2026년 8월 2일 일요일

황혼기를 헤쳐나가기: 루이소체 치매의 진행 단계 이해- YouTube

Navigating the Twilight: Understanding the Advanced Stages of Lewy Body Dementia - YouTube

Navigating the Twilight: Understanding the Advanced Stages of Lewy Body Dementia
LBDAtv
10,661 views  Jul 25, 2025
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The Lewy Body Dementia Association (LBDA) is proud to present 'Navigating the Twilight: Understanding the Advanced Stages of Lewy Body Dementia'.
 
This session discusses the complexities and challenges of the advanced stages of Lewy body dementia (LBD), offering practical advice to help those living with Lewy, care partners, and healthcare professionals navigate this progressive neurological disorder with confidence and compassion. 

Chapters:
00:00 - Introduction with Julia Wood MOT, OTR/L
04:30 - Polling questions
Read more »
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2026년 7월 24일 금요일

카그라스 증후군 - 위키백과, Capgras syndrome, Capgras delusion

카그라스 증후군 - 위키백과, 우리 모두의 백과사전

카그라스 증후군

위키백과, 우리 모두의 백과사전.
카그라스 증후군
다른 이름Capgras delusion, Capgras syndrome
발음
진료과정신의학

카그라스 증후군(Capgras syndrome, Capgras delusion)은 망상적 동일시(Delusional misidentification syndrome)의 하나로써 자신의 친구나 배우자 또는 주변인들이 완전히 똑같은 모습으로 분장한 전혀 다른 사람으로 바꿔치기 되었다고 믿는 증상이다. 자신이 겪은 사건에 대한 기억이 왜곡되었거나 전혀 다른 것으로 대체되었다고 믿는 경우도 보고된 바 있으며 심지어 과거의 자기 자신조차 자신과 닮은 다른 누군가로 인식하는 경우도 있다.

카그라스 증후군은 뇌손상이나 치매등에서 유발되는 경우도 있으나 조현증(정신분열증) 환자들에게서 가장 빈번하게 발생한다. 당뇨병이나 갑상선 기능 저하증 환자들에게 발생하는 경우도 있으며 단일 사례이긴 하지만 건강한 사람이 케타민주사를 맞고 일시적으로 발병한 경우도 있다. 여성과 남성의 발병비율은 대략 3:2 정도다.

역사

카그라스 증후군이라는 이름은 이 증상을 1923년 르블-라쇼(Reboul-Lachaux)와의 공동 논문인 꼭 닮은 것에 대한 환상(l'illusion des sosies)에서 처음으로 언급한 프랑스인 정신과의사 조셉 카그라스(Joseph Capgras)의 이름에서 따온것이다. 이 논문에서 카그라스는 자신의 남편과 주변사람들이 꼭 닮은 누군가와 바꿔치기되었다고 호소하던 한 노파를 예로들어 증상에 대하여 설명한다.

사례

워녹(Warnock)과 패서(Passer)는 1991년의 논문에서 자신들이 담당했던 환자에 대해서 다음과 같이 설명하였다.

"74세의 기혼여성인 D 여사는 다른 병원에서 정신과 치료를 받다가 퇴원한 후 재진을 위해 우리 병원을 방문하였다. 처음에 방문한 병원에서 그녀는 자신의 남편이 똑같이 생긴 전혀 다른 타인으로 바꿔치기되었다고 믿는 비정상적인 정신병으로 진단받은 바 있었다. 그녀는 그 사기꾼과 동침하기를 거부하고 밤에는 문을 걸어잠궜고, 아들에게 총기를 구해달라고 부탁하였으며 얼마 후에는 그녀를 강제적으로 입원시키려는 경찰과 마찰을 일으키기도 했다. 때때로 환자는 남편을 오래전에 사망한 그녀의 아버지라 믿기도 하였다. 그녀는 다른 가족은 명확하게 구별하였으나 유독 남편만은 알아보지 못하였다."

