Scientific letter
Capgras syndrome as a psychiatric manifestation in Parkinson's disease: A case report and literature review
I. Estrada-Bellmanna, Y. Ulloa-Escobarb, S.L. Barbosa-Floresb,
, R.E. Pech-Georgeb, R. González-Treviñob, L. Conde-Gómezb, A. Marfil-Riveraa
Corresponding author
sandrabarbosa03@hotmail.com
Corresponding author at: Paseo de las Fuentes, No. 4637 Col. Villa Las Fuentes, Monterrey, Nuevo León, C.P. 64890, Mexico.
Corresponding author at: Paseo de las Fuentes, No. 4637 Col. Villa Las Fuentes, Monterrey, Nuevo León, C.P. 64890, Mexico.
Read
8119
Timeswas read the article
1274
Total PDF
6845
Total HTML
Share statistics
array:24 [ "pii" => "S1665579614000040" "issn" => "16655796" "doi" => "10.1016/j.rmu.2014.07.002" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "3" "copyright" => "Universidad Autónoma de Nuevo León" "copyrightAnyo" => "2014" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Medicina Universitaria. 2015;17:49-52" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2145 "formatos" => array:3 [ "EPUB" => 48 "HTML" => 1468 "PDF" => 629 ] ] "itemSiguiente" => array:19 [ "pii" => "S1665579615000071" "issn" => "16655796" "doi" => "10.1016/j.rmu.2014.06.001" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "12" "copyright" => "Universidad Autónoma de Nuevo León" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "ssu" "cita" => "Medicina Universitaria. 2015;17:53-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2176 "formatos" => array:3 [ "EPUB" => 54 "HTML" => 1454 "PDF" => 668 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Review article</span>" "titulo" => "Gender dysphoria: An overview" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "53" "paginaFinal" => "58" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2008 "Ancho" => 1569 "Tamanyo" => 208916 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">TIC flowchart.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "N.C. Capetillo-Ventura, S.I. Jalil-Pérez, K. Motilla-Negrete" "autores" => array:3 [ 0 => array:2 [ "nombre" => "N.C." "apellidos" => "Capetillo-Ventura" ] 1 => array:2 [ "nombre" => "S.I." "apellidos" => "Jalil-Pérez" ] 2 => array:2 [ "nombre" => "K." "apellidos" => "Motilla-Negrete" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579615000071?idApp=UINPBA00004N" "url" => "/16655796/0000001700000066/v1_201508210029/S1665579615000071/v1_201508210029/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665579614000039" "issn" => "16655796" "doi" => "10.1016/j.rmu.2014.07.001" "estado" => "S300" "fechaPublicacion" => "2015-01-01" "aid" => "2" "copyright" => "Universidad Autónoma de Nuevo León" "documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "crp" "cita" => "Medicina Universitaria. 2015;17:46-8" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 2789 "formatos" => array:3 [ "EPUB" => 42 "HTML" => 2312 "PDF" => 435 ] ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Long QT syndrome in a neonate" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "46" "paginaFinal" => "48" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1308 "Ancho" => 1601 "Tamanyo" => 83646 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Calculation of the corrected QT interval.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "I. Rodríguez-Balderrama, I.B. Morales-Rodríguez, V. Rodríguez-Martínez, R. Rodríguez-Bonito" "autores" => array:4 [ 0 => array:2 [ "nombre" => "I." "apellidos" => "Rodríguez-Balderrama" ] 1 => array:2 [ "nombre" => "I.B." "apellidos" => "Morales-Rodríguez" ] 2 => array:2 [ "nombre" => "V." "apellidos" => "Rodríguez-Martínez" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Rodríguez-Bonito" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579614000039?idApp=UINPBA00004N" "url" => "/16655796/0000001700000066/v1_201508210029/S1665579614000039/v1_201508210029/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Capgras syndrome as a psychiatric manifestation in Parkinson's disease: A case report and literature review" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "49" "paginaFinal" => "52" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "I. Estrada-Bellmann, Y. Ulloa-Escobar, S.L. Barbosa-Flores, R.E. Pech-George, R. González-Treviño, L. Conde-Gómez, A. Marfil-Rivera" "autores" => array:7 [ 0 => array:3 [ "nombre" => "I." "apellidos" => "Estrada-Bellmann" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Y." "apellidos" => "Ulloa-Escobar" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:4 [ "nombre" => "S.L." "apellidos" => "Barbosa-Flores" "email" => array:1 [ 0 => "sandrabarbosa03@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 3 => array:3 [ "nombre" => "R.E." "apellidos" => "Pech-George" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "R." "apellidos" => "González-Treviño" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "L." "apellidos" => "Conde-Gómez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 6 => array:3 [ "nombre" => "A." "apellidos" => "Marfil-Rivera" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Neurology Service of the “Dr. José Eleuterio González” University Hospital of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Psychiatry Service of the “Dr. José Eleuterio González” University Hospital of the Universidad Autónoma de Nuevo León, Monterrey, Nuevo León, Mexico" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Paseo de las Fuentes, No. 4637 Col. Villa Las Fuentes, Monterrey, Nuevo León, C.P. 64890, Mexico." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The ability to recognize faces and discriminate those which are not familiar to us is there since birth, and it is developed and perfected through the first years of life. Delusional misidentification syndromes are a group of phenomena in which patients erroneously identify familiar people or places or even themselves, believing said objects or people to have been replaced or transformed. There are several subtypes, however, most authors divide it into 4 main syndromes (Capgras syndrome, Frégoli syndrome, Intermetamorphosis syndrome and syndrome of subjective doubles), Capgras syndrome being the most common among these syndromes.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Joseph Capgras described the first case of a syndrome characterized by the delusional belief that a close relative has been replaced by an impostor. In the beginning, it was believed to be associated to a higher degree with psychiatric disorders, but in fact it is more frequently associated with neurodegenerative diseases, especially with Lewy body disease, and it is commonly found in association with visual hallucinations.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the case of Capgras syndrome, there is not only the misidentification of someone familiar to them, but a delusional belief that the person has been replaced by a double that is not quite exact. Study of the causes has been closely linked to the analysis of patients with brain injuries which would have developed prosopagnosia.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> This perceptual disorder causes the patient to be unable to recognize faces in a consistent way, despite the fact that he/she is able to recognize visual objects.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Continuing along the lines of the study of Capgras syndrome, starting from the prosopagnosia phenomenon, it has been suggested that there would be a “mirror image” of prosopagnosia, in a way that, although the conscious ability to recognize faces would be intact, there would be damages to the system that produces automatic emotional excitement when observing familiar faces.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> This finding was later confirmed in patients with a Capgras syndrome diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Traditionally, the origin of Capgras syndrome was considered to reside in a psychodynamic base; the premise was that people who received a great deal of affection from the patients were also recipients of their ambivalence, which made them the object of the projections and led to the patient's psychological disintegration.</p><p id="par0025" class="elsevierStylePara elsevierViewall">On the other hand, in addition to prosopagnosia, Capgras syndrome has been linked with multiple pathologies. It has been described in psychiatric as well as organic disorders. Within psychiatric profiles, it is common to find this delusion in paranoid schizophrenia, as well as psychotic depression, delusional disorders, schizoaffective disorder or bipolar disorder, with a frequency of 1–15% in psychotic patients.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Regarding the organic conditions that occur in Capgras delusion, this appears mainly in various types of dementia like Alzheimer, Lewy bodies and Parkinson, as well as posterior to brain injuries. It is followed among other conditions by ictus, epilepsy, chronic alcoholism cases and encephalitis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Capgras syndrome has been considered a type of paranoid psychosis more frequently linked to Lewy body dementia, as well as psychiatric illnesses like schizophrenia. Nevertheless, there are reports in medical literature that even link it to dopaminergic deficiency, which appears during the “off” states, solving it with an increment in L-dope and less frequently in an isolated form as a psychiatric manifestation of Parkinson's disease.