Capgras syndrome is a psychiatric condition where patients believe that friends or family members have been replaced by identical impostors. It was first identified by French psychiatrist Jean Marie Joseph Capgras. Vitamin B12 deficiency is a potential cause of Capgras syndrome and is common in developing countries due to factors like atrophic gastritis or intestinal surgery. Symptoms of vitamin B12 deficiency include fatigue, memory loss, hallucinations, and psychiatric manifestations like delusions. Deficiency can be detected through blood tests and treated with vitamin B12 injections.

1. Topic
Capgras syndrome- Vit B12
Deficiency
By-Dr.Ashok Laddha

2. Definition and History
 Capgras Syndrome, named for its discoverer, the
French psychiatrist Jean Marie Joseph Capgras.
The person's primary delusion is that a close
relative or friend has been replaced by an
impostor, an exact double, despite recognition of
familiarity in appearance and behavior.

3. Introduction
 Capgras syndrome is an unusual presentation of long
standing psychotic symptoms without anaemia
 Although Capgras is commonly called a syndrome, it
may occur as part of, or alongside, various other
disorders and conditions, such as schizophrenia and
neurological illness.
 Therefore, some researchers have argued that it should
be considered as a symptom, rather than a syndrome
or classification in its own right

4. Causes
 It has been reported that the Capgras Syndrome and related
substitution delusions, that 35% have an organic etiology.
 Some researchers believe that Capgras' syndrome can be blamed
on a relatively simple failure of normal recognition processes
following brain damage from a stroke, drug overdose, or some
other cause like vit B12 deficiency.
 This disorder can also follow after accidents that cause damage to
the right side of the brain. Therefore, controversies exist about
the etiology of Capgras Syndrome, some researchers explain it
with organic factors, others with psychodynamic factors,
 or a combination of the two,

5. characteristics
 The syndrome typically has the following characteristics:
The person is convinced that one or several persons known by
the sufferer have been replaced by a double, an identical looking
imposter.
The patient sees true and double persons.
It can may extend to animals and objects.
The person is conscious of the abnormality of these perceptions.
There is no hallucination.
The double is usually a key figure for the person at the time of
onset of symptoms. If married, always the husband or wife
accordingly.

6. Associated Features:
 Cerebral lesions caused by head injury, which are often
located in the posterior area of the right hemisphere,
where face recognition is performed.
Schizophrenic diseased conditions (paranoid-
hallucinatory schizophrenia), but also in affective and
organic-psychic disturbances.
Affects both sexes, but prevalent in women.

7. Psychiatric Manifestation
 Fatigue
 Decrease Memory
 Hallucination
 Irritability
 Confusion
 Anxiety
 Schizophrenia
 Delusion
 Depression
 Slow cerebration
 Acute psychotic stage
 Ataxic gait

8. Psychiatric Manifestation
 insomnia,
 suspiciousness,
 hearing multiple female voices,
 social withdrawal,
 personal deterioration and functional impairment
 Hyper pigmentation of extremities

9. Introduction-B12
 Vitamin B12 deficiency is common in developing
countries
 vitamin B12 is very common because of widespread
causative factors.
 The deficiency state has a very wide presentation and
can cause or exacerbate neuropsychiatric and other
vague symptoms.
 It has been observed that vitamin B12 deficiency is far
more prevalent than expected
 prevalence ranges up to 65% among Indian men

10. Causes of Vit B12 deficiency-1
 Pernicious anaemia
 Atrophic gastritis
 Surgery in which part of the stomach and/or small
intestine is removed.
 Conditions affecting the small intestine, bacterial
growth, or a parasite.
 Excessive alcohol consumption.
 Autoimmune disorders
 Smoking/Tobacco

11. Causes of Vit B12 deficiency-2
 Intrinsic factor Deficiency
 Drugs- Ranitidine, Metformin, Phynentoin
 Bariatric surgical procedures
 Hereditary causes
 Worm infestation
 Chemical Gases – chlorofluorocarbon, Nitrous oxide
 Antibiotics
 High Temperature

12. Causes of Vit B12 deficiency-3
 Stress
 Free radicals
 Chlorine
 Mercury
 Pentachlorophenol
 Pesticides

13. Causes of Vit B12 deficiency in
Non- Vegetarian
 High Alkaline and acidic condition
 Excessive use of Garlic
 Destruction of friendly bacteria in intestine
by constant putrefaction
 Naturally presence of putrefactive bacteria
in meat
 High temperature cooked food

14. well-defined cut-offs for deficiency
 serum vitamin B12 can be broken down into 3
values:
 Likely vitamin B12 deficiency: <148 picomols/L
(<200 picograms/mL)
 Possible vitamin B12 deficiency: 148 to 258
picomols/L (201 to 350 picograms/mL)
 Unlikely vitamin B12 deficiency: >258 picomols/L
(>350 picograms/mL).

15. Treatment
 Individual therapy may be best suited to treat the
persons delusions. Persistence is needed in
establishing a therapeutic empathy without validating
the person’s delusional system or overtly confronting
the system. Cognitive techniques that include reality
testing and reframing can be used. Antipsychotics and
other drugs have been used with some success.
 intramuscular vitamin B12 daily during the first week
and once weekly for the next four week

16. Q-1
 1.Vitamin B12 deficiency is detected through-Choose
correct answer
 Urine test
 Blood test
 Stool test


17. Q-2
 vitamin B12 deficiency common in—choose correct
answer
 Vegetarian
 Non-Vegetarian
 Both
 None of them

18. Q-3
 Write the correct answer in following given box--First
person who has discovered vitamins

19. Q-4
 Pernicious anemia is caused by a deficiency of-choose
correct answer
 vitamin B2
 folic acid
 vitamin D

20. Q-5
 Write the correct answer in following given box-Who
has discovered Capgras Syndrome?

21. Q-6
 Vit B12 Deficiency caused by—choose correct answer
 Excessive alcohol consumption
 Tobacco
 Smoking
 All of the above

22. Q-7
 Psychiatric manifestation in Vit B12 deficiency-Choose
correct answer
 hearing multiple female voices,
 social withdrawal,
 personal deterioration and functional impairment
 Hyper pigmentation of extremities
 All of the above

23. Q-8
 Causes of Vit B12 deficiency in Non- Vegetarian-
Choose correct answer
 High Alkaline and acidic condition
 Excessive use of Garlic
 Destruction of friendly bacteria in intestine by
constant putrefaction
 Naturally presence of putrefactive bacteria in
meat
 High temperature cooked food
 All of the above

24. Q-9
 Capgras syndrome common in---choose correct
answer
 Male
 Female
 Both

25. Q-10
 Chemical causes Vit B12 Deficiency---Choose correct
answer
 Chlorine
 Mercury
 Pentachlorophenol
 Pesticide
 chlorofluorocarbon,
 Nitrous oxide
 All of the above