olanzapine and Capgras-Syndrome

Capgras delusion (CD) has multiple etiologies including neurodegenerative disorders and can be associated with violent behavior. CD is a common complication of Alzheimer dementia (AD); however, CD with violent behavior is uncommon in AD. We report escalating violent behavior by a patient with advanced AD and CD who presented to the emergency department (ED) and required admission to an academic medical center.. Case analysis with PubMed literature review.. A 75-year-old male with a 13-year history of progressive AD, asymptomatic bipolar disorder, chronic kidney disease, hypertension, hyperlipidemia, and benign prostatic hypertrophy presented to the ED with recurrent/escalating violence toward his wife, whom he considered an impostor. His psychotropic regimen included potentially inappropriate medications (PIMs) for geriatric/AD patients-topiramate/amitriptyline/chlordiazepoxide/olanzapine-that are associated with delirium, cognitive decline, dementia, and mortality. Renal dosing for topiramate, reduction in PIMs/anticholinergic burden, and substituting haloperidol for olanzapine resolved his violent behavior and CD.. CD in AD is a risk factor for violent behavior. As the geriatric population in the United States grows, CD in patients with AD may present more frequently in the ED, requiring proper treatment. Pharmacovigilance is necessary to minimize PIMs in geriatric/AD patients. Clinicians and other caregivers require further education to appropriately address CD in AD.

Topics: Aged; Aggression; Alzheimer Disease; Amitriptyline; Anticonvulsants; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Bipolar Disorder; Capgras Syndrome; Chlordiazepoxide; Fructose; Haloperidol; Humans; Hypnotics and Sedatives; Male; Olanzapine; Potentially Inappropriate Medication List; Renal Insufficiency, Chronic; Topiramate; Violence

We present the case of an elderly woman with hypothyroidism and no psychiatric history who presented with new onset of psychosis, paranoia, catatonic features and Capgras syndrome (CS). This case illustrates the spectrum of neuropsychiatric symptoms that may accompany hypothyroidism and the importance of considering thyroid dysfunction as a primary contributor to severe psychiatric symptoms, especially in previously stable patients. We demonstrate the effectiveness of combination levothyroxine and olanzapine, with its favourable cardiac profile, in the treatment of myxoedema madness. Antipsychotics can be weaned once psychiatric symptoms resolve and hormone levels are stabilised.

Topics: Aged; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Catatonia; Female; Humans; Hypothyroidism; Myxedema; Olanzapine; Thyroxine

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

The case of a 16-year old Jamaican girl who presented to the psychiatric service of a general hospital with features of Capgras syndrome is presented. Her history, treatment, progress and relevant psychodynamic and neurocognitive issues are explored. This is the first known published case of an adolescent with Capgras syndrome from the Caribbean. The case highlights that the syndrome may occur in different cultural contexts and that clinicians should be sensitive to its existence in order to avert under-diagnosis or misdiagnosis.

Topics: Adolescent; Antidepressive Agents; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Caribbean Region; Depression; Dibenzothiazepines; Dose-Response Relationship, Drug; Family Relations; Female; Humans; Neuropsychological Tests; Olanzapine; Psychiatric Status Rating Scales; Quetiapine Fumarate; Remission Induction; Sertraline; Suicidal Ideation; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Basal Ganglia Diseases; Benzodiazepines; Brain; Calcinosis; Capgras Syndrome; Female; Humans; Olanzapine; Tomography, X-Ray Computed; Treatment Outcome

Topics: Adult; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Cyclohexanols; Drug Therapy, Combination; Female; Humans; Olanzapine; Recurrence; Schizophrenia; Self Concept; Social Identification; Venlafaxine Hydrochloride; Visual Perception

Topics: Adult; Antidepressive Agents, Tricyclic; Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Drug Therapy, Combination; Gynecomastia; Hallucinations; Humans; Imipramine; Male; Olanzapine; Suicide, Attempted

Topics: Adult; Benzodiazepines; Brain; Capgras Syndrome; Cognition Disorders; Depersonalization; Female; Humans; Magnetic Resonance Imaging; Olanzapine; Pirenzepine; Selective Serotonin Reuptake Inhibitors; Self Concept; Severity of Illness Index; Single Parent; Syndrome; Wechsler Scales

We present a 46-year old lady suffering from chronic paranoid schizophrenia accompanied by a chronic Fregoli's syndrome. The patient feels persecuted by a male person and identifies this persecutor in different persons of different shape, different age and different sex. The symptoms are very refractory to treatment despite various neuroleptic therapies. Historical, psychodynamic and neuropsychological aspects of this delusional syndrome are discussed.

Topics: Antipsychotic Agents; Benzodiazepines; Capgras Syndrome; Chronic Disease; Delusions; Female; Humans; Male; Middle Aged; Olanzapine; Pirenzepine; Schizophrenia, Paranoid; Treatment Failure

The aim of this paper is to document regular nocturnal intensification of delusional nihilistic and persecutory ideas (Cotard delusion) linked with extreme depersonalisation and hypervivid dreaming.. A 17-year-old man presented with Cotard and Capgras delusions after sustaining multiple cognitive impairments secondary to traumatic brain injury.. Delusional ideation fully resolved within 14 days of commencement of olanzapine 5 mg daily.. This patient's experience of perceptual abnormalities and impairments in meta-abilities related to self-monitoring and critical inferencing lends support to multicomponent sensory processing accounts of brain injury related, content-specific delusional syndromes.

Topics: Adolescent; Antipsychotic Agents; Benzodiazepines; Brain Injuries; Capgras Syndrome; Circadian Rhythm; Delusions; Humans; Male; Olanzapine; Perceptual Disorders; Pirenzepine; Syndrome