Capgras syndrome is rare. Treatment includes both drug and nondrug options.<\/p>\n
Dear Dr. Roach: My mom has Capgras syndrome and firmly believes that her husband (my dad) is dead. She thinks there\u2019s someone who I snuck in and built a lie around, and she tells everyone that this man is the same man. It\u2019s really difficult for us, especially my dad.<\/p>\n
I understand that Capgras cannot be cured, but there are medications that help with the situation. She won\u2019t go see any medical professionals (since they believe that she has Capgras and her husband isn\u2019t dead). There are some other wild stories she tells\/believes that absolutely aren\u2019t true.<\/p>\n
What can a husband do with his elderly wife when she\u2019s raging at him over his identity or raging over the horrible daughter who \u201ccreated this lie?\u201d<\/p>\n
Can she be treated against her will? Where do we go for this? Who even knows anything about treating Capgras?<\/p>\n
W.H.<\/p>\n
Capgras syndrome is exactly as you\u2019ve said \u2014 a delusion that a familiar person, usually a spouse or another close family member such as a child or sibling, has been replaced by an imposter. Symptoms can come and go over minutes to months, and they\u2019re often worse at night. Violence to the person who\u2019s thought to be \u201cfake\u201d is common, with one series showing that 80 per cent of Capgras patients commit violence to the perceived imposter.<\/p>\n
Lewy body dementia is responsible for about 70 per cent of Capgras syndrome cases. In fact, many people with Lewy body disease believe that there\u2019s someone living in their home with them, which can be an important clue when making the diagnosis. Capgras syndrome is rare. At a major referral centre (Mayo Clinic), 204 cases were identified in 28 years, but it may not always be recognized or reported.<\/p>\n
Treatment includes both drug and nondrug treatment. Drug treatment by itself is modestly effective and includes medicines to treat dementia (such as donepezil), as well as meds to treat psychosis, but these must be used with caution and by an expert. Treatment against a person\u2019s will requires that many criteria be met, including that the person has a severe mental disorder and that they have an impaired decision-making capacity (both of which seem to be the case with your mother).<\/p>\n
Most critically, the person must present a danger to themselves or others, which is particularly important in Capgras syndrome. The legal process varies by state and should be navigated by an expert. The expert in this syndrome is primarily a psychiatrist, who\u2019s most likely to have expertise on the process of involuntary commitment \u2014 either as an inpatient or outpatient. A neurologist may also be a useful consultant.<\/p>\n
I\u2019m sorry that you and your father are involved in this situation, which must be horrible for both of you. It\u2019s also terrible for your mother, who really believes her husband\u2019s dead and that someone else is pretending to be him. I recommend that you and your father, without your mother, see a psychiatrist \u2014 ideally one with expertise in psychosis and delusions \u2014 to discuss options.<\/p>\n