Capgras delusion with violent behavior in Alzheimer dementia: Case analysis with literature review
METHODS: Case analysis with PubMed literature review.
RESULTS: A 75-year-old male with a 13-year history of progressive AD, asymptomatic bipolar disorder, chronic kidney disease, hypertension, hyperlipidemia, and benign prostatic hypertrophy presented to the ED with recurrent/escalating violence toward his wife, whom he considered an impostor. His psychotropic regimen included potentially inappropriate medications (PIMs) for geriatric/AD patients—topiramate/amitriptyline/chlordiazepoxide/olanzapine—that are associated with delirium, cognitive decline, dementia, and mortality. Renal dosing for topiramate, reduction in PIMs/anticholinergic burden, and substituting haloperidol for olanzapine resolved his violent behavior and CD.
CONCLUSIONS: CD in AD is a risk factor for violent behavior. As the geriatric population in the United States grows, CD in patients with AD may present more frequently in the ED, requiring proper treatment. Pharmacovigilance is necessary to minimize PIMs in geriatric/AD patients. Clinicians and other caregivers require further education to appropriately address CD in AD.
Keywords: Alzheimer dementia; Capgras delusion; amitriptyline; anticholinergic burden; benzodiazepines; bipolar disorder; caregiver; education; ethics; haloperidol; neurodegenerative disorders; olanzapine; pharmacovigilance; potentially inappropriate medications; prevalence; sertraline; topiramate; trazodone; violent behavior
Document Type: Research Article
Affiliations: 1: Departments of Psychiatry, Neurology, and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA 2: Department of Psychiatry, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
Publication date: May 1, 2014