A fascinating case study described in the June 2008 issue of Clinical Neurophysiology concerns a patient who presented visual hallucinations and identification disorders associated with a Capgras syndrome. During his Capgras episodes, the patient not only misidentified his wife's face, but also perceived her as being an entirely different sexual partner. Not only did he have sexual intercourse with his wife's "double" without having the slightest recollection of any familiarity towards her, he even changed his sexual habits. According to the authors, he is the only known neurological patient who ever made his wife a mistress. In discussing the case, the authors discuss the mechanism of Capgras delusion with reference to the processes involved in face recognition. The complete loss of familiarity not only with face but also with all aspects of sexual intimacy suggests a specific disconnection between the neural pathways linked to face identification and the systems involved in emotional and episodic memory.
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