clozapine and Capgras-Syndrome

Topics: Antiparkinson Agents; Antipsychotic Agents; Brain Diseases, Metabolic; Capgras Syndrome; Clozapine; Dopamine; Hallucinations; Humans; Infusions, Parenteral; Levodopa; Male; Middle Aged; Psychoses, Substance-Induced

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Clozapine; Diagnosis, Differential; Haloperidol; Humans; Identification, Psychological; Male; Olanzapine; Psychiatric Status Rating Scales; Schizophrenia, Paranoid; Treatment Outcome

We report a Malay man, with underlying chronic medical illnesses, presenting with positive symptoms of schizophrenia, including Capgras syndrome (CS) at the age of 73. Physical examination and blood investigations were normal and brain CT scan showed age-related cerebral atrophy. Neuropsychological assessment showed probable right hemisphere lesions but relatively intact memory and intellectual functions. Several neuroleptics including depot injections were tried but ineffective. Positive symptoms including CS eventually improved with clozapine before his death from myocardial infarction. This case report highlights the uncommon occurrence of CS in treatment resistant schizophrenia (TRS) of very late onset and its treatment challenges.

Topics: Aged; Antipsychotic Agents; Autopsy; Capgras Syndrome; Clozapine; Comorbidity; Delusions; Humans; Late Onset Disorders; Male; Neuropsychological Tests; Psychiatric Status Rating Scales; Schizophrenia; Schizophrenic Psychology

Capgras delusion is a delusional misidentification syndrome, in which the patient is convinced that someone that is well known to them, usually a close relative, has been replaced by an impostor or double. Although it has been frequently described in psychotic syndromes, including paranoid schizophrenia, over a third of the documented cases of Capgras delusion are observed in patients with organic brain lesions or neurodegenerative disease, including Parkinson's Disease. Variants of Capgras involving animals or inanimate objects have also been described. The etiology of Capgras in Parkinson's remains unclear, but may arise from a combination of factors, such as frontal lobe dysfunction and dopaminergic medication.. We present the case of a 53-year old right-handed female with Parkinson's disease who developed Capgras delusion during treatment with dopamine agonists and Levodopa/Carbidopa. She became convinced that her pet dogs and the plants in her garden had been substituted by identically looking ones. Our patient was initially treated with Quetiapine, with no improvement, and subsequently treated with Clozapine, which lead to partial regression of her symptoms. Neuropsychological Evaluation showed Mild Cognitive Impairment in Executive Functions.. Given the clinical history, onset and evolution of symptoms we believe our patient's delusion resulted from the overlap of dopaminergic medication and Mild Cognitive Impairment in executive functions. Zoocentric Capgras, the variant we describe, has been rarely described in scientific literature, and we believe it is of interest due to its unusual characteristics.

Topics: Animals; Antiparkinson Agents; Antipsychotic Agents; Capgras Syndrome; Carbidopa; Clozapine; Cognitive Dysfunction; Delusions; Dibenzothiazepines; Dogs; Dopamine Agonists; Drug Therapy, Combination; Female; Humans; Levodopa; Parkinson Disease; Pets; Plants; Quetiapine Fumarate

The delusional misidentification syndrome (DMS) has been associated with a range of neurological conditions. Three cases of DMS in patients with Parkinson's disease and dementia, treated with dopaminergic medications, are presented. It is postulated that DMS associated with parkinsonism results from a combination of dopaminergic psychosis and cognitive dysfunction involving the frontal lobe in particular. DMS in the setting of parkinsonism may be more frequent than commonly supposed.

Topics: Aged; Antiparkinson Agents; Antipsychotic Agents; Capgras Syndrome; Clozapine; Delusions; Female; Hallucinations; Humans; Male; Parkinson Disease

Misidentification syndromes represent false, delusionally-based identification of self and/or others. These are variants of the Capgras Syndrome. Although the frequency of misidentification syndromes in schizophrenic populations has not yet been established, the authors believe this syndrome is more prevalent than previously described. Seven of twenty-five (28%) consecutive patients admitted to a chronic clozapine unit with a variant of misidentification syndrome will be described. Their symptoms are categorised according to traditional classification, and Silva's proposed nomenclature. Problems inherent in these classifications are discussed. The need for a more systematic classification of misidentification syndromes is emphasised. Longitudinal studies of misidentification syndrome, and the development of a standardised assessment tool for clinicians who treat chronically psychotic patients, are encouraged.

Topics: Adult; Capgras Syndrome; Clozapine; Delusions; Female; Hospitalization; Humans; Male; Middle Aged; Psychiatric Status Rating Scales; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology

Topics: Brain; Capgras Syndrome; Clozapine; Functional Laterality; Humans; Male; Middle Aged; Neuropsychological Tests; Schizophrenia, Paranoid; Tomography, X-Ray Computed