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      Uncovering Capgras delusion using a large-scale medical records database

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          Abstract

          Background

          Capgras delusion is scientifically important but most commonly reported as single case studies. Studies analysing large clinical records databases focus on common disorders but none have investigated rare syndromes.

          Aims

          Identify cases of Capgras delusion and associated psychopathology, demographics, cognitive function and neuropathology in light of existing models.

          Method

          Combined computational data extraction and qualitative classification using 250 000 case records from South London and Maudsley Clinical Record Interactive Search (CRIS) database.

          Results

          We identified 84 individuals and extracted diagnosis-matched comparison groups. Capgras was not ‘monothematic’ in the majority of cases. Most cases involved misidentified family members or close partners but others were misidentified in 25% of cases, contrary to dual-route face recognition models. Neuroimaging provided no evidence for predominantly right hemisphere damage. Individuals were ethnically diverse with a range of psychosis spectrum diagnoses.

          Conclusions

          Capgras is more diverse than current models assume. Identification of rare syndromes complements existing ‘big data’ approaches in psychiatry.

          Declaration of interests

          V.B. is supported by a Wellcome Trust Seed Award in Science (200589/Z/16/Z) and the UCLH NIHR Biomedical Research Centre. S.W. is supported by a Wellcome Trust Strategic Award (WT098455MA). Q.D. has received a grant from King’s Health Partners.

          Copyright and usage

          © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

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          Most cited references31

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          Capgras syndrome: a novel probe for understanding the neural representation of the identity and familiarity of persons.

          Patients with Capgras syndrome regard people whom they know well such as their parents or siblings as imposters. Here we describe a case (DS) of this syndrome who presents several novel features. DS was unusual in that his delusion was modality-specific: he claimed that his parents were imposters when he was looking at them but not when speaking to them on the telephone. Unlike normals, DS's skin conductance responses to photographs of familiar people, including his parents, were not larger in magnitude than his responses to photographs of unfamiliar people. We suggest that in this patient connections from face-processing areas in the temporal lobe to the limbic system have been damaged, a loss which may explain why he calls his parents imposters. In addition, DS was very poor at judging gaze direction. Finally, when presented with a sequence of photographs of the same model's face looking in different directions, DS asserted that they were "different women who looked just like each other'. In the absence of limbic activation, DS creates separate memory "files' of the same person, apparently because he is unable to extract and link the common denominator of successive episodic memories. Thus, far from being a medical curiosity. Capgras syndrome may help us to explore the formation of new memories caught in flagrante delicto.
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            Monothematic Delusions: Towards a Two-Factor Account

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              Cognitive neuropsychiatry: towards a scientific psychopathology.

              Cognitive neuropsychiatry represents a systematic and theoretically driven approach to explain clinical psychopathologies in terms of deficits to normal cognitive mechanisms. A concern with the neural substrates of impaired cognitive mechanisms links cognitive neuropsychiatry to the basic neurosciences. The emergence of cognitive neuropsychiatry in the 1990s illustrates the growing rapprochement between cognitive neuropsychology, clinical medicine and the neurosciences in addressing common questions about disorders of the mind/brain. In reviewing recent applications, we highlight how this hybrid discipline will make a distinctive contribution to the science of psychopathology.
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                Author and article information

                Journal
                BJPsych Open
                BJPsych Open
                bjporcpsych
                bjporcpsych
                BJPsych Open
                The Royal College of Psychiatrists
                2056-4724
                3 August 2017
                July 2017
                : 3
                : 4
                : 179-185
                Affiliations
                [1] Vaughan Bell, PhD DClinPsy, Division of Psychiatry, University College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
                [2] Caryl Marshall, MBBS MRCPsych, Lewisham Mental Health Learning Disabilities Team, Behavioural & Developmental, Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
                [3] Zara Kanji, MSc, Psychological Interventions Clinic for Outpatients with Psychosis, Maudsley Psychology Centre, Maudsley Hospital, London, UK
                [4] Sam Wilkinson, PhD, School of Philosophy, Psychology and Language Sciences, University of Edinburgh, Edinburgh, UK
                [5] Peter Halligan, PhD DSc, School of Psychology, Cardiff University, Cardiff, UK
                [6] Quinton Deeley, PhD, MRCPsych, Cultural and Social Neuroscience Research Group, Institute of Psychiatry, Psychology and Neuroscience, London, UK
                Author notes
                Correspondence: Vaughan Bell, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK. E-mail: Vaughan.Bell@ 123456ucl.ac.uk
                Article
                bjporcpsych005041
                10.1192/bjpo.bp.117.005041
                5541249
                0bd83a36-b510-4f94-9401-f12152ff0dee
                © 2017 The Royal College of Psychiatrists

                This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 3 May 2017
                : 26 June 2017
                : 27 June 2017
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