Tuesday, April 10, 2012

Coast to Coast...Delusions Part 2

So what's the clinical answer to the previous post?  Let's look at the definition for the term "delusion."

A delusion is a false belief held with absolute conviction despite superior evidence. Unlike hallucinations, delusions are always pathological (the result of an illness or illness process).   As a pathology, it is distinct from a belief based on false or incomplete information, dogma, poor memory, illusion, or other effects of perception.

The patient was not being treated for a delusional disorder, but was treated for an anxiety disorder. The patient's daughter was unaware of the source of her mother's belief, thereby, believing that her mother made it all up. The attending physician never made note of these thought contents because the patient did not perseverate on it. She only brought it up when I politely inquired during an interview session. In other words C2C/Hoagland did not cognitive-wise over rule her daily routine. She simply found pleasure listening to the program and thoroughly enjoyed the program. Simply, it was good entertainment for an elderly widowed woman.

I hold that her belief in moon bases and ancient alien lunar civilizations simply suffered from incomplete information due to her only quoting from one source: C2C/Hoagland.   Hoagland was her only point of reference.  There was no indication of a pathological source.  But in the end, the patient was not delusional.

Contrast this with another case.

An 83 year old widowed woman was admitted onto my unit secondary to her neighbors raising concerns due to her bizarre behaviors: talking to her self, poor nutritional intake/self care deficits, hoarding, neglecting to pay her utility bills and calling the police stating that "people" are coming into her house to steal her food. The local police were called by her concerned neighbors and brought the her to my hospital's emergency department.

On admission, she is calmly sitting in her room. She is alert, presents with a pleasant but superficial guarded demeanor. She is aware of her name, the current day/month/year, aware of what hospital she is in, and the city which the hospital is located. She does express concerns as to why she is in the hospital as she denies any issues and does not know why the police removed her from her home. She further expresses concerns that people may try to break into her house while she is in the hospital.

A check of her personal belongings reveal miscellaneous clothing, a purse, one pair of slippers, and an object that resembles a "Tootsie Roll Pop" ie, small ball-like object with a stick/tube attached.

When asked the purpose of the object, she stated that it was a device that allows her to communicate with aliens from another planet. When asked what planet these aliens are from she states that she does not know for certain. She further stated that she used the device numerous times a day as the aliens provide her with advice and are able to warn her of impending trouble.

She was given the diagnosis of Psychosis NOS, Rule Out Dementia

The first couple of days on the unit were uneventful as she appeared to have settled in to the unit's routine. On the third day she started to make request for two to three cartons of milk with her meals. She stated that the extra milk was important for her "two babies." Further questioning revealed that she was of the strong opinion that she was pregnant and carrying twins. When I asked her if she thought it irrational for an 83 year old woman to be pregnant, she told me that she thought that someone her age being pregnant was indeed impossible, but she had been blessed by God and felt with total certainty that she would soon deliver the twins.

On one particular evening I heard her having a conversation with someone in her room. On entering her room, I found her seated by the room' window facing an empty chair. I told her that I thought that someone else was in her room. She stated that she was having a conversation with her husband (she gestured towards the empty chair). When I reminded her that her husband had been dead for fifteen years, she smiled and said that she was aware but that husband "dropped by" from time to time to check on her. Then she abruptly dismissed me from her room stating that I had interrupted a private conversation between her and her husband and there was more that she had to discuss with him.

This case shows the pathology of the delusional state. Actually, ideations concerning her being "pregnant" had been an on-going issue for a number of years. In reviewing additional history from a family member, she had never had children due to a medical condition that precluded her from conceiving. She had always wanted children so over a period of time she convinced herself that she was pregnant and the delusion became "fixed", hence the inability to convince her otherwise. The psychotic state only made the thoughts more prevalent.

Whether her talking to her dead husband constituted a visual/auditory hallucinations or just an extension of her delusional state is still an interesting question.

Going back to the original theme of my posts:  Does Coast to Coast foster delusional thinking.  Coast to Coast did not cause any delusional ideations with the first case. I contend that programs and forums that tend to cater to the "unusual" have no causative effects on one's state of mind since that "state" was already in place.  Whether C2C exacerbates the issues with individuals who have clinical delusional thoughts is an entirely different matter.

Why the subject matter? From time to time skeptics and Ufologist banter around the term "delusional" to describe one an other's opposing view points. I find it irritating to see people acting as if they are psychologist/psychiatrist rendering a  diagnosis on each other when no one knows what the term "delusional" actually means and in what proper context to use it.

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