, she was diagnosed with delusional depression. Treatment did not dispel her delusion of a double, but she was eventually discharged while continuing treatment with desipramine and fluphenazine. The group of 20 cases from the literature is discussed. The cases reveal that patients most often believe that there is a double of their physical self (who often looks almost identical to them), but some believe their personality (psychological self) has been replaced. In only three of the 20 cases was the delusion of impostors limited to the self; most cases also involved delusions that other people, places, and animals had been replaced. It is concluded that many delusions of misidentification involve the self, and that this syndrome may be underreported because therapists are not aware of the symptoms. (Consumer Summary produced by Reliance Medical Information, Inc.)

The case of a 35-year-old woman with Capgras syndrome associated with migraine headache is reported. In Capgras syndrome, patients have the delusion that familiar people have been replaced by identical impostors. The syndrome is usually attributed to schizophrenia or affective (mood) psychoses, although recent reports have implicated organic brain disease in some Capgras patients. The patient was brought to a psychiatric clinic by her husband who stated that she had been talking strangely and had an excruciating headache. She had been vomiting, sweating and avoiding light. Her migraine attacks typically lasted for 48 hours and occurred once a month. The patient claimed that her husband was dead and that the man who said he was her husband was an impostor. Other than this delusion, she appeared to be normal; her mood and manner were appropriate, and she did not hallucinate or have any other delusions. Memory and orientation to time and place were intact, and she showed no evidence of thought disorder. Neurologic and psychiatric examinations were negative. She was treated with aspirin and a neuroleptic (antipsychotic medication). The migraine was relieved within one day, but the Capgras delusion did not subside for three weeks. At a six-month follow-up, there were no recurrent symptoms. It is not known whether this case of Capgras delusion was caused by an undetected organic defect which produced the migraine, or whether the simultaneous presentation of migraine with Capgras syndrome was coincidental. (Consumer Summary produced by Reliance Medical Information, Inc.)

Capgras syndrome is a rare disorder in which a person has a delusional belief that another person has been replaced by a double. Capgras is usually related to other paranoid phenomena or to an organic disorder. In a very rare variant, the affected person believes that an inanimate object has been replaced by an exact replica. A case report illustrating such a variant is presented. A 57-year-old caucasian woman became severely depressed in 1977 after her husband's death. She responded well to supportive therapy, but had subsequent bouts of depression, which were treated with dothiepen (an antidepressant medication). In 1981, she began complaining that her spectacles had been stolen by someone and replaced with an identical pair that did not belong to her. The glasses in question fit well, and were the right prescription, but she refused to wear them. She was placed on a trial regimen with a neuroleptic (antipsychotic) medication (fluphenazine), and subsequently developed a depressive psychosis. In 1982, the woman was admitted to a psychiatric ward. After fluphenazine was withdrawn and dothiepen was readministered, a good therapeutic response was obtained, and the patient was able to return home. It is suggested that some patients with Capgras syndrome are not psychotic, but may become preoccupied with doubles of inanimate objects connected to them either by a symbolic attachment or because the object is thought to be an extension of the self. In this case, the patient may have had a subconscious desire to avoid the world, which was not such a nice place to see. Since she had a clinical picture of severe depressive illness with no clear signs of schizophrenia or organic psychosis, it is not surprising that antipsychotic medication had no effect, while there was a rapid and complete response to the antidepressant. (Consumer Summary produced by Reliance Medical Information, Inc.)