Capgras syndrome, mania and delusionally motivated assaults

Abstract

Two men with a DSM-III-R diagnosis of mania, and no previous psychiatric history, presented having made life-threatening assaults on the subjects of their Capgras delusions. Although delusionally motivated assaults are a feature of the misidentification syndromes, sustained violent assaults are unusual in manic illness.

Capgras Syndrome has been described as a feature of a number of psychotic states but, in the English literature, has only rarely been reported occurring in the manic phase of a bipolar mood disorder. On those occasions, the clinical picture and resultant behaviour differed from that presented here.

In these two cases, Capgras Syndrome arising in mania was characterized by a delusion of doubles, with paranoid beliefs about the subject, altered mood, grandiosity and a manic drive. The presence of the manic drive to act on a delusion of doubles is a particularly dangerous combination of symptoms.