title: Capgras delusion with violent behavior in Alzheimer dementia: case analysis with literature review.
abstract: BACKGROUND
  Capgras delusion (CD) has multiple etiologies including neurodegenerative disorders and can be associated with violent behavior. CD is a common complication of Alzheimer dementia (AD); however, CD with violent behavior is uncommon in AD. We report escalating violent behavior by a patient with advanced AD and CD who presented to the emergency department (ED) and required admission to an academic medical center.
  
  
  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.
authors.affiliation: Departments of Psychiatry, Neurology, and Anesthesiology, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA. E-mail: kaufmakr@rwjms.rutgers.edu; adamskaufman@verizon.net.
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Kaufman
authors.forename: Neil B
authors.initials: NB
authors.lastname: Newman
authors.forename: Alveena
authors.initials: A
authors.lastname: Dawood
mesh_terms: D000368:Aged; D000374:Aggression / Q000523:psychology; D000544:Alzheimer Disease / Q000150:complications / Q000523:psychology*; D000639:Amitriptyline / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D002194:Capgras Syndrome / Q000139:chemically induced / Q000150:complications / Q000523:psychology*; D002707:Chlordiazepoxide / Q000009:adverse effects; D005632:Fructose / Q000009:adverse effects / Q000031:analogs & derivatives; D006220:Haloperidol / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects; D008297:Male; D000077152:Olanzapine; D000067561:Potentially Inappropriate Medication List; D051436:Renal Insufficiency, Chronic / Q000150:complications; D000077236:Topiramate; D014754:Violence / Q000523:psychology*
chemical_list: D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D014150:Antipsychotic Agents; D006993:Hypnotics and Sedatives; D000077236:Topiramate; D001569:Benzodiazepines; D000639:Amitriptyline; D005632:Fructose; D002707:Chlordiazepoxide; D006220:Haloperidol; D000077152:Olanzapine