Tony Rosato, a former cast member of SCTV and Saturday Night Live, appeared in court on Wednesday to defend himself against accusations of criminal harassment.  The twist: Rosato has Capgras’ syndrome (also referred to as delusional misidentification syndrome), a condition that has led to the mistaken belief that his wife and daughter were replaced by imposters.

He has also accused his lawyer of putting his life in danger.

The bizarre behaviour has afforded equally bizarre responses from lawyers on both sides of the aisle.  Ultimately, the judge — Superior Court Justice Gordon Thomson — had to ask them to review their guidelines on professional conduct, which includes not “making faces, audible comments, gesticulations or other body language.”

Capgras is a serious diagnosis.  And it may well be the root cause of the charges he now faces.  As a result, a review of the historical literature describing the condition seems warranted.

Capgras bibliography.

• Christodoulou, G. N.  (1977).  The syndrome of Capgras.  British Journal of Psychiatry, 130, 556-564.

Conducted a detailed clinical laboratory investigation of 11 28-67 yr old psychiatric patients with the syndrome of Capgras, the delusional negation of identity of a familiar person. Clinical data and the results of EEG, echoencephalographic, air encephalographic, psychological (e.g., the WAIS and Benton Visual Retention Test), and brain-scanning investigations were examined. Results show that all patients were psychotic: Six were schizophrenic, 4 were depressive, and 1 suffered from an organic psychosis. A paranoid element was marked in all cases. Marked differences were found between Verbal and Performance IQs, and laboratory tests reveal EEG abnormalities and enlargement of the 3rd ventricle in some patients. Results support the view that organic factors are important in the pathogenesis of the Capgras syndrome. Two illustrative case reports are presented.

• Debruille, J. B. & Stip, E.  (1996).  Syndrome de Capgras: Évolution des hypothèses. / Capgras syndrome: Evolution of hypotheses.  The Canadian Journal of Psychiatry, 41(3), 181-187.

Traced the evolution of hypotheses concerning Capgras syndrome. Data consisted of about 60 studies published between 1866 and 1994 which were selected in terms of their innovative nature and relevance to the clinical description of the syndrome and to psychodynamic, neurological, and neuropsychological interpretations. Two partially overlapping major stages can be identified in the evolution of hypotheses regarding the mechanisms of the syndrome. The 1st, begining in 1923, is characterized by the predominance of psychodynamic interpretations. The 2nd, resulting from the observation of organic dysfunctions in a high percentage of cases, is distinguished by the advent of neurological interpretations, and by several mixed hypotheses. The review highlights the broad diversity of viewpoints concerning the syndrome.

• Ellis, H. D., Whitley, J., & Luauté, J.-P.  (1994).  Delusional misidentification: The three original papers on the Capgras, Frégoli and intermetamorphosis delusions.  History of Psychiatry, 5(17, Pt 1), 117-146.

Provides English translations of 3 original papers describing different forms of what is now termed delusional misidentification syndrome (DMS) published by French psychiatrists. The 3 papers concern the Capgras delusion (J. Capgras and J. Reboul-Lachaux, 1923); the Fregoli delusion (P. Courbon and G. Fail, 1928); and intermetamorphosis (P. Courbon and J. Tusques, 1933). The articles are preceded by biographical comments on the principal authors and are followed by a commentary on the theoretical impact of their findings. The translations attempt to retain the flavor of the original presentations and avoid technical terms that have no contemporary meaning. The occasional informalities of style and inappropriateness of tense reportedly have been preserved in the interests of historical accuracy.

See also:

• Turner, T. H.  (1992).  A diagnostic analysis of the casebooks of Ticehurst House Asylum, 1845-1890.  Psychological Medicine, 21(Mono Suppl), 1-70.

Reviews the clinical features of a cohort of patients admitted to Ticehurst House (a private asylum) between 1845-1890. Data were taken from elaborate notes in casebooks from the asylum. 601 patients were analyzed in terms of age, sex, length of stay, symptoms, treatment and outcome. Using modern operational diagnoses, 80% of the patients conformed to Research Diagnostic Criteria (RDC), in particular to the categories for schizophrenia and manic-depressive disorder. There was also a high prevalence of movement and postural disorder among the schizophrenic group. The presence of Capgras delusions and Cotard’s syndrome, erotomania and rarer forms of anorexia and alcohol-induced states further reinforces the recognizability and severity of psychopathology encountered in Ticehurst. Representative cases with histories, diagnostic discussion, and modern diagnosis are appended.

-JTB.