Capgras and Fregoli Syndromes in Criminal Justice

Ethical integrity of criminal law seems to necessitate at least some provisions of heightened scrutiny in assessment of insanity claims for the individuals who - as the result of mental illnesses involving prosopagnosia and reduplicative paramnesia - act in a way they do not perceive to be wrong. This study informs a more differentiate approach to the ill intent (or formation of requisite intent) - a legitimate objective of the fair deterrence. Accurate diagnostics of the offenders with delusional misidenitifaction syndromes would include careful assessment of comorbidity, brain trauma, organic psychosis (Lewy body disease, frontal brain tumor, pituitary tumor, cerebral amyloid angiopathy, spino-cerebral ataxia, Parkinson's disease, Prion disease, Huntington's disease), epilepsy and postictal delirium, cerebrovascular disorders (hemorrhagic or ischemic stroke, arteriovenous malformations, Moyamoya disease, atherosclerosis, carotid artery stenosis), other severe mental illnesses (paranoid schizophrenia, schizoaffective disorders, bipolar depression, obsessive -compulsive disorder, generalized anxiety disorder), pharmacokinetic induction (Ketamine), cerebral metabolic disorders, postpartum psychosis, genetic mutations (E1A binding protein, P300), biological age of the offender. Often, the psychognomic inventories employed by the expert-witnesses lack in the construct, external, concurrent, and discriminative validity; as well as test-retest reliability - leading to the poorly informed and unidimensional solutions. A more accurate assessment of the offenders with Capgras or Fregoli syndromes would include: MRI or CT scan to map the hippocampal atrophy and varying amounts of the increased T2-weighted signals in subcortical and periventricular white matter, voxel-based morphometry of the right frontal gray matter, fusiform gyrus and Brodmann speech area-37, tractography of the face processing circuitry and occulomotor processing speed. Test utilized by the Courts for trying sanity and volition (ALI, M'Naghten), or justifying a death sentence when the defendant does not understand the reason for imminent execution (Sell factors, Panetti or Alleyne tests), should appreciate differences between the mental capacity and competence - the requisites of autonomy in making decisions, self-incrimination, as well as separation of the wrong from the right.