Month: June 2007

A brief article published in the Journal of the Royal Society of Medicine in 2001 reported the case of a young man who suffered delusions that he was a player inside a computer game.

The game isn’t mentioned by name, but it seems to be Grand Theft Auto.

The authors of the case study point out that they’re not suggesting that computer games cause psychosis, but they comment on how it’s a somewhat unusual illustration of how ideas from a person’s life get incorporated into the themes of psychosis.

A young man was admitted from prison to a psychiatric facility after reports that he had been acting in a bizarre manner. He had been arrested for stealing motor vehicles and assaults with weapons. At interview he was found to be experiencing the delusion that he was a player inside a computer game (adult-certificate game, widely available) in which points are scored for stealing cars, killing assailants and avoiding police vehicles.

Psychotic symptoms had emerged slowly over two years. His family had noticed him becoming increasingly withdrawn and isolated from social activities. He developed delusions that strangers were planning to kill him and also experienced auditory hallucinations, constantly hearing an abusive and derogatory voice. Previously a computer enthusiast, he began to play computer games incessantly. He felt that the games were communicating with him via the headphones.

In a complex delusional system he came to believe he was inside one of these games and had to steal a car to start scoring points. He broke into a car and drove off at speed, believing he had `invulnerable’ fuel and so could not run out of petrol. To gain points he chose to steal increasingly powerful vehicles, threatening and assaulting the owners with weapons. Later he said he would have had no regrets if he had killed someone, since this would have increased his score.

After arrest and while in prison he continued to believe he was in the game, despite initial medication. When he was admitted to hospital six weeks later, part of ward management was to deny him access to computer games. Nothing abnormal was found on physical examination, blood investigations, drug screen, electroencephalography or a computed tomographic brain scan. Paranoid schizophrenia was diagnosed and he responded well to further treatment with antipsychotic medication.

Similarly, ‘rock and roll delusions’ have occasionally been reported in the medical literature (David Bowie seems to be a favourite).

Link to JRSM full-text article ‘Computer Game Delusions’.

The New York Times reports on a new study that examined how doctors disclose information about themselves during patient consultations. The study found that disclosures are usually for the benefit of the doctor and rarely help the patient.

The study recorded 113 doctor-patient interactions and analysed the conversation for themes, timing, effect and number of self-disclosures.

Self-disclosure is usually specifically covered in clinical training and, if done carefully, is thought to enhance the relationship with the patient and make them feel more at ease.

In this case, the research team found that none of the self-disclosures were primarily focused on patient concerns and only 4% were useful, providing education, support, explanation, or acknowledgment, or prompting some indication from the patient that it had been helpful.

The study also contains a few transcripts, including this gem:

Physician: No partners recently?

Patient: I was dating for a while and that one just didn’t work out. . . . about a year ago.

Physician: So you’re single now.

Patient: Yeah. It’s all right.

Physician: [laughing] It gets tough. I‚Äôm single as well. I don’t know. We’re not at the right age to be dating, I guess. So, let’s see. No trouble urinating or anything like that?

As was found in a previous study, it was also found that the longer the doctor talked about themselves, the less likely it was to be useful.

We tend to think of medical diagnosis as a scientific process, but so much of it relies on conversation, with patients – to get their experience of symptoms, and colleagues – to get their opinions and advice. In other words, it relies as much on negotiation as diagnostic tests.

Another key element is how the doctor transforms the patient’s personal problem into a medical one, so he or she can apply medical knowledge and problem-solving techniques to it.

As found by a key study in medical sociology, doctors use various non-scientific strategies to interpret the objective medical symptoms while making a diagnosis.

When medicine is discussed as ‘part art, part science’, the art seems to be in how doctors interact with their patients and interpret their concerns, which seems to be equally as important as medical tests.

Link to NYT article ‘Study Says Chatty Doctors Forget Patients’.
Link to abstract of study.

Childhood stress can interfere with the development of the teeth to the extent that a traumatic experience leaves a recognisable line in the tooth enamel that remains as a record of past traumas.

I discovered this when reading about a study published in the Annals of the New York Academy of Sciences [pdf] that used these lines to compare the number of childhood traumatic experiences that occured in people diagnosed with schizophrenia and healthy controls.

New approaches to the problem of estimating stress during early brain development are required. In this regard, human enamel has promise as accessible repositories of indelible information on stress between gestation and the age of 13. Stressful experiences induce long-term activation of the sympatho-adrenal system, slowing of tropic [growth-related] parasympathetic functions, and they then induce disrupted secretion of the enamel matrix.

During the brain development (in infancy, childhood and preadolescence), ameloblast activity in human enamel is slowed during 1 to 2 days of extreme stress, and the segment of enamel rods is smaller and often misshapen, making a particular dark line seen by the use of a microscope (we referred this line to Pathological Stress Line, PSL in short). Retzius reported that this line is incremental lines reflecting the layered apposition of enamel during amelogenesis (Retzius, 1937), and after that this line is termed the Retzius line. The line is conceptually akin to tree rings which are markers of environmental adversity in the tree’s life.

Schizophrenia was once thought to be largely caused by genetic factors, but in the last decade a number of studies have shown that childhood trauma contributes to the chance of developing the disorder.

One difficulty with this type of research is that it often relies on people remembering back to their childhood after the onset of psychosis, which could mean that the memories aren’t perfectly reliable in some cases.

Stress-induced lines in tooth enamel are one way of looking at the link between trauma and schizophrenia that doesn’t rely on potentially hazy memories of the past.

Link to abstract of study.
pdf of scientific paper.

Science has just published a study of almost a quarter-of-million people providing strong evidence that oldest children have slightly higher IQs, and, most interestingly, the evidence suggests that this isn’t a biological effect – it’s likely to do with family environment and upbringing.

In fact, first-born children are known to have a number of psychological differences. For example, they are less likely to be gay, show differences in autistic-like traits, and are typically less severely affected by schizophrenia if it occurs.

These differences have often been explained by a theory that argues that the mother adapts her immune system during the first pregnancy and it might not be fully attuned to later children and this might affect the brain development of subsequent children.

In order to test this idea the Science study looked at the records of almost 250,000 Norwegian army recruits, all of which have routine IQ tests and full medical and family histories.

It turned out, as has been found many times before, that first-born children had higher IQs by about 3 points on average.

Crucially, it also turned out that some second-born children who had an older sibling who had died young also had higher IQs.

In other words, although they were second-born biologically, they were brought up as the oldest child after their sibling passed away.

Being brought up as the oldest child seems to be the crucial factor: family-rank, not birth order affects IQ. This suggests that the immune system theory is unlikely to explain this effect.

This has generated a great deal of discussion and many parents are interested in whether they can provide the ‘first child advantage’ to their younger children as well.

The New York Times featured the study and just published a follow-up article discussing the role of family-dynamics in the development of intelligence after all the interest it generated.

Some psychologists are suggesting that the effect might be because older children get the chance to coach the junior family members which may help them consolidate knowledge and provide practice in manipulating information.

It’s also interesting that a recent study on birth-order in Thai medical students found exactly the reverse pattern. Younger siblings were found to be more intelligent and have more positive personality factors.

All of these studies suggest that culture and environment are crucial factors during childhood, both for mental and emotional development.

Link to abstract of Science study (thanks Laurie!).
Link to NYT write-up.
Link to NYT on intelligence and family dynamics.