Prim Care Companion CNS Disord. 2012; 14(1): PCC.11l01227.

Published online 2012 January 26. doi:  10.4088/PCC.11l01227

PMCID: PMC3357570

A “Contemporary” Case of Frégoli Syndrome

Tanya Kochuparackal, MD and Andor E. Simon, MD

Author information ► Copyright and License information ►

To the Editor: Frégoli syndrome belongs to the group of delusional misidentification syndromes and was first described in 1927.1 The hallmark of Frégoli syndrome is the belief that a familiar person is disguised as a strange person, ie, the familiar person has taken on a different physical appearance but remains the same person psychologically. The syndrome has been associated with organic cerebral dysfunction, in particular of the right hemisphere; however, most cases occur in the setting of schizophrenia.2,3 We report the case of a patient with schizophrenia who developed Frégoli syndrome within the context of using social networking Web sites.

Case report. Mr A, a 21-year-old man, was referred to our psychiatric outpatient service in 2010 with a first episode of schizophrenia (DSM-IV criteria). He had developed the belief that his daily facial cream strongly attracted female students and claimed that this cream was able to perfect his facial look. He spent an excessive amount of time on Facebook, where he met a young woman with whom he wished to engage in an intimate relationship, but the young woman withdrew. Subsequently, he developed the belief that each time he was contacted by other young women via Facebook, it was in fact the young woman with whom he had been in contact before and who now was disguising herself. He strongly believed that she was applying the same cream as he did himself to transform her facial looks. Thus, he was convinced that, despite her withdrawal, she was actually interested in pursuing a relationship with him. Full neurologic assessments, including cerebral magnetic resonance imaging, revealed no abnormalities.

Frégoli syndrome has been associated with some degree of objective face-processing impairment.3,4 It is understood as a syndrome of hyperidentification caused by a breakdown of the identification process, thus leading to the inability to attribute uniqueness to a specific person.2 As in the present case, hyperidentification may not be limited to one single person only.2 This is the first case reporting emergence of Frégoli syndrome in association with using social network Web sites. As these networks generally feature portraits of familiar persons and strangers alike and are massively used today throughout the world to initiate and foster social contacts, the combination with Frégoli syndrome is intriguing. To what extent this shift in social behavior will be paralleled by a shift of context in which this disorder occurs remains an open yet tempting question that may be answered by further reports and case studies of Frégoli syndrome.

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References

1. Courbon P., Fail G. Syndrome d'llusion de Frégoli et schizophrenie. Bull Soc Clin Med Ment.1927;15:121–124.

2. Christodoulou G.N., Margariti M., Kontaxakis V.P., et al. The delusional misidentification syndrome: strange, fascinating, and instructive. Curr Psych Rep. 2009;11(3):185–189. [PubMed]

3. Walther S., Federspiel A., Horn H., et al. Performance during face processing differentiates schizophrenia patients with delusional misidentifications. Psychopathology. 2010;43(2):127–136.[PubMed]

4. Ellis H.D., Young A.W. Accounting for delusional misidentifications. Br J Psychiatry.1990;157(2):239–248. [PubMed]

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Articles from The Primary Care Companion for CNS Disorders are provided here courtesy of Physicians Postgraduate Press, Inc.

AN IMPOSTOR IN THE FAMILY ARTICLE #252 • WRITTEN BY GERRY MATLACK

Imagine, 


imagine, if you will, that one by one your friends and family-- the people closest to you-- are being removed and replaced with exact duplicates. Although they are identical in appearance and manner, you are certain that these people are not your loved ones. They are impostors. While most people would become deeply paranoid in such a scenario, there are some individuals who experience such things every day without fear... and just wonder, "why?" Such is the life of people stricken with Capgras' Syndrome.

A person with Capgras' Syndrome suffers from the delusion that one or more of their close friends or family members have been replaced with exact duplicates, and they cannot be shaken from this belief in spite of an otherwise clean bill of mental health. In some instances, the person believes that they themselves are, in whole or in part, a duplicate. Unlike the paranoia expected from such a condition, there is never a motive assigned for the appearance of the duplicates - the patients do not believe someone is "out to get them," but they are at a loss for an explanation why anyone would want to replace their loved ones.

