In 1923, a patient of French psychiatrist Jean-Marie Joseph Capgras, Madame M, was convinced her husband, children, neighbors, and even the police had been replaced by look-alike imposters or, as you may have heard them called, changelings. Madame M’s was perhaps not the first documented case of such a phenomenon, but it did give a name to it: Capgras syndrome.
“Although it finally had a name, Capgras syndrome still was not immediately linked to brain disorders in 1923,” says Jillian Castellano, Director of Community Relations at YourLife™ of Palm Beach Gardens, a community offering Independent Living with Supportive Services, Assisted Living and Memory Care in Palm Beach Gardens, Florida. “But there is now evidence that it can occur with head trauma, stroke, and neurodegenerative conditions like Alzheimer’s disease and other dementias.”
In this post, we’ll give an overview of Capgras syndrome, who’s at risk, and what to do if your loved one experiences it.
WHAT IS CAPGRAS SYNDROME?
Capgras syndrome (also called Capgras delusion or ‘imposter syndrome’) is a rare psychiatric disorder classified as a delusional misidentification syndrome, where the face and identity of a highly familiar person, usually the spouse, is thought to have been stolen by an impostor. Capgras syndrome can also apply to misidentified places or objects. People suffering from Capgras may become aggressive or violent and pose a threat to themselves or others.
WHO GETS CAPGRAS SYNDROME AND WHY?
The exact cause of Capgras syndrome is unknown. Research shows that around 16% of people with Lewy body dementia or Alzheimer’s also have Capgras syndrome. Other brain conditions associated with Capgras are Parkinson’s, epilepsy, stroke, and traumatic brain injury. Traumatic lesions on the brain were present in more than one-third of all documented cases of Capgras syndrome looked at in one study. Many people with Capgras syndrome have lesions or areas of damage on the brain.
People with Capgras syndrome may also have other types of delusions. People with schizophrenia and bipolar disorder are also associated with Capgras syndrome.
A 2015 study looked at a case of Capgras syndrome that was related to hypothyroidism, or an underactive thyroid gland, so hormonal imbalances may also be a risk factor.
SIGNS AND SYMPTOMS
- An irrational belief that a familiar person (e.g., daughter, husband, friend), place, or item has been replaced with an exact duplicate.
- A persistently held false belief that is contradicted by overwhelming evidence accepted by others in the person’s social network.
- May obsess about the ‘imposter’ or finding the ‘real’ person.
- Intact face recognition – the patient correctly identifies the relative the imposter looks like but lacks the emotional connection they normally would have.
- Negative emotional response such as anxiety or fear and, in some cases, violent actions.
Because Capgras syndrome is rare, there is no standard treatment. Anyone experiencing or witnessing the symptoms of Capgras syndrome should speak to a doctor as soon as possible. Treating the underlying condition can reduce or cure the symptoms. Treatments for underlying conditions may include:
- Memory and recognition medications
Validation therapy may be useful, as it requires the caregiver to ‘go along with’ rather than dispute the misidentification. It’s far easier – and less harmful, whether emotionally or physically – for caregivers to step into their loved one’s reality rather than the other way around. Correcting someone with dementia and forcing them to accept a reality that they can’t grasp is square peg/round hole personified. It just won’t work.
IS MEDICAL INTERVENTION NECESSARY?
“With any of the neuropsychiatric symptoms of dementia, such as Capgras, we always try behavioral and environmental interventions before medications,” says Susan M. Maixner, Associate Professor of Psychiatry in the University of Michigan School of Medicine and Director of the U-M Geropsychiatry Program and Geriatric Psychiatry Fellowship.
It is important to remember that Capgras is a fixed false belief that cannot be reasoned with, and no amount of argument, logic, or proof will change their mind. Dr. Maixner recommends the following to help family members cope:
- Don’t argue with the belief. That just makes the person angrier and more convinced they are right.
- Be patient and go with the emotion. Acknowledge your loved one’s fear, frustration, and anger.
- Change the focus or redirect your loved one. Try to distract them with an activity, music, or a car ride.
- Agree to disagree about this belief. Reassure them that no matter who you are, you love and care for them and are there for them.
- Be creative. In some cases, the caregiver accused of being an impostor may be able to leave the room to get the ‘real’ person, then come back in and no longer be perceived as an impostor.
- Limit exposure to the ‘imposter’ when an episode is taking place.
- Have the ‘imposter’ speak before they are seen, as their voice may be recognized.
For more information on how to handle dementia’s behavioral changes in your loved one, call the experts at YourLife™ of Palm Beach Gardens. 561-214-8549
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