Capgras syndrome, mania and delusionally motivated assaults

Schizophrenia and Moral Responsibility: A Kantian Essay

In this paper, I give a Kantian answer to the question whether and why it would be inappropriate to blame people suffering from mental disorders that fall within the schizophrenia spectrum. I answer this question by reconstructing Kant's account of mental disorder, in particular his explanation of psychotic symptoms. Kant explains these symptoms in terms of various types of cognitive impairment. I show that this explanation is plausible and discuss Kant's claim that the unifying feature of the symptoms is the patient's inability to enter into an exchange of reasons with others. After developing a Kantian Quality of Will Thesis, I analyze some real life cases. Firstly, I argue that delusional patients who are unable to enter into an exchange of epistemic reasons are exempted from doxastic rather than moral responsibility. They are part of the moral community and exonerated from moral blame only if their actions do not express a lack of good will. Secondly, I argue that disorganized patients who are unable to form intentions and to make plans are exempted from moral responsibility because they do not satisfy the conditions for agency.

Capgras syndrome: a review of the neurophysiological correlates and presenting clinical features in cases involving physical violence

OBJECTIVE

Acts of violence have been frequently reported in cases of Capgras syndrome (CS), a misidentification syndrome characterized by the delusional belief that imposters have replaced people familiar to the individual. CS has been observed in many neuropsychiatric and organic disorders, and neuroimaging studies indicate an association between CS and right hemisphere abnormalities. However, CS has received limited attention from a forensic psychiatric perspective. We propose that elucidating demographic and clinical features noted in cases of violence secondary to CS may highlight important factors in the progression of CS to violence.

METHOD

We review the neurophysiological correlates and clinical factors observed in CS and present characteristics of a series of cases that demonstrate the potential of CS patients for severe physical violence toward the misidentified person.

RESULTS

For patients with CS involving assault, we present and discuss commonly reported demographic and clinical features that may contribute to an increased risk for violence.

CONCLUSIONS

An understanding of the presenting clinical features of CS resulting in aggressive acts may assist clinicians to assess the potential for violence in these patients.

Delusional misidentification of health care professionals

Delusional misidentification of others generally involves a person misidentifying others who are emotionally and geographically proximate to that person. Health care professionals may become the objects of delusional misidentification. The present study reviews and analyzes the anglophonic literature on published reports of misidentified health care professionals and adds two new cases. Relevant issues raised when patients misidentify health care professionals are explored, particularly the danger posed by these misidentification delusions.