WHAT IS DELUSION ?

Quoting the definition – “It is a false belief brought about without appropriate external stimulation and inconsistent with the individual’s own knowledge and experience”. In simple term, delusional patient see things in places where normal people don’t. It’s all in his head & is unreal.

Among many type of delusions yet discovered by the medical science is one of the rare kind, known with the name of Capgra’s Delusion.

CAPGRA’S DELUSION

Capgra’s Delusion is a rare kind of delusional disorder in which the patient seems to be perfectly normal physically and mentally but he is delusional about the people and things around him for being just an impostor of who or what they really are.

An example: He sees his mother and is assured that the lady in front of him looks exactly like his mother but refuses to accept her as his real mother and claims her being just an imposter of his mother, pretending to be his mother.

Its not just the loved ones they get delusional about. They often tend to “impostorify“:

• The house they have been living in
• Other inanimate objects like chair, book, lamp, etc.
• Their pet
• And amazingly, sometimes even their real self.

A short cartoon about the illness:

AN EXPLANATION THEORY FOR CAPGRA’S DELUSION

According to the theory of visual-emotional disconnection:

When we look at the object or some faces, the message reaches the visual centre of the brain via visual pathway then it gets relayed to amygdala which is the gateway to the limbic system containing the emotional centre of the brain. So, when those objects or faces are familiar to us, an emotional response is shown or even other emotional response like fear is reflexively shown by us when we see a lion. But, in the patient with Capgra’s delusion, the message reaches upto the visual cortex in the brain so he recognizes the person in front of him being his mother evoking the previous memories, but the fibers that help relaying information from the visual cortex to amygdala is damaged as a result of any head injuries or accidents causing no emotional response towards the person or object in front of him due to which he thinks the object or person to be an impostor as he doesn’t feel any emotional attachment with them. Owing to an intact connection between the hearing cortex and the amygdala, the delusion doesn’t occur when talking to a person in phone.

COMMONLY ASSOCIATED WITH CAPGRA’S DELUSION ARE

• Schizophrenia
• Head injury
• Epilepsy
• Alzheimer’s disease

Causes

Mental retardation affects about 1 – 3% of the population. There are many causes of mental retardation, but specific reason can only be found in only 25% of cases. Causes of mental retardation can be roughly categorized as:

A) Infections (present at birth or occurring after birth)

1. Congenital CMV
2. Congenital rubella
3. Congenital toxoplasmosis
4. Encephalitis
5. HIV infection
6. Listeriosis
7. Meningitis

B) Chromosomal abnormalities

1. Chromosome deletions
2. Chromosomal translocations
3. Defects in the chromosome or chromosomal inheritance (Eg- fragile X syndrome, Angelman syndrome, Prader-Willi syndrome)
4. Errors of chromosome numbers (such as Down syndrome)

C) Genetic abnormalities and inherited metabolic disorders

1. Adrenoleukodystrophy
2. Galactosemia
3. Hunter syndrome
4. Hurler syndrome
5. Lesch-Nyhan syndrome
6. Phenylketonuria
7. Rett syndrome
8. Sanfilippo syndrome
9. Tay-Sachs disease
10. Tuberous sclerosis

D) Metabolic

1. Congenital hypothyroid
2. Hypoglycemia (poorly regulated diabetes)
3. Reye syndrome
4. Hyperbilirubinemia (very high bilirubin levels in babies)

E) Nutritional

1. Malnutrition

F) Toxic

1. Intrauterine exposure to alcohol, cocaine, amphetamines, and other drugs
2. Lead poisoning
3. Methylmercury poisoning

G) Trauma (before and after birth)

1. Intracranial hemorrhage before or after birth
2. Lack of oxygen to the brain before, during, or after birth
3. Severe head injury

H) Unexplained

Symptoms

A family may suspect mental retardation if the child’s motor skills, language skills, cognitive and social skills do not seem to be developing, or are developing at a far slower rate than the expected. The degree of impairment from mental retardation varies widely, from profoundly impaired to mild or borderline retardation. Failure to adapt normally and grow intellectually may become apparent early in a child’s life. In the case of mild retardation, these failures may not become recognizable until school age or later.

1. Language delay: One of the first signs may be language delays, including expressive language (speech) and receptive language (understanding). Danger sign include no mama/dada/babbling by 12 months, no 2-word phrases by age 2, and parents reporting they are concerned that the child may be deaf.
2. Fine motor/adaptive delay: Significant delays in activities such as self-feeding, toileting, and dressing.
3. Gross motor: Subtle delays in gross motor acquisition, or clumsiness.
4. Cognitive delay: Difficulties with memory, problem-solving and logical reasoning.
5. Social delays: Lack of interest in age-appropriate toys and delays in imaginative play and reciprocal play with age-matched peers.

Family history: It is recommend that the evaluation of a child with MR should include an extensive family history, with particular attention to family members with mental retardation, developmental delays, consanguinity, psychiatric diagnoses, congenital malformations, miscarriages, stillbirths, and early childhood deaths.

Exams and Tests

The diagnosis of MR requires an intelligence deficit of at least 2 standard deviations (SDs) below the mean IQ. Equivalent deficits in at least 2 areas of functional life skills or adaptive skills also must be present to meet the diagnostic criteria for MR. Adaptive skills encompass functional life skills within the domains of communication, self-care, home living, social and interpersonal skills, use of community resources, self-direction, functional academic skills, work, leisure, health, and safety.