This odd misperception is named after the French psychiatrist Jean Marie Joseph Capgras, who described the case of a Madame M. in 1923. The woman insisted that identical-looking persons had taken the place of her family. Over time her delusion expanded to include neighbors, friends and acquaintances. But Madame M. never bothered to get to know these impostors because it was her belief that each one regularly left to make room for the next double. In all, she eventually claimed to have had more than eighty husbands.

People suffering from Capgras' Syndrome can sometimes even doubt their own identity after seeing their reflection in a mirror. One man pinched himself on the arm after seeing his reflection at the doctor's office, and wondered aloud whether he and the man in the reflection were the same person. There was also a woman who flew into a jealous rage every time she caught sight of her own reflection, believing this "other woman" was trying to lure her husband away from her. Her husband eventually covered every reflective surface in the house in an effort to keep her from hurting herself. Oddly enough, she had no problem recognizing herself in the mirror of her makeup compact, but anything larger resulted in an assault on the imaginary impostor. Her doctor tried a novel solution: he gathered a number of mirrors of varying sizes, and had the woman view herself in each one. He started with the smallest and gradually moved to the next larger as soon as she recognized herself. Ultimately she was able to see herself in a full-length mirror, and she was cured from then on.

In some instances, individuals with the Capgras delusion see duplicate objects rather than duplicate people. One doctor reported a patient who believed that his poodle had been replaced with an identical dog, and another reported a patient who believed that during the night his running shoes and many other personal possessions were being replaced.

Capgras' delusion always centers around just one of the subject's senses. The most common is the sense of sight; for example, one person readily recognized his wife on the phone when speaking to her, yet when she arrived in the flesh he thought the impostor was actually his sister-in-law. Blind people have also been diagnosed with the disorder, and they believe that the voices of certain loved ones are actually coming from duplicates.

While the causes of Capgras' syndrome are not specifically known, there is no shortage of theories. It has been shown that many people with the syndrome have brain lesions in the right temporal lobe from traumatic injuries, epilepsy, and other causes, yet there are also significant numbers of patients with no such damage in evidence. Also, there is a somewhat higher incidence of schizophrenia among people with Capgras, and in New Zealand there is a markedly higher incidence of the disorder among the Maori people than in the general population.

Some earlier researchers attempted to draw connections to Prosopagnosia, a condition which prevents some people from being able to recognize faces. By measuring a person's galvanic skin response-- the amount of electrical resistance in the skin-- scientists can detect when an individual is experiencing emotions. Patients with Prosopagnosia show an emotional response to familiar faces, though they exhibit no conscious recognition. With a Capgras patient there is no such reaction. Though no emotional connection is present when shown a picture of their father, the patient will remark on the striking resemblance. This test also rules out mental illness as a definitive cause, since the emotional center of the brain would subconsciously react even with impaired perceptions.

Another proposed cause involves some form of damage or impairment in two lobes of the brain: One site of damage affecting the emotional connections with respect to people's faces, and the other affecting the brain's consistency-checking abilities.

In at least one case, doctors have successfully cured Capgras' Syndrome by suspending a prescription of diazepam, yet in other cases symptoms have disappeared after administering anti-psychotic medication. To date, no single treatment has been found to be consistently effective, and so far there is no single theory that can explain all the reported cases of Capgras' Syndrome. We do know, however, that the human mind uses many interlocking cognitive tricks to fill in the gaps of our observations, essentially building a simulation which allows us to interact with our world and society. When just one or two of those links go awry, the true complexity of that simulation is revealed by the fascinating problems that arise.

Written by Gerry Matlack, posted on 05 February 2007. Gerry is a contributing editor for DamnInteresting.com.

