Psychosis and Capgras delusions in a patient diagnosed with Cogan’s syndrome

Vincent is a 39-year-old Hispanic American gentleman who was admitted to our acute inpatient service on a legal hold as a danger to self, danger to others as well as being gravely disabled. He presented with a chief complaint: “I need to sleep.” A 5150legal hold was initiated by the Police Department. The family had called law enforcement because the patient was trying to attack family members with a kitchen knife. When the police arrived, he was sitting on a couch with a large kitchen knife behind his back. The patient struggled with the officers when they attempted to retrieve the weapon. Remarkably, Vincent has total visual loss and near total hearing loss. The patient was unable to provide much of the history, which was obtained mostly from collateral sources, his family and previous medical records. The patient’s brother reports that Vincent had become convinced that family members had been substituted by “intruders.” Vincent was not convinced that neither his mother, nor his brother were “real” and had been substituted by imposters. We observed this quite dramatically during a family meeting. His brother leaned over to Vincent and spoke into his right ear (in which Vincent has some residual hearing), announcing his name to get Vincent’s attention. Vincent began violently waving his arms protesting “no, no,” indicating that he did not accept his brother’s identification. Vincent also believed that his brother’s girlfriend was in fact his own wife and was frequently angry because she did not join him in his bed at night. In addition, he believed that his nephew was in fact his own child.