스킨맨(Skinman)이 2008년에 보고한 논문에서의 또다른 사례는 아래와 같다.

"28살의 다이앤(Diane)은 23살에 처음으로 증상이 나타났는데 그녀를 담당했던 의사에 따르면 처음 그녀는 담당의가 그녀의 장기에 항구적인 손상을 입혀 그녀가 임신이 불가능하게 되었다는 망상에 사로잡혀 있었다. 이러한 증상은 신경이완제를 통한 치료를 통해 차도를 보였으나 퇴원 이후 그녀가 치료를 거부하면서 악화되었다. 8개월후 그녀가 재입원한 시점에서 증상은 더욱 악화되어 다이앤은 누군가가 자신과 자신이 아는 사람들을 똑같이 닮은 복제(그녀의 이것을 screen이라고 불렀다)를 만들었는데 자신은 착한 면(good one)과 나쁜 면(evil one)의 두개의 복제가 있다고 믿고 있었다. 그녀는 카그라스 증후군을 동반한 정신분열증을 진단받았다"

루첼리(Lucchelli)와 스핀러(Spinnler)의 2007년 논문은 신경퇴행성 질환이 카그라스 증후군을 유발한 경우를 보여준다.

"59세의 프레드는 인지행동장애(Cognitive and behavioural disturbances)를 진단받았던 상태였다. 그가 처음으로 카그라스 증후군 증세를 보이기 시작한것은 그로부터 약 15개월 이후였는데 그의 부인인 윌마(Wilma)에 따르면 갑자기 그녀를 자신의 부인을 꼭 닮은 다른 누군가(Double)로 인식하였다고 한다. 어느날 직장에서 돌아온 프레드는 그녀에게 자신의 부인이 어디에 있냐고 물었는데 이상한 질문에 당황한 윌마가 지금 당신 앞에 있다고 말하자 프레드는 단호하게 그녀가 자신의 아내와 매우 닮았지만 전혀 다른 사람이라고 말하며 아내가 아무래도 잠시 밖에 외출한 모양이라고 말하고는 그녀에게 자신의 집에서 나가달라고 부탁했다는 것이다.

원인

카그라스 증후군의 원인은 뇌손상을 입은 이후 안면실인증으로까지 번진 환자들에 대한 연구에서 그 실마리를 찾을 수 있다. 위의 환자들은 다른 시각적 물체들에 대한 지각능력은 손상되지 않았으나 유독 안면에 대한 의식적 인지능력만은 손상된 상태였는데 1984년에 바우어는 이러한 환자들도 익숙한 안면들에 대해서는 무의식적인 인지가 발생하는 것을 확인하였으며 이에 따라 안면 인지능력은 의식적인 경우와 무의식적인 경우의 두가지의 경로가 있음이 밝혀졌다.

이에 근거하여 헤딘 엘리스( Hadyn Ellis)와 앤디 영(Andy Young)는 1990년에 영국 정신과학저널(British Journal of Psychiatry)에 한가지 가설을 발표하였는데 그들에 따르면 카그라스 증후군 환자들은 의식적인 안면 인식능력은 완전하나 익숙한 얼굴들에 대한 감정적인 반응을 주관하는 감각신경 회로가 손상되었고 이로 인해 환자들은 개개인의 얼굴은 인식하나 인지된 안면들이 불러일으키는 감각적인 경험은 제대로 유발되지 않을 수 있다는 것이다.

이들의 가설은 1997년 하딘과 그의 동료들이 정신분열병 진단을 받은 다섯명의 카그라스 증후군 환자를 대상으로 한 논문을 통해서 어느정도 인정되었는데 여기서 하딘은 환자들이 의식적으로는 안면을 인식할 수 있으나 친숙한 얼굴에 대한 정상적인 감각 반응을 보이지 않았음을 확인하였다고 기술하였다.

