First-episode psychosis and violence in Capgras syndrome: a retrospective case series

Capgras syndrome (CS) is a rare delusional misidentification syndrome in which individuals believe that another person has been replaced by an impostor.

A retrospective chart review was conducted for all admissions to two male psychiatric inpatient departments in a tertiary hospital in Israel between August 1, 2024, and January 31, 2025. Cases with explicit documentation of CS were included. Demographic and clinical data were extracted and analyzed.

Among 308 hospitalised patients, five (1.62%) met criteria for CS, with a mean age of 33.6 years. Three patients (60%) had schizophrenia spectrum disorders, and two (40%) had organic psychosis associated with left frontal brain lesions. Four patients (80%) presented during their first psychiatric admission after committing severe violence against family members perceived as impostors. Treatment response varied: CS resolved in some cases with antipsychotics alone, while others required Clozapine and adjunctive interventions.

CS may be underrecognized but carries significant clinical implications, particularly due to its association with violence in first-episode psychosis. Early identification and tailored treatment are critical for risk reduction.