Research Day

Aripiprazole vs Lurasidone in the Treatment of a Patient with Capgras Syndrome

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Abstract: Under DSM 5 criteria, Capgras Syndrome is currently classified as a Delusional disorder, Unspecified type. It is a complex psychotic phenomenon that may arise in the context of neurological or psychiatric pathology. We present a patient with Capgras syndrome and the effectiveness of treatment with Aripiprazole vs Lurasidone Introduction: Capgras Syndrome is characterized by misidentification of one or more people and by the delusional belief that the misidentified person has been replaced by a double, an imposter who is generally perceived as a persecutor. Currently there is a dearth of recent scientific literature on the subject and treatment of Capgras syndrome. There are no formal guidelines delineating the standards for assessment or treatment of this syndrome. There is a plethora of pathogenic hypotheses for the cause of Capgras syndrome. With no current treatment guidelines for the disorder, we offer a case study on the effectiveness of treatment with Aripiprazole vs Lurasidone. Case Report: Patient is a Single 54-year-old Caucasian female with a past Psychiatric history of bipolar depression who was admitted involuntarily for paranoid delusions, disorganized behavior, delusions of grandeur and threatening statements. Multiple delusional persecutory beliefs of hitmen and “shape-shifters from another planet” coming to kill her, son and son’s girlfriend replaced by “morphs”, and pregnant with a shapeshifter. Believes sons girlfriend has tried to poison here. Patients first psychiatric admission with no recent psychiatric care. Aripiprazole was started and titrated to a therapeutic level. Patient saw no improvement in her delusions. Lurasidone was started and titrated to a therapeutic dose. Patient saw a great improvement in her delusions. At time of discharge she no longer believed any of her bizarre delusions stating “I don’t believe that crazy stuff anymore”. Discussion/Conclusion: Capgras syndrome generally occurs as part of a psychiatric disorder, most often during paranoid schizophrenia. Current research recommends treatment of cooccurring psychiatric, substance use or medical disorder. The utility of this case report is vital due to the lack research on the appropriate treatment of Capgras syndrome. Limited case reports have shown favorable responses with: Olanzapine, trifluoperazine, clorazepate, and pimozide. Although Aripiprazole has been shown to have greater efficacy over Lurasidone in treating psychosis, we show vastly greater symptom improvement with Lurasidone. This case shows efficacy of newer atypical antipsychotics in treating Capgras. With a lack of research on treatment, it is our aim to fill the void of reports on effective treatment of Capgras syndrome.

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