월리엄 헐스테인과 라마찬드란은 뇌손상 이후에 증상이 나타난 환자에 대한 연구에서 위와 비슷한 결과를 얻었다고 발표한 바 있다. 라마찬드란의 저서 '뇌 속의 유령'(Phantoms in the Brain)에서 그는 환자가 감정을 느끼고 얼굴을 인식하는 것이 가능하였으나 익숙한 얼굴을 보았을 때 아무런 감정의 반응이 일어나지 않았음을 확인하였고 이에 따라 라마찬드란은 이 증후군이 안면 인식을 담당하는 측두엽 피질과 감정과 관련된 대뇌변연계 사이의 단절에서 기인한다는 가설(더욱 자세하게는 하측두 피질과 편도체 사이의 단절)을 주장하였다.

2010년에 헐스테인은 카그라스 증후군에 대한 자신의 견해를 다음과 같이 설명하였다.

"(...) 내가 주장하는 가설은 1997년의 것을 더욱 구체화한 것이다. 내가 보기에 우리는 우리에게 친숙한 사람을 다음과 같은 두가지 방법을 모두 사용하여 분별한다. 하나는 외관적인 것들로써 보거나 듣는것들을 바탕으로 판단을 내리는 것이며 다른 하나는 내부적인 측면으로써 그들의 특성, 믿음, 개인적으로 갖는 감정들 같은 것들을 기반으로 하는 것이다. 카그라스 증후군은 두가지 방법중 후자의 측면이 손상되거나 사용할 수 없을 때 나타나는 증상이다. 이로 인하여 우리는 개인들의 생김새는 같게 여기나 수반되는 감정이 (우리가 친숙하게 여기는 대상들로부터 일어나야 하는 것들과는)전혀 다르게 나타나게 되므로 우리는 그들을 겉모습만 비슷하게 꾸민 다른 누군가로 인식하게 된다.

아마도 카그라스 증후군의 발현에는 감정의 인식이라는 측면외에도 다른것이 추가적으로 필요한 것으로 여겨지는데 이는 후에 연구에서 망상의 증상이 없는 환자들에서도 감정 인식의 부재가 확인되는 경우가 종종 있음이 확인되었기 때문이다. 엘리스와 다른 연구자들은 다른 요인이 이러한 감각경험의 부재를 망상적 믿음으로 변형되는 이유를 설명해줄 것이라고 기대한다. 이것을 추론능력의 결함으로 보는 연구자들도 있으나 모든 사례를 설명할 수 있는 명확한 요인은 아직까지 발견되지 않았다.

치료법

개인의 망상을 치료하는데는 개별적인 치료가 사용된다. 현실 인식능력 시험을 포함은 인지 테크닉이 사용되기도 하며 항정신병약을 사용하여 효과를 본 경우도 보고되었다.

같이 보기

각주

  1. Ramachandran interview showing usual pronunciation by experts
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カプグラ症候群

出典: フリー百科事典『ウィキペディア（Wikipedia）』
カプグラ症候群
別称Capgras syndrome
発音[kæpˈɡrɑː] kap-GRAH
概要
診療科精神医学
分類および外部参照情報
DiseasesDB32606
MeSHD002194

カプグラ症候群（カプグラしょうこうぐん、Capgras delusion、カプグラシンドローム）とは、家族・恋人・親友などが瓜二つの替え玉に入れ替わっているという妄想を抱いてしまう精神疾患の一種。ソジーの錯覚[1][2]（ソジーのさっかく）とも呼ばれる。よく見知った人物が、見知らぬ他人に入れ替わっていると感じてしまう現象を言う。偽物だと思い込む対象は無生物の例もある。以前は稀な症状であると思われていたが、今ではそれほど珍しいものでないことが分かっている。1923年にフランスの精神科医ジョセフ・カプグラ（1887年-1950年）らによって報告された。 仏人女性は側頭葉に損傷を負っており、認識した人や物に本来なら起こるはずの感情が起こらなかったことで、替え玉だと納得したと考えられている[3]。