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Below, we describe a peculiar case of a patient who presented Parkinson's disease and Capgras syndrome simultaneously.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Clinical case</span><p id="par0040" class="elsevierStylePara elsevierViewall">The patient is a 58-year-old male with a history of systemic arterial hypertension (since he was 45 years old), without a history of any other major health issue. His symptoms began in 2004 with a right upper limb tremor which did not affect his everyday life, and thus was not given importance. In 2005 he witnessed a situation of social violence having been caught in a crossfire and having his workplace attacked with a grenade. As a result, he began displaying the following symptoms: anxiety, fear, recurrent memories of the event, affective bottling, hypervigilance and avoidance behavior, with a significant decline in his work and social activity. He was diagnosed with acute stress disorder and began treatment with 50<span class="elsevierStyleHsp" style=""></span>mg of sertraline every 24<span class="elsevierStyleHsp" style=""></span>h, with a remission of symptoms. Subsequently, other symptoms characterized by bradykinesia appeared, with an increase in the right upper limb rest tremor, fine motor clumsiness and gait and posture alterations being asymmetrical with uncoordinated arm movement. A Parkinson's disease diagnosis was established in 2006. In 2009 the patient displayed neuropsychiatric signs and symptoms, apathy, anhedonia, a tendency to isolation, affective bottling, and later aural and visual hallucinations with paranoid content, soliloquies, as well as a false belief that his wife and daughter were not them but had been replaced by other people, thus integrating a Capgras syndrome.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The following clinimetrics were performed: The Schwab & England Activities of Daily Living Scale, which evaluates the patient's functional state, with a value of 10%, meaning the patient is “Totally dependent, harmless; completely handicapped”. Hoehn and Yahr evaluation scale, a descriptive staging scale of the progression of Parkinson's disease symptoms, placing the patient in a stage 4: Severe disability; still able to walk or stand unassisted. Freezing and “on-off” unpredictable (Stages 1–5, where stage 1: minimal or no functional disability and stage 5: the patient is confined to a bed). Montreal Cognitive Assessment battery (MoCa) evaluates mild cognitive impairment, with a score of 11, corresponding to a moderate cognitive impairment (normal range of 24–30). Hamilton anxiety rating scale of 10 (mild anxiety). Hamilton depression scale with 5 points (not depressed). Folstein Mini-Mental State Exam with 17 points, corresponding to moderate impairment.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Treatment was begun with levodopa/carbidopa 250<span class="elsevierStyleHsp" style=""></span>mg/25<span class="elsevierStyleHsp" style=""></span>mg orally, ½ pill every 6<span class="elsevierStyleHsp" style=""></span>h, and amantadine 100<span class="elsevierStyleHsp" style=""></span>mg orally ½ tbsp every 8<span class="elsevierStyleHsp" style=""></span>h with a positive control of Parkinsonism symptoms. Regarding psychotic symptoms, we began treatment with quetiapine 150<span class="elsevierStyleHsp" style=""></span>mg with positive results. Currently the patient continues with the same treatment and is stable, with good control of Parkinson's symptoms, in addition to not presenting current active psychosis.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Discussion and conclusions</span><p id="par0055" class="elsevierStylePara elsevierViewall">The presence of hallucinations and delusions is frequent in Parkinson's disease, affecting around 20–30% of the patients.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Psychotic symptoms have been linked to the disease before there were treatments for it, but its prevalence has considerably risen since the generalization of the use of dopaminergic stimulation.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> There also have been reports of the presence of transient neurocognitive changes, secondary to the placement of a deep cerebral stimulator for resistant Parkinson's, causing symptoms characteristic of Capgras syndrome.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0060" class="elsevierStylePara elsevierViewall">One of the most relevant intrinsic factors in the development of psychosis is the cholinergic deficit. Other precipitant and risk factors linked to the disease itself are the age of onset, length, presence of depression and especially the presence of cognitive impairment, because Capgras syndrome appears in the later stages of dementia in Parkinson's, which results in stressing situations for the patients and even more for the caregivers.