Co-existence of Capgras syndrome and OCD in children: Case studies

Abstract

Introduction

Capgras syndrome (CS) is characterized by the delusional belief that a person, usually a close relative, has been replaced by an imposter. This study focuses on the co-occurrence of CS and Obsessive-Compulsive Disorder (OCD) in children.

Methods

We present two cases of children diagnosed with CS and OCD treated at our inpatient child psychiatric unit.

Cases presentation

We describe the cases of an 11-year-old male who believed his parents were demonic entities and a 12-year-old female who believed her parents were robots. Both children exhibited additional psychiatric manifestations such as depression, catatonia, obsessive-compulsive (OC) symptoms, persecutory delusions, reduced food intake, and suicidal ideation. Our treatment approach combines antipsychotic medication, selective serotonin reuptake inhibitors (SSRIs), and gradual exposure therapy accompanied by parent training, has yielded favorable outcomes in managing the patients’ psychiatric symptoms.

Discussion and Conclusion

We provide insights into CS with comorbid OCD in children and discuss the behavioral treatment approach employed in our cases. We also discuss similar cases of CS comorbid with OCD from the English literature.

Plain Language Summary

Introduction: Capgras syndrome (CS) is a rare mental condition where someone believes a familiar person, usually a family member, has been replaced by an impostor. This condition often appears in adults with schizophrenia and is very rare in children. Our study focuses on two cases of children with both CS and obsessive-compulsive disorder (OCD). Case Presentations: Case 1: “Michael,” an 11-year-old boy, developed severe OCD symptoms and delusions that his parents were impostors. He engaged in compulsive hygiene rituals, became aggressive, and experienced emotional distress. Traditional treatments were ineffective. At our psychiatric unit, we used gradual exposure therapy (gradual, controlled exposure to his parents) combined with antipsychotic and SSRI medications. Over a few months, Michael's condition improved significantly, allowing him to reconnect with his family and return to normal activities. Case 2: “Dana,” a 12-year-old girl, experienced sudden severe behavior changes, believing her parents were robots. She also had catatonia, depression, and OCD. Initial treatments were not effective. At our unit, she received gradual exposure therapy and adjusted medications. This treatment led to significant improvements, allowing her to interact positively with her parents and manage her delusions. Discussion and Conclusion: Our study suggests that combining gradual exposure therapy with antipsychotic and SSRI medications can effectively treat children with both CS and OCD. This therapy helped the children gradually accept their parents and reduced their delusional thoughts. While exposure therapy is typically used for OCD, it showed promising results for CS as well. By sharing these rare cases, we aim to enhance understanding and treatment of CS in pediatric patients. Further research is needed to explore these innovative treatment methods and improve outcomes for children with CS.