脚注

  1.  カプグラが報告した仏人女性のケースで使用された「l'illusion des sosies（替え玉の幻想、錯覚）」に由来する用語。
  2.  宮本忠雄『精神分裂病の世界』p.63によれば、「ローマの喜劇詩人プラウトゥスおよびフランスの作家モリエールの『アンフィトリオン』のなかに出てくる召使いの名から由来するもの」である。
  3.  デイヴィッド・J・リンデン (2017). 脳はいいかげんにできている　その場しのぎの進化が生んだ人間らしさ. 夏目大. 河出書房新社. p. 96. ISBN 9784309464435

関連項目

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Capgras delusion

From Wikipedia, the free encyclopedia
Capgras delusion
Other namesCapgras syndrome
Pronunciation
SpecialtyPsychiatry
SymptomsDelusion that familiar people or pets have been replaced by identical imposters; aggression with the person suspected as an imposter
ComplicationsViolence, homicide
CausesUncertain; exacerbated by head injury
Risk factorsNeuroanatomical damage, schizophrenia
PreventionUnknown
TreatmentNo cure; therapy generally used
MedicationAntipsychotics

Capgras delusion or Capgras syndrome (CS) is a psychiatric disorder in which a person holds a delusion that a friend, spouse, parent, other close family member, or pet has been replaced by an identical impostor. It is named after Joseph Capgras (1873–1950), the French psychiatrist who first described the disorder.

The Capgras delusion is classified as a delusional misidentification syndrome, a class of beliefs that involves the misidentification of people, places, or objects.[2] It can occur in acute, transient, or chronic forms. Cases in which patients hold the belief that time has been "warped" or "substituted" have also been reported.[3]

The delusion most commonly occurs in individuals diagnosed with a psychotic disorder, usually schizophrenia;[4] it has also been seen in brain injury,[5] dementia with Lewy bodies,[6][7] and other forms of dementia.[8] It presents often in individuals with a neurodegenerative disease, particularly at an older age;[9] it has also been reported as occurring in association with diabetes, hypothyroidism, and migraine attacks.[10] In one isolated case, the Capgras delusion was temporarily induced in a healthy subject by administration of ketamine.[11] It occurs 50% more frequently in females when compared to males.[12]

History

Capgras syndrome is named after Joseph Capgras, a French psychiatrist who first described the disorder in 1923 in his paper co-authored by Jean Reboul-Lachaux.[13] They described the case of a French woman, "Madame Macabre," who complained that corresponding "doubles" had taken the places of her husband and other people she knew.[5] Capgras and Reboul-Lachaux first called the syndrome "l'illusion des sosies", which can be translated literally as "the illusion of doppelgängers."[14]

The syndrome was initially mistakenly considered purely psychiatric, as well as to be a female disorder often symptomatic of hysteria. Most of the proposed explanations initially following that of Capgras and Reboul-Lachaux were psychoanalytical in nature. It was not until the 1980s that attention turned to the usually co-existing organic brain lesions originally thought to be essentially unrelated or coincidental. Today, Capgras syndrome is understood to primarily result from neurodegenerative diseases and neurological damage, and is less commonly caused by psychotic disorders.[15]

Signs and symptoms

Symptoms of Capgras delusion include:[16][17]

  • A genuine belief that a close relative, friend or significant other has been replaced by an impostor.
  • A sudden change of behaviour when dealing with that close relative, friend or significant other.
  • Refusing to talk in the presence of the believed impostor.
  • Feeling fear or anxiety in the presence of the believed impostor.
  • Acting aggressively towards the believed impostor; this may include verbal outbursts, threats of violence or attempting to physically attack them.
  • Acting aggressively towards other loved ones who do not believe there is an impostor.
  • Feelings of agitation, anger, upset or confusion.
  • Feelings of paranoia or a lack of trust towards the believed impostor and/or other close family members and friends.
  • Refusing to accept any evidence that shows the believed impostor is not an imposter.
  • Becoming focused or fixated on exposing the impostor.