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">The most important factor is the direct and indirect stimulation of the corticolimbic dopaminergic receptors. In fact, these phenomena may appear even in patients being treated with L-Dopa or dopaminergic agonists in early stages, although its frequency increases considerably in more advanced patients and in patients with complications, especially if they develop dementia. Recent processing models highlight the dissociation between recognition and emotional response, based – from the neurobiological point of view – on the disconnection between the frontal lobe and the right temporal and limbic regions, along with the bilateral frontal damage. Some theories suggest a two-way intervention as an explanation, one lateral non-cortical and the other subcortical, located in the right hemisphere.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Evidence that not all patients with right hemisphere affectation develop a delusional syndrome has led to suggest the presence of a positive mechanism creator of delusions, which would require at least a certain preservation of the left hemisphere. This usually acts to inhibit the right side; it tries to give coherence and sense and interpret dissonant information between recognition and absence of familiarity, thus its affectation would lead to delusion.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">Moreover, the monothematic delusion two-factor theory, among which there is the Capgras syndrome, suggests that the genesis is caused by a double failure: a right hemisphere injury, probably in the ventromedial zone of the right-frontal lobe, in addition to the failure of the beliefs comparison mechanism, which produces delusion persistence in spite of evidence against it, sustained also by the right frontal lobe.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> The positive mechanism in this case would be the beliefs evaluation system, similar to the reality monitoring functions.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">On the other hand, psychiatric manifestations of Parkinson's disease are: depression and anxiety. Mood disorders are probably Parkinson's disease's most frequent symptoms, so much that they may precede motor symptoms in up to 30% of cases.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">Significant depression prevalence presents itself in more than double the number of patients with Parkinson's (37%) than what is normally found in other diseases (18%). Less severe forms of depression are more frequent than major depression, however; the latter occurs in 5% of patients. Despite everything, the depressive symptomatology displayed in this context goes beyond the simple expected reaction caused by suffering an upsetting disease and being mostly disabled to a greater or lesser degree. Changes in the serotoninergic system play a major role, a link with noradrenergic transmission, based on the presence of a deficit of noradrenergic neurons in the locus coeruleus. There is a dopamine deficit in mesocortic-limbic projections and of dopaminergic cells in the ventral tegmentum in depressed parkinsonians.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">The anxiety disorders are manifested through agitation, chronic anxiety, panic attacks and obsessive-compulsive disorders. The pathogeny of anxiety is explained by the increment caused by levodopa of the catecholamine and its metabolites of the brain. It is usually linked to the amount and duration of treatment and it is more frequent in the “off” periods.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Chronic anxiety can be an exclusive manifestation of the “off” periods and may be present during the whole day. Due to therapeutic implications, it is important to determine this symptom's presentation profile, because in the case of being secondary to the increment of catecholamine by levodopa, dopaminergic treatment must be adjusted, in addition to applying psycho-pharmaceutics.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> Panic attacks are usually linked to prolonged treatments with levodopa. They constitute a rare complication and occasionally occur in concurrence with the “off” periods of levodopa dependents, much later than dyskinesia and motor fluctuations.