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Multiple sclerosis and Capgras' syndrome

Vincenzo Sidoti1, Lorenzo Lorusso

  • 1Multiple Sclerosis Centre, Neurology Department, Mellino Mellini Hospital, V.le Mazzini 6, 25032 Chiari, Brescia, Italy. VincenzoSidoti@hotmail.com

Clinical Neurology and Neurosurgery
|July 17, 2007
PubMed

Insights

Multiple sclerosis (MS) patients rarely experience psychotic disorders. This case highlights a rare instance of Capgras' syndrome, a delusional misidentification, in an MS patient following steroid treatment.

Area of Science:

  • Neurology
  • Psychiatry

Background:

  • Psychotic disorders are uncommon in multiple sclerosis (MS).
  • While manic psychosis is more frequent, pure paranoid states are rare.
  • Capgras' syndrome, a specific delusional misidentification, is exceptionally rare in MS.

Observation:

  • A 36-year-old female with a history of MS since age 18 developed psychiatric symptoms after high-dose steroid treatment for optic neuritis.
  • Initial symptoms included delusions of reference, treated with clozapine.
  • Following a relapse with ataxia and corticosteroid treatment, she developed a paranoid disorder with persecutory delusions, specifically Capgras' syndrome towards her husband.

Findings:

  • The patient presented with Capgras' syndrome, a rare manifestation of psychosis in multiple sclerosis.
  • Psychiatric symptoms, including delusions, emerged after corticosteroid therapy for optic neuritis.
  • Treatment with glatiramer acetate and quetiapine led to improvement in her neuropsychiatric condition.

Implications:

  • This case underscores the importance of considering rare psychiatric complications like Capgras' syndrome in multiple sclerosis patients, particularly after steroid use.
  • It highlights the complex interplay between neurological disease, psychiatric symptoms, and treatment side effects in MS.
  • Effective management may involve a combination of immunomodulatory and antipsychotic therapies tailored to the individual patient.

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