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Dear Dr. Roach: My mom has Capgras syndrome and firmly believes that her husband (my dad) is dead. She thinks that there's someone whom I snuck in and built a lie around, and she tells everyone that this man is the same man. It's really difficult for us, especially my dad.
I understand that Capgras cannot be cured, but there are medications that help with the situation. She won't go see any medical professionals (since they believe that she has Capgras and her husband isn't dead). There are some other wild stories she tells/believes that absolutely aren't true.
What can a husband do with his elderly wife when she's raging at him over his identity or raging over the horrible daughter who "created this lie?" Can she be treated against her will? Where do we go for this? Who even knows anything about treating Capgras? -- W.H.
Answer: Capgras syndrome is exactly as you've said -- a delusion that a familiar person, usually a spouse or another close family member such as a child or sibling, has been replaced by an imposter. Symptoms can come and go over minutes to months, and they're often worse at night. Violence to the person who's thought to be "fake" is common, with one series showing that 80% of Capgras patients commit violence to the perceived imposter.
Lewy body dementia is responsible for about 70% of Capgras syndrome cases. Treatment includes both drug and nondrug treatment. Drug treatment by itself is modestly effective and includes medicines to treat dementia (such as donepezil), as well as meds to treat psychosis, but these must be used with caution and by an expert.
I'm sorry that you and your father are involved in this situation, which must be horrible for the both of you. It's also terrible for your mother, who really believes that her husband's dead and that someone else is pretending to be him. I recommend that you and your father, without your mother, see a psychiatrist -- ideally one with expertise in psychosis and delusions -- to discuss options.