Disclosures: Siulam C. Koo, DO: No financial relationships or conflicts of interest

Case Diagnosis: Selective Organic Capgras Delusions in a Patient with Delirium.

Case Description or Program Description: The patient was a 70-year-old female who was admitted after a right cerebellar hemorrhagic stroke complicated by gastrointestinal hemorrhage and urinary tract infection. After she was adequately treated, the patient started expressing that the nursing and therapy staff were imposters and began refusing care. However, she did not express that any of the physicians or her children were imposters. The patient denied any auditory or visual hallucinations. The family denied any history of psychiatric conditions or medications, and the patient was previously independent.

Setting: Acute Inpatient Rehabilitation Center.

Assessment/Results: Encephalopathy workup, including non-contrast head CT, routine lab work, EEG, were within normal limits. MRI brain was contraindicated due to metallic fragments in the patient’s eye. An antipsychotic regimen was started with separate low-dose risperidone and aripiprazole trials. Results were inconclusive as the patient became overly sedated. A urinalysis was repeated, which was positive for urinary tract infection. Treatment with antibiotics was initiated with limited improvement. Given the waxing and waning nature of her symptoms, the etiology of her delusions was ruled to be delirium. The patient was lost to followup upon discharge, and progression of her delusions were unable to be assessed.

Discussion (relevance): Capgras syndrome is usually associated with cerebral strokes, post-ictal states, infectious or metabolic derangements, or acute psychosis, and patients typically associate their loved ones as imposters; this is an atypical case since only therapy and nursing staff were seen as imposters, and the patient was responsive to physician and family redirection. Given the patient’s presentation and lack of response to antipsychotics, delirium is likely the cause.

Conclusions: Capgras syndrome can present in a multitude of ways, and organic causes should be ruled out before any psychiatric diagnoses are made. Treatment of underlying conditions should be pursued, and psychotropic medications can be considered.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/selective-organic-capgras-delusions-in-a-patient-with-delirium-a-case-report/