Capgras syndrome is a misidentification syndrome typically characterized by the delusional belief that a close relative has been replaced by an impostor. This monothematic delusion can be found in numerous disorders such as paranoid schizophrenia, schizoaffective disorder, affective disorders, Alzheimer's disease, Lewy body dementia, head trauma, epilepsy, cerebrovascular disease and dementia, pituitary tumor, multiple myeloma, multiple sclerosis, viral encephalitis, frontal lobe pathology and AIDS. We present a case of a patient that presents Capgras Syndrome at the first psychiatric evaluation in the context of three-decades untreated paranoid schizophrenia.

A 56-year-old woman was brought to the psychiatric department for evaluation for aggressive behavior directed to relatives. She has a history of auditory hallucinations, experiences of self-reference and paranoid delusions with more than 30 years of evolution. More recently, she started becoming aggressive with relatives, saying her real family members had been taken by strangers to an unknown hospital. She also said that her ID photo had been replaced by another person's photo. After detailed psychiatric evaluation, blood analysis and imaging study, the diagnosis of Paranoid Schizophrenia was established. She was treated with olanzapine 20mg/day with behavioral improvement.

Although Capgras Syndrome is not a psychiatric diagnosis but a feature of several different conditions, psychiatrists should be aware of this syndrome as it can signalize underlying psychiatric disorders and is usually associated with violent behaviors that should be managed.