Capgras Syndrome: When a Loved One Is Perceived as an Imposter
Capgras syndrome is a rare delusion in which a familiar person, often a spouse, is believed to be replaced by an impostor. Symptoms can come and go and may be worse at night, with a notable risk of violence toward the perceived impostor. Lewy body dementia accounts for many cases. Treatment combines medication (dementia meds such as donepezil and antipsychotics) and non-drug approaches, used with caution and under expert supervision. Involuntary treatment may be possible if the patient has a severe mental disorder, impaired decision-making, and poses danger; laws vary by state and require a psychiatrist or neurologist to guide the process. Families should seek a psychiatric evaluation to discuss options and safety for both the patient and caregivers.