</p><p id="par0100" class="elsevierStylePara elsevierViewall">In this case, the patient has presented the three most frequent types of psychiatric manifestations, although what draws attention has been the Capgras syndrome, because this syndrome constitutes a complex process that is not limited to a simple facial processing problem, but a multiple cerebral dysfunction which sustains it, since it may become chronic. Due to the high frequency of the psychiatric manifestations of Parkinson's disease, linked or not to medical treatment, it is important to know the syndromes associated with the “off” periods of the disease and to know how to tell them apart from the medications’ side effects and psychotic symptoms of other origin in order to implement the proper treatment, because it impacts quality of life and its functional prognosis. Clinical interviews are basic for establishing the order of the symptoms.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conflict of interest</span><p id="par0105" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:3 [ "identificador" => "xres542822" "titulo" => "Abstract" "secciones" => array:1 [ 0 => array:1 [ "identificador" => "abst0005" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec562171" "titulo" => "Keywords" ] 2 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 3 => array:2 [ "identificador" => "sec0010" "titulo" => "Clinical case" ] 4 => array:2 [ "identificador" => "sec0015" "titulo" => "Discussion and conclusions" ] 5 => array:2 [ "identificador" => "sec0020" "titulo" => "Conflict of interest" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2014-04-01" "fechaAceptado" => "2014-07-31" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec562171" "palabras" => array:5 [ 0 => "Capgras syndrome" 1 => "Parkinson disease" 2 => "Psychotic disorders" 3 => "Delusional misidentification syndromes" 4 => "Identification agnosia" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:2 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">We present the case of a 58-year-old male patient who had symptoms of anxiety after witnessing a case of social violence in his community in 2005. After that, he presented symptoms of Parkinson Disease and in 2006 we established this as the main diagnosis. In 2009 he presented neuropsychiatric symptoms such as apathy, anhedonia, social isolation, blunted affect, visual and auditory hallucinations, paranoid delusions, soliloquies, and the false belief that his wife and daughter had been replaced by identical impostors. We established the diagnosis of Capgras Syndrome. This case is clinically relevant because of the presentation of its symptoms, its evolution and its presenting comorbidity.</p></span>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:19 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Mental illness, violence and delusional misidentifications: the role of Capgras syndrome in matricide" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "F. Carabellese" 1 => "G. Rocca" 2 => "C. Candelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jflm.2013.10.012" "Revista" => array:6 [ "tituloSerie" => "J Forensic Leg Med" "fecha" => "2014" "volumen" => "21" "paginaInicial" => "9" "paginaFinal" => "13" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24365679" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Delusional misidentification syndrome and other unusual delusions in advanced Parkison's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "A. Moro" 1 => "R.P. Munhoz" 2 => "M. Moscovich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.parkreldis.2013.04.021" "Revista" => array:6 [ "tituloSerie" => "Parkinsonism Relat Disord" "fecha" => "2013" "volumen" => "19" "paginaInicial" => "751" "paginaFinal" => "754" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23680417" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The role of the right hemisphere in the Capgras delusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "H.D. Ellis" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Psychopathology" "fecha" => "1994" "volumen" => "27" "paginaInicial" => "177" "paginaFinal" => "185" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7846235" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "R.J. Berson" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1176/ajp.140.8.969" "Revista" => array:6 [ "tituloSerie" => "Am J Psychiatry" "fecha" => "1983" "volumen" => "140" "paginaInicial" => "969" "paginaFinal" => "978" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6869616" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Psychodynamic approaches to the Capgras delusion: a critical historical review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.W. Pauw" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Psychopathology" "fecha" => "1994" "volumen" => "27" "paginaInicial" => "154" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7846232" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Behavioral, neuropsychiatric