Prevalence

The prevalence of Capgras delusion (CS) in psychiatric populations (e.g., individuals with existing mental illnesses) ranges from less than 1% to 4.1%. It has the highest prevalence among individuals with psychosis, at 50% for schizophreniform psychosis, 35% for brief psychosis, and 24% for unspecified psychosis. About 15% of patients under major depressive episodes and 11% of the patients with delusional disorders and schizophrenia displayed CS symptoms.[18]

Compared to other delusional misidentification syndromes, like the Fregoli delusion, CS is more widely documented.[19]

Causes

It is generally agreed[20] that the Capgras delusion has a complex and organic basis and can be better understood by examining neuroanatomical damage associated with the syndrome.[21]

In one of the first papers to consider the cerebral basis of the Capgras delusion, Alexander, Stuss and Benson pointed out in 1979 that the disorder might be related to a combination of frontal lobe damage causing problems with familiarity and right hemisphere damage causing problems with visual recognition.[22]

Further clues to the possible causes of the Capgras delusion were suggested by the study of brain-injured patients who had developed prosopagnosia. In this condition, patients are unable to recognize faces consciously, despite being able to recognize other types of visual objects. However, a 1984 study by Bauer showed that even though conscious face recognition was impaired, patients with the condition showed autonomic arousal (measured by a galvanic skin response measure) to familiar faces,[23] suggesting there are two pathways to face recognition—one conscious and one unconscious.

In a 1990 paper published in the British Journal of Psychiatry, psychologists Hadyn Ellis and Andy Young hypothesized that patients with Capgras delusion may have a "mirror image" or double dissociation of prosopagnosia, in that their conscious ability to recognize faces was intact, but they might have damage to the system which produces the automatic emotional arousal to familiar faces.[24] This might lead to the experience of recognizing someone while feeling something was not "quite right" about them. In 1997, Ellis and his colleagues published a study of five patients with Capgras delusion (all diagnosed with schizophrenia) and confirmed that although they could consciously recognize the faces, they did not show the normal automatic emotional arousal response.[25] The same low level of autonomic response was shown in the presence of strangers. Young (2008) has theorized that this means that patients with the disease experience a "loss" of familiarity, not a "lack" of it.[26] Further evidence for this explanation comes from other studies measuring galvanic skin responses (GSR) to faces. A patient with Capgras delusion showed reduced GSRs to faces in spite of normal face recognition.[27] This theory for the causes of Capgras delusion was summarised in Trends in Cognitive Sciences in 2001.[2]

William Hirstein and Vilayanur S. Ramachandran reported similar findings in a paper published on a single case of a patient with Capgras delusion after brain injury.[28] Ramachandran portrayed this case in his book Phantoms in the Brain[29] and gave a talk about it at TED 2007.[30] Since the patient was capable of feeling emotions and recognizing faces but could not feel emotions when recognizing familiar faces, Ramachandran hypothesizes the origin of Capgras syndrome is a disconnection between the temporal cortex, where faces are usually recognized (see temporal lobe), and the limbic system, involved in emotions. More specifically, he emphasizes the disconnection between the amygdala and the inferotemporal cortex.[5]

In 2010, Hirstein revised this theory to explain why a person with Capgras syndrome would have the particular reaction of not recognizing a familiar person.[31] Hirstein explained the theory as being "a more specific version of the earlier position I took in the 1997 article with V. S. Ramachandran," and elaborated:

According to my current approach, we represent the people we know well with hybrid representations containing two parts. One part represents them externally: how they look, sound, etc. The other part represents them internally: their personalities, beliefs, characteristic emotions, preferences, etc. Capgras syndrome occurs when the internal portion of the representation is damaged or inaccessible. This produces the impression of someone who looks right on the outside, but seems different on the inside, i.e., an impostor. This gives a much more specific explanation that fits well with what the patients actually say. It corrects a problem with the earlier hypothesis in that there are many possible responses to the lack of an emotion upon seeing someone.[32]

