Speakers - PAWC2025

Abstract

Capgras delusion is a delusional misidentification syndrome, characterized by the belief that persons well known to the individual have been replaced by identical impostors. Although traditionally considered a symptom of schizophrenia spectrum disorders, emerging evidence increasingly indicates that, those dysfunctions result from specific neuroanatomical distortions of facial recognition and emotional affective integration areas. This delusional belief has been correlated with lesions of right fusiform face area, amygdala, ventromedial prefrontal cortex and other structures responsible for face-affect coupling and reality testing.
in this anatomical background, a targeted review of literature was performed in PubMed and Psychiatry Online. Search items comprised “Capgras delusion,” “face recognition,” “limbic disconnection,” and “frontal lobe lesion.” Only English language peer-reviewed case reports with clinical imaging and neuroanatomical involvement were eligible for inclusion. Exclusion criteria were studies which did not provide explicit diagnosis, or lacked peer review. three in-depth clinical reports were chosen for anatomic correlation and tracking of symptom resolution: from Case Reports in Neurology, Journal of the Neurological Sciences and Journal of Neuropsychiatry and Clinical Neurosciences.
The cases presented show common pattern of structural disruption of the right hemisphere. A patient with Parkinson’s disease developed Capgras’s syndrome after deep brain stimulation of the subthalamic nucleus, implicating basal ganglia–limbic modulatory damage involvement mechanism. Another case described right frontal tumor (meningioma) compressing the ventromedial prefrontal cortex and the alleviation of symptoms after removal of the tumor. A third report demonstrated vascular lesions involving the right temporal and cingulate regions in patient with schizophrenia, again supporting involvement of temporolimbic connections in Capgras delusion development.
Therefore, it becomes evident that, Capgras delusion is associated with disconnection of specific frontotemporal-limbic pathways. early recognition is crucial in differential diagnosis, as well as to encourage psychiatrists to collaborate with neurologists and neuroimaging researchers in the multidisciplinary approach to targeted treatments.