and cognitive disorders in Parkinson's disease patients with and without motor complications" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "P. Solla" 1 => "A. Cannas" 2 => "G.L. Floris" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pnpbp.2011.02.002" "Revista" => array:6 [ "tituloSerie" => "Prog Neuropsychopharmacol Biol Psychiatry" "fecha" => "2011" "volumen" => "35" "paginaInicial" => "1009" "paginaFinal" => "1013" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21324349" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome and its relationship to neurodegenerative disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.A. Josephs" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archneur.64.12.1762" "Revista" => array:6 [ "tituloSerie" => "Arch Neurol" "fecha" => "2007" "volumen" => "64" "paginaInicial" => "1762" "paginaFinal" => "1766" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18071040" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome in Parkinson's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Miwa" 1 => "Y. Mizuno" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Neurol" "fecha" => "2001" "volumen" => "248" "paginaInicial" => "804" "paginaFinal" => "805" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11596786" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Dopamine deficiency may lead to Capgras syndrome in Parkinson's disease with dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "H. Shiotsuki" 1 => "Y. Motoi" 2 => "S. Nakamura" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Neuropsychiatry Clin Neurosci" "fecha" => "2010" "volumen" => "22" "paginaInicial" => "352e14" "paginaFinal" => "352e15" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome after deep brain stimulator placement for Parkinson disease: a case report" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "D. Brooks" 1 => "A. Reish" 2 => "M. Segal" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "Phys Med Rehabil" "fecha" => "2010" "volumen" => "2" "paginaInicial" => "S18" ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Parkinson's disease: before the motor symptoms and beyond" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. Korczyn" 1 => "T. Gurevich" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "J Neurol Sci" "fecha" => "2010" "paginaInicial" => "2892" "paginaFinal" => "2896" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A prospective study of delusional misidentification syndromes in Parkinson's disease with dementia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "J. Pagonabarraga" 1 => "G. Llebaria" 2 => "C. García-Sánchez" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/mds.21864" "Revista" => array:6 [ "tituloSerie" => "Mov Disord" "fecha" => "2008" "volumen" => "23" "paginaInicial" => "443" "paginaFinal" => "448" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18076112" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "W. Hirstein" 1 => "V. Ramachandran" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Proc R Soc Lond" "fecha" => "1997" "volumen" => "264" "paginaInicial" => "437" "paginaFinal" => "444" ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The case of lost Wilma: a clinical report of Capgras delusion" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "F. Lucchelli" 1 => "H. Spinnler" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10072-007-0819-8" "Revista" => array:6 [ "tituloSerie" => "Neurol Sci" "fecha" => "2007" "volumen" => "28" "paginaInicial" => "188" "paginaFinal" => "195" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17690850" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome: out of sight, out of mind?" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "T. Dietl" 1 => "A. Herr" 2 => "H. Brunner" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Acta Paediatr Scand" "fecha" => "2003" "volumen" => "108" "paginaInicial" => "460" "paginaFinal" => "463" ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Complicaciones psiquiátricas de la enfermedad de Parkinson: clínica y tratamiento" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Castro-García" 1 => "A. Sesar-Ignacio" 2 => "B. Ares-Pensado" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Rev Neurol" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "646" "paginaFinal" => "650" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15490352" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Manifestaciones Neuropsiquiatricas de la enfermedad de Parkinson" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "R. Eduardo" 1 => "P. Jares" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Arch Neurol Neuroc