Capgras syndrome (CS), late-onset schizophrenia (LOS) and refractory schizophrenia are relatively common conditions in psychiatric practice. However, the combination of these three conditions in a single case is a very rare event and so far seldom reported. We report a case of a patient with LOS presenting with of CS and super-refractoriness since its first crisis. A 53-year-old woman was admitted to a psychiatric hospital in an acute psychotic episode. On admission, she was convicted that her family had been enrolled in a plot in which they were replaced by lookalikes. This was the first time she presented psychotic symptoms and no treatment had yet been instituted.