Furthermore, Ramachandran suggests a relationship between the Capgras syndrome and a more general difficulty in linking successive episodic memories because of the crucial role emotion plays in creating memories. Since the patient could not put together memories and feelings, he believed objects in a photograph were new on every viewing, even though they normally should have evoked feelings (e.g., a person close to him, a familiar object, or even himself).[33] Others like Merrin and Silberfarb (1976)[34] have also proposed links between the Capgras syndrome and deficits in aspects of memory. They suggest that an important and familiar person (the usual subject of the delusion) has many layers of visual, auditory, tactile, and experiential memories associated with them, so the Capgras delusion can be understood as a failure of object constancy at a high perceptual level.[34]

Most likely, more than a mere impairment of the automatic emotional arousal response is necessary to form the Capgras delusion, as the same pattern has been reported in patients showing no signs of delusions.[35] Ellis suggested that a second factor explains why this unusual experience is transformed into a delusional belief; this second factor is thought to be an impairment in reasoning, although no specific impairment has been found to explain all cases.[36] Many have argued for the inclusion of the role of patient phenomenology in explanatory models of the Capgras syndrome in order to better understand the mechanisms that enable the creation and maintenance of delusional beliefs.[37][38]

Capgras syndrome has also been linked to reduplicative paramnesia, another delusional misidentification syndrome in which a person believes a location has been duplicated or relocated. Since these two syndromes are highly associated, it has been proposed that they affect similar areas of the brain and therefore have similar neurological implications.[39] Reduplicative paramnesia is understood to affect the frontal lobe, and thus it is believed that Capgras syndrome is also associated with the frontal lobe.[40] Even if the damage is not directly to the frontal lobe, an interruption of signals between other lobes and the frontal lobe could result in Capgras syndrome.[9] One 2022 case study following a 28-year-old male patient without a previous history of psychiatric illnesses or Capgras-associated physical illnesses highlights the potential for heavy cannabinoid consumption to function as a trigger for Capgras syndrome.[41] The authors of this 2022 case study referred to recreational drug use triggered Capgras syndrome as being an extremely rare condition with infrequent documentation which therefore requires first ruling out other potential triggers and direct causes associated with Capgras syndrome. A 2019 systematic review of 255 published cases of Capgras syndrome in the scientific literature had found 7 known cases where the syndrome occurred with cannabis use or cannabinoid consumption as a reported possible trigger.[42]

Diagnosis

Because it is a rare and poorly understood condition, there is no established way to diagnose the Capgras delusion. Diagnosis is primarily made on a psychiatric evaluation of the patient, who is most likely brought to a psychiatrist's attention by a family member or friend believed to be an imposter by the person under the delusion. The patient may undergo mental skills tests to check for dementia or other conditions, and brain imaging tests like MRI or EEG that look for lesions or other brain changes.[43]

Treatment

Treatment of Capgras delusion has not been well studied, so there is no evidence-based approach.[44] Typically, treatment of delusional disorders is challenging due to poor patient insight and lack of empirical data.[39] Treatment is generally therapy, often with support of antipsychotic medication.[44][45][46] As manifestation of Capgras delusion is often a symptom rather than a syndrome itself, treatment may focus on the accompanying condition.[4] A study has shown that using medications appropriately to target the underlying disorder's core symptoms can be an effective management strategy. Hospitalization may be necessary, if the patient is engaging in self-harm or violence.[39]

See also

References

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  3.  Aziz, V.M.; Warner, N.J. (2005). "Capgras' Syndrome of Time". Psychopathology. 38 (1): 49–52. doi:10.1159/000083970. PMID 15722649. S2CID 21363443.
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  41.  Bello Castro D, Segura Ayala L, Saavedra S, García S, Herrera Ortiz AF. Capgras Syndrome Due to Cannabinoids Use: A Case Report with Radiological Findings. Cureus.2022;14(1):21412. https://doi.org/10.7759/cureus.21412
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