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I have come to know a man who has been diagnosed with paranoid schizophrenia and treated currently with respiradone consta to limited effect.  Whilst his bizarre delusions mostly of somatic formation have reduced, he maintains a firm belief of delusional intensity that his personal belongings  (towels, sheets, clothing, ornaments) are being frequently changed, returned (after he has disposed of them), been substituted for similar items of a different aesthetic quality to his preference).  Could this be the rare form of Capgras syndrome, which I think is also known as Delusional gross misidentification of familiar objects?  He has not ever been diagnosed with this syndrome. If it is such, is there a known more effective treatment than respiradone?  His delusions cause him a high level of distress.  Most of the objects that he believes are being changed are items that he has himself bought or given to someone and therefore he is convinced that he would not buy something of the quality of the substitute, as he says, they are substitutes that others would value, but not to his taste.  He maintains that his brother (with whom he lives) is involved in changing the belongings in his household to drive him insane.  He feels utterley persecuted and believes there is a conspiracy to make him appear insane and take medication. He does not agree that he has a mental illness as he is convinced this phenomena of things changing, returning etc is happening to him.   He will go around the house showing me all the items that he believes to have changed, desperate to prove to me that it is happening and imploring me to believe him.  He becomes furious at the suggestion of delusions, let alone mental illness and he finds this explanation outrageous.  I have been responding to his thought content with empathy, with the intention to connect with his feelings of distress and helplessness around this perception of what is happening to him (careful not to agree that it is happening), and to support him to identify his needs around it ie. need for understanding, shared reality, relief.    I have tried reality testing, however to no effect as all the evidence he produces forms part of his delusion.  It appears he wants to talk about it, as he is so perpetually distressed by it, however it intensifies his distress by getting too caught up in it.  I try to move his focus more towards coping strategies and whilst he can identify some helpful strategies, every time I see him, we go through the same process and oftentimes, he rejects me and seems to indicate a suspicion that I am part of the conspiracy.  I am seeking here some guidance or ideas re. helpful ways I could try to communicate with him when he expresses his distress around his subjective “Capgras??” experience and also if there are any treatments that have been evidenced as effective.  Also, does anyone have links to any client/carer information that could be useful to provide this man, if he is diagnosed with this syndrome?  There is also a suspicion of some neurological changes/deterioration and further neurocognitive testing has been suggested as he complains frequently of memory difficulties. Otherwise, this man functions quite well as far as self-care and domestic and community living activities is concerned.  My approach at the moment is to empathically demonstrate to him that my intention is to try to understand and support, by staying consistent and present to whatever comes up without judgement.  I just want to be very careful not to do any unnecessary harm as I have never met anyone with this delusion  before and with such a persistent place in his everyday reality.  I just want some relief for him too!!  Any ideas???<?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

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I know someone with this injury. From what I understand the lastest hypothesis is that it is caused by a right frontal lobe injury. I have also read that can be related to hypothyroidism or possibly a nodule on the thyroid that is difficult to diagnose. This man's mind has him convinced of the substitution of his belongings. If he accepts that he is ill it means he must stop believing his own mind, which is terrifying. It seems to me that you are doing an excellent job with him. It is very stressful to relate to anyone with this affliction. Imagine how devastatingly lonely he would be without your efforts. My son has this problem. He thinks that I am a replacement for his mother. It is heartbreaking, I know.
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I have capgras syndrome. you can contact me.
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Any news regarding treatment of this syndrome? Where did you find anything relating to hypothyroidism? Thanks
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