1. Study looks at effect of media on “Truman Show”-type delusions

    June 22, 2012 by Sue

    From the Taylor & Francis press release via AlphaGalileo:

    ‘We accept the reality of the world with which we are presented.’ – Ed Harris, The Truman Show (1998)

    Over the last decade, millions of words have been written about the effect of ‘Reality TV’ on our cultural and social lives. Much less discussed are the possible interior ramifications such forms of broadcasting can have on our minds.

    A vital new investigation into this subject appears in the latest issue of the journal Cognitive Neuropsychiatry.  A paper by Joel and Ian Gold, entitled The “Truman Show” Delusion: Psychosis in the Global Village describes several cases of patients who think their lives are being filmed and broadcast in circumstances like the scenario in the 1998 Jim Carrey film. Three of the patients featured in the report even refer to the movie by name.

    Directed by Peter Weir, The Truman Show depicted Carrey’s character as a man unaware that the intimate details of his life are being shown every day to a global audience of millions. As the realisation of his true predicament gradually dawns, he begins to exhibit symptoms and behaviors indistinguishable from what the real world would understand as a persecutory delusion. The closer to the truth he gets, the crazier he seems.

    The real-life patients described in The “Truman Show” Delusion are therefore engaged in a reversal of the movie’s plot – their symptoms recall Truman’s, without the knowledge that their attempts to understand the ‘truth’ of their situation will afford them a happy, Hollywood ending.

    Although it might sometimes feel like it, it’s not the case that watching reality TV can trigger psychotic or delusional episodes. But underlying illnesses such as schizophrenia can react with ‘reality’-saturated TV schedules to shape and colour the nature of the delusion the patient experiences – sometimes creating forms that, observed from outside, seem curiously half-familiar.

    The report itself looks at the phenomenon from three directions: the first describes and characterises the “Truman Show” delusion; the next looks at the role that cultural objects and influences can play in shaping clinical delusions; and the third discusses the implications of this ‘cultural study’ of delusion, and how it effects our existing understand of how delusions work.

    The preliminary result of the investigation shows that while particular delusional ideas are culture-sensitive, the broader categories of the types of delusion people suffer from tend to remain the same across time and cultural influence. The authors conclude that cultural studies of delusion are to become an essential part of understanding how such conditions operate.

  2. Researchers suggest behaviour-based treatment as an option for dementia patients

    March 27, 2012 by Sue

    From the AFTAU press release:

    Dementia — an acute loss of cognitive ability — can be marked by memory loss, decreased attention span, and disorientation. It occurs in severe disorders such as Alzheimer’s disease. Despite the fact that the condition is common, especially among older persons, there is still a lack of effective treatment.

    According to Prof. Jiska Cohen-Mansfield of Tel Aviv University’ Herczeg Institute on Aging and Sackler Faculty of Medicine, dementia sufferers are often prescribed psychotropic drugs to mitigate symptoms such as delusions. But this tactic can cause more harm than good, she says. Many of the delusions experienced by dementia patients may have a rational basis and could be more effectively treated through behavioral therapy than by medications, suggests Prof.Cohen-Mansfield. A better understanding of delusions has direct implications for the care and perception of those who suffer from dementia.

    The study, done in collaboration with Prof. Hava Golander of the Department of Nursing and Drs. Joshua Ben-Israel and Doron Garfinkel of the Shoham Medical Center, was published in the journal Psychiatry Research.

    A rational basis for delusion

    The researchers examined six common categories of delusion, including fears of abandonment, suspicions that patients’ possessions were being stolen, and feelings that they were not “at home.” The participants in the study were 74 adults from nine nursing homes in Israel who had received a diagnosis of dementia. The research team questioned caretakers, including registered nurses and nursing home staff, who had daily interactions with the patients.

    Researchers assessed elements including the patient’s mental state, behavioral pathology, and incidents of past trauma. Caretakers were asked to describe not only the patient’s delusions, but to explain the circumstances under which they emerged. Taking into account all these parameters, researchers discovered that a large percentage of the delusions that the caregivers described seemed to have logical explanations. Some were even the result of the patient re-experiencing traumas they had suffered earlier in their lives.

    “If you begin to think about these delusions from the point of view of the dementia patient, you begin to understand that their delusions are explainable reflections of the reality they live in,” explains Prof. Cohen-Mansfield. For example, for patients who felt that they were not at “home,” the nursing home did not satisfy their definition of home. Anxiety often accompanied separation from the outside environment or from their loved ones — a rational response.