Latuda (Lurasidone)

IMPORTANT SAFETY INFORMATION AND INDICATIONS FOR LATUDA

WARNINGS: INCREASED MORTALITY IN ELDERLY PATIENTS WITH DEMENTIA-RELATED PSYCHOSIS; AND SUICIDAL THOUGHTS AND BEHAVIORS Elderly patients with dementia-related psychosis (having lost touch with reality due to confusion and memory loss) treated with this type of medicine are at an increased risk of death, compared to patients receiving placebo (sugar pill). LATUDA is not approved for treating these patients. Antidepressants have increased the risk of suicidal thoughts and actions in some children, teenagers, and young adults. Patients of all ages starting treatment should be watched closely for worsening of depression, suicidal thoughts or actions, unusual changes in behavior, agitation, and irritability. Patients, families, and caregivers should pay close attention to any changes, especially sudden changes in mood, behaviors, thoughts, or feelings. This is very important when an antidepressant medicine is started or when the dose is changed. Report any change in these symptoms immediately to the doctor. LATUDA is not approved for patients under the age of 18 years.

Neuroleptic malignant syndrome (NMS): NMS is a rare and potentially fatal side effect reported with LATUDA and similar medicines. Call your doctor right away if you have high fever; stiff muscles; confusion; changes in pulse, heart rate, or blood pressure; sweating; or muscle pain and weakness. LATUDA should be stopped if you have NMS.

Tardive dyskinesia (TD): TD is a serious and sometimes permanent side effect reported with LATUDA and similar medicines. Tell your doctor about any movements you cannot control in your face, tongue, or other body parts, as they may be signs of TD. TD may not go away, even if you stop taking LATUDA. TD may also start after you stop taking LATUDA.

Metabolic Changes

High blood sugar: High blood sugar and diabetes have been reported with LATUDA and medicines like it. If you have diabetes or risk factors for diabetes, your blood sugar should be tested at the beginning of and throughout treatment with LATUDA. Complications of diabetes can be serious and even life threatening. Tell your healthcare provider if you have blood sugar problems or signs of diabetes, such as being thirsty all the time, going to the bathroom a lot, or feeling weak or hungry.

High cholesterol and triglycerides: Increases in triglycerides and in LDL (bad) cholesterol and decreases in HDL (good) cholesterol have been reported with LATUDA.

Weight gain: Some patients may gain weight while taking LATUDA. Your doctor should check your weight regularly.

Additional Important Warnings

• Other risks may include feeling dizzy or lightheaded upon standing, decreases in white blood cells (which can be fatal), or trouble swallowing. Tell your doctor if you experience any of these.
• LATUDA and medicines like it may raise the levels of prolactin. Tell your healthcare provider if you experience a lack of menstrual periods, leaking or enlarged breasts, or impotence.
• Tell your healthcare provider if you have a seizure disorder, have had seizures in the past, or have conditions that increase your risk for seizures.
• Tell your healthcare provider if you experience prolonged, abnormal muscle spasms or contractions, which may be a sign of a condition called dystonia.
• LATUDA can affect your judgment, thinking, and motor skills. You should not drive or operate hazardous machinery until you know how LATUDA affects you.
• LATUDA may make you more sensitive to heat. You may have trouble cooling off. Be careful when exercising or when doing things likely to cause dehydration or make you warm.
• Tell your healthcare provider about all prescription and over-the-counter medicines you are taking or plan to take, since there are some risks for drug interactions with LATUDA. Avoid drinking alcohol while taking LATUDA.
• Tell your healthcare provider if you are pregnant or if you are planning to get pregnant. Avoid breast feeding while taking LATUDA.

The most common side effects for LATUDA in clinical studies:

• in adults with Bipolar Depression include: an inner sense of restlessness or need to move (akathisia); difficulty moving, slow movements, muscle stiffness, or tremor; and sleepiness
• in adults with Schizophrenia include: sleepiness; an inner sense of restlessness or need to move (akathisia); difficulty moving, slow movements, muscle stiffness, or tremor; and nausea

This is not a complete summary of safety information. Please discuss the full Prescribing Information for prescription LATUDA with your doctor.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.

INDICATIONS

LATUDA is used to treat:

• Depressive episodes in bipolar I disorder (bipolar depression) in adults when used alone or with lithium or valproate
• Schizophrenia in adults