Neuropsiq" "fecha" => "2007" "volumen" => "13" "paginaInicial" => "20" "paginaFinal" => "35" ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cognitive neuropsychiatry and delusional belief" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "M. Coltheart" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Q J Exp Psychol" "fecha" => "2007" "volumen" => "60" "paginaInicial" => "1041" "paginaFinal" => "1062" ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Capgras syndrome in the modern era: self-misidentification on an ID picture" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "S. Grignon" 1 => "M. Trottier" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Can J Psychiatry" "fecha" => "2005" "volumen" => "50" "paginaInicial" => "74" "paginaFinal" => "75" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15756733" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16655796/0000001700000066/v1_201508210029/S1665579614000040/v1_201508210029/en/main.assets" "Apartado" => array:4 [ "identificador" => "42852" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/16655796/0000001700000066/v1_201508210029/S1665579614000040/v1_201508210029/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665579614000040?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 13 | 2 | 15 |
| 2024 October | 130 | 9 | 139 |
| 2024 September | 137 | 19 | 156 |
| 2024 August | 103 | 16 | 119 |
| 2024 July | 97 | 12 | 109 |
| 2024 June | 78 | 6 | 84 |
| 2024 May | 102 | 6 | 108 |
| 2024 April | 96 | 4 | 100 |
| 2024 March | 116 | 13 | 129 |
| 2024 February | 95 | 6 | 101 |
| 2024 January | 121 | 6 | 127 |
| 2023 December | 101 | 13 | 114 |
| 2023 November | 104 | 15 | 119 |
| 2023 October | 122 | 17 | 139 |
| 2023 September | 116 | 11 | 127 |
| 2023 August | 99 | 4 | 103 |
| 2023 July | 126 | 15 | 141 |
| 2023 June | 137 | 11 | 148 |
| 2023 May | 121 | 8 | 129 |
| 2023 April | 195 | 14 | 209 |
| 2023 March | 88 | 4 | 92 |
| 2023 February | 86 | 16 | 102 |
| 2023 January | 85 | 13 | 98 |
| 2022 December | 80 | 8 | 88 |
| 2022 November | 98 | 14 | 112 |
| 2022 October | 121 | 19 | 140 |
| 2022 September | 85 | 11 | 96 |
| 2022 August | 113 | 15 | 128 |
| 2022 July | 96 | 8 | 104 |
| 2022 June | 67 | 28 | 95 |
| 2022 May | 80 | 22 | 102 |
| 2022 April | 49 | 11 | 60 |
| 2022 March | 111 | 11 | 122 |
| 2022 February | 121 | 27 | 148 |
| 2022 January | 132 | 13 | 145 |
| 2021 December | 54 | 10 | 64 |
| 2021 November | 83 | 14 | 97 |
| 2021 October | 76 | 15 | 91 |
| 2021 September | 82 | 14 | 96 |
| 2021 August | 50 | 7 | 57 |
| 2021 July | 50 | 11 | 61 |
| 2021 June | 57 | 4 | 61 |
| 2021 May | 75 | 10 | 85 |
| 2021 April | 240 | 9 | 249 |
| 2021 March | 120 | 5 | 125 |
| 2021 February | 55 | 16 | 71 |
| 2021 January | 78 | 10 | 88 |
| 2020 December | 94 | 10 | 104 |
| 2020 November | 118 | 12 | 130 |
| 2020 October | 85 | 8 | 93 |
| 2020 September | 62 | 8 | 70 |
| 2020 August | 52 | 8 | 60 |
| 2020 July | 37 | 9 | 46 |
| 2020 June | 41 | 4 | 45 |
| 2020 May | 68 | 17 | 85 |
| 2020 April | 74 | 5 | 79 |
| 2020 March | 82 | 10 | 92 |
| 2020 February | 59 | 13 | 72 |
| 2020 January | 69 | 8 | 77 |
| 2019 December | 38 | 24 | 62 |
| 2019 November | 45 | 3 | 48 |
| 2019 October | 85 | 4 | 89 |
| 2019 September | 81 | 2 | 83 |
| 2019 August | 40 | 2 | 42 |
| 2019 July | 34 | 7 | 41 |
| 2019 June | 46 | 22 | 68 |
| 2019 May | 107 | 12 | 119 |
| 2019 April | 51 | 10 | 61 |
| 2019 March | 17 | 6 | 23 |
| 2019 February | 16 | 8 | 24 |
| 2019 January | 12 | 3 | 15 |
| 2018 December | 12 | 9 | 21 |
| 2018 November | 13 | 11 | 24 |
| 2018 October | 18 | 4 | 22 |
| 2018 September | 24 | 3 | 27 |
| 2018 August | 3 | 16 | 19 |
| 2018 July | 3 | 9 | 12 |
| 2018 June | 3 | 1 | 4 |
| 2018 May | 7 | 8 | 15 |
| 2018 April | 12 | 4 | 16 |
| 2018 March | 11 | 3 | 14 |
| 2018 February | 8 | 8 | 16 |
| 2018 January | 12 | 2 | 14 |
| 2017 December | 9 | 3 | 12 |
| 2017 November | 12 | 4 | 16 |
| 2017 October | 21 | 18 | 39 |
| 2017 September | 19 | 9 | 28 |
| 2017 August | 8 | 11 | 19 |
| 2017 July | 13 | 12 | 25 |
| 2017 June | 13 | 42 | 55 |
| 2017 May | 27 | 10 | 37 |
| 2017 April | 23 | 9 | 32 |
| 2017 March | 19 | 62 | 81 |
| 2017 February | 11 | 17 | 28 |
| 2017 January | 18 | 5 | 23 |
| 2016 December | 26 | 11 | 37 |
| 2016 November | 21 | 11 | 32 |
| 2016 October | 48 | 15 | 63 |
| 2016 September | 27 | 9 | 36 |
| 2016 August | 18 | 10 | 28 |
| 2016 July | 20 | 6 | 26 |
| 2016 June | 41 | 18 | 59 |
| 2016 May | 20 | 17 | 37 |
| 2016 April | 24 | 24 | 48 |
| 2016 March | 32 | 21 | 53 |
| 2016 February | 23 | 14 | 37 |
| 2016 January | 33 | 15 | 48 |
| 2015 December | 22 | 15 | 37 |
| 2015 November | 28 | 14 | 42 |
| 2015 October | 46 | 17 | 63 |
| 2015 September | 41 | 8 | 49 |
| 2015 August | 2 | 2 | 4 |
Show all