    A better quality of care

    These findings can have an impact on the way heath care providers and family members respond to dementia patients, says Prof. Cohen-Mansfield. Characterizing their delusions as “psychotic” puts them in the category of severe mental illness, which is frequently inappropriate. Instead, caretakers can devise methods to work with patients that take context into account.

    Prof. Cohen-Mansfield also notes that participants in the study were highly medicated, with 47 percent on antidepressants, a third taking sedatives/hypnotics, and 13.5 percent on antipsychotic medications. “If you can ascertain why the patient is experiencing these ‘delusions,’ you can create another treatment plan that addresses issues of orientation,” she explains.

    In people with dementia, delusions do not really match the psychiatric definition of psychosis. A closer analysis of these behaviors is likely to promote empathy, understanding, and ultimately a more humane and compassionate treatment, the researchers concluded.

  3. Study links type of brain activity to delusional thinking in people with schizophrenia

    January 10, 2012 by Sue

    From the CAMH (Centre for Addiction and Mental Health) press release:

    In a new study from the Centre for Addiction and Mental Health (CAMH), people with schizophrenia showed greater brain activity during tests that induce a brief, mild form of delusional thinking. This effect wasn’t seen in a comparison group without schizophrenia.

    The study appears in the December issue of Biological Psychiatry.

    “We studied a type of delusion called a delusion of reference, which occurs when people feel that external stimuli such as newspaper articles or strangers’ overheard conversations are about them,” says CAMH Scientist Dr. Mahesh Menon, adding that this type of delusion occurs in up to two-thirds of people with schizophrenia. “Then they come up with an explanation for this feeling to make sense of it or give it meaning.”

    The study was an initial exploration of the theory that the overactive firing of dopamine neurons in specific brain regions is involved in converting neutral, external information into personally relevant information among people with schizophrenia. This may lead to symptoms of delusions. “We wanted to see if we could find a way to ‘see’ these delusions during Magnetic Resonance Imaging scanning,” says Dr. Menon. The senior author of the study is Dr. Shitij Kapur, dean and head of the Institute of Psychiatry in the U.K.

    A better understanding of the brain activity and thinking patterns leading to delusions could point the way to more focused treatment options, the researchers say.

    The study results are based on 14 people with a schizophrenia diagnosis and 15 people in a control group. Participants were presented with 60 statements while in an MRI scanner. For each statement, they were asked whether they felt it was about them.

    Twenty statements were specific to each participant, and included details taken from initial screening interviews. The remaining 40 statements were generic, and evenly divided between statements that were neutral (“he collects CDs”) or that had an emotional connotation (“everybody hates her”).

    People with schizophrenia and in the comparison group were just as likely to agree that personalized statements were about themselves. However, those with schizophrenia were significantly more likely to say that the generic statements referred to them. “The participants with schizophrenia had a harder time telling the difference between personally relevant and non-relevant statements,” says Dr. Menon.

    When participants agreed a statement was personal, specific brain areas “lit up” in the scanner, indicating activity in these areas. Among those with schizophrenia, this brain activity occurred even when they said “no” to a statement that was not about them, suggesting that they had greater difficulty in distinguishing what was self-relevant to what was not.

    The brain regions with activity included the cortical midline structures (such as the medial prefrontal cortex and anterior cingulate cortex), as well as regions like the insula and ventral striatum. These areas are connected to the brain’s dopamine regions, or are involved in introspective and emotional processing – which fit the researchers’ original expectations.

    The control group, which was more likely to respond “no” to irrelevant statements, showed little brain activity in response to generic statements.

    Even when people with schizophrenia agreed a generic statement was not about them, they took longer to respond and the difference in certain brain activity levels was not as great as in the control group.

    Once these processes are better understood, approaches such as attentional retraining therapy, or repetitive transcranial magnetic stimulation (rTMS) may be explored possible treatments of delusions. rTMS is a non-invasive form of brain stimulation currently used for depression treatment.

    Further research is needed to expand on these initial findings. For instance, patients in this study were all taking anti-psychotic medication. Other studies could look at people early in illness who are not on medication, and could also follow people over time, before and after they take medication.

    It is estimated that one person in 100 develops schizophrenia, a disturbance of the brain’s functioning that can seriously impact the way people think, feel and relate to others. Some people diagnosed with schizophrenia recover almost completely, while others need treatment and support for the rest of their lives.