IQ scores can vary based on age, instrument, and practitioner. IQ scores can be measured using assessment instruments, such as the Stanford-Binet, Wechsler Adult Intelligence Scale (WAIS), or Wechsler Intelligence Scale for Children (WISC-IV). Nonverbal children can be tested with the Leiter International Performance Scale (Leiter-R).
The second component of diagnosis, adaptive skills, is usually measured with a self-reported or parent/caregiver-reported inventory, such as the Vineland Adaptive Behavior Scales, Second Edition (VABS-II).

Treatment

The primary goal of treatment is to develop the person’s potential to the fullest. Special education and training may begin as early as infancy. This includes social skills to help the person function as normally as possible. It is important for a specialist to evaluate the person for other affective disorders and treat those disorders. Behavioral approaches are important for people with mental retardation.

No specific pharmacologic treatment is available for cognitive impairment in the developing child or adult with MR. Medications, when prescribed, are targeted to specific comorbid psychiatric disease or behavioral disturbances.

Prevention

1. Genetic: Prenatal screening for genetic defects and genetic counseling for families at risk for known inherited disorders can decrease the risk of inherited mental retardation.
2. Toxic: Environmental programs to reduce exposure to lead, mercury, and other toxins will reduce toxin-associated retardation. Increased public awareness of the risks of alcohol and drugs during pregnancy can help reduce the incidence of retardation.
3. Infectious: The prevention of congenital rubella syndrome is probably one of the best examples of a successful program to prevent one form of mental retardation. Constant vigilance helps reduce retardation that results from infection.

Statistics show that more than 15% of the population is affected by clinical depression at some point. Most people prone to depression do not seek professional treatment, attributing their feelings to a bad mood that will pass. If left untreated, depression can get worse, and may even lead to suicide in some people.

Causes of Depression

There are various theories that suggest a multiple number of reasons, both internal and external factors which can cause depression.

1) Genetic is thought to be one of them. With this theory the family and their behavior has a predisposition towards depression.

2) It has also been noted that changes in the brain structure or even brain functions may be one of the causes of depression.

3) Low self-esteem and pessimism are thought to be the other causes of depression. With these mood traits a person suffering from low self-esteem will regard themselves with feelings of pessimism, worthlessness, a desire to end their life and perhaps even attempts at suicide. In this case the person who suffers from low self-esteem and depression will only see the negative aspects of life. These low self-esteem and pessimistic feelings maybe some of the causes of depression, as they invoke the response towards depression.

4) Being overwhelmed by stress can easily lead a person into a state of depression. As more stress enters our lives, depression begins to set in.

Low self-esteem, pessimism and stress are considered to be psychological causes of depression.

5) Other causes of depression can include any physical changes that occur to our bodies. Severe medical conditions like Parkinson disease, heart attacks, strokes and diabetes can make the individual believe that there is nothing worthwhile living for. This emotional state in many cases causes the person to drop into a depression phase. And depression, in turn delays the rate of recovery.

Clinical Features

Depression affects people across all age ranges, genders, ethnicities, cultures and religions.

The common symptoms of clinical depression can be broken up into three categories. Any combination of these symptoms that last for more than a two week period of time signifies that someone is suffering with depression.

Physical Symptoms:

1. Sleep problems either insomnia or oversleeping and not having normal sleep patterns.
2. Lack of energy and chronic fatigue
3. Appetite changes leading to weight gain or loss.
4. Headaches, digestive problems, back pain and other physical symptoms for which there is no medical illness.

Behavioral Symptoms:

1. Loosing interest in hobbies and activities that were once enjoyable.
2. Withdrawing from social functions and obligations.
3. Memory loss, inability to concentrate and make good decisions.
4. Lack of concern over personal appearance, responsibilities and work.

Emotional Symptoms:

1. Feelings of hopelessness, worthlessness and guilt.
2. Continual feelings of sadness or not feeling whole.
3. Constant crying and weeping.
4. Irritable feelings including anxiousness and agitation.
5. Feeling like committing suicide.

If any combination of these symptoms last for more than two weeks then a diagnosis of clinical depression will be made in most cases.

Treatment

Before any sort of cure can be administered the depression sufferer must admit that they have depression. The time to cure clinical depression is when the symptoms are noticed early and acted upon without delay. It is therefore, critical for everyone to be aware of the symptoms, and to take action as soon as possible, to avoid needless suffering on the part of the depressed.

Some of these treatments are long term and can eventually cure the depression sufferer of their aliment. Other medications act only as a way of controlling the bouts of depression. Many of these treatments work best in conjunction with each other. At the present the medication that is prescribed for depression is that of antidepressants.

1) Antidepressants are classified as TCA (Tricyclic Antidepressant Drugs), SSRI (Selective Serotonin Reuptake Inhibitors, RIMA (Reversible Inhibitors of Monoamine Oxidase), MAOI (Monoamine Oxidase Inhibitors) and SNRI (Serotonin and Noradrenaline Reuptake Inhibitors). All of these cures for depression work by altering the chemical patterns within the brain.

2) Cognitive-behavioral therapy is another proven form of cure for depression. With this therapy you relearn your reaction to situations that can lead you into depression. Also you learn how to cope with the day to day situations that you will find yourself in. This way the problems can’t overwhelm you and make you feel like a failure for not being able to solve them quickly.

Article by: Dr. Mandeep Kunwar

As defined by DSM-IV, Dissociative fugue formerly called psychogenic fugue is a rare condition characterized by sudden, unexpected travel away from home or one’s customary place of work, with inability to recall one’s past, confusion about personal identity, or the assumption of a new identity, or significant distress or impairment. It is one of the least understood and yet clinically one of the most fascinating disorders in Mental Health.

The word fugue comes from the Latin word for “flight.” The travels associated with the condition can last for a few hours or as long as several months. People experiencing dissociative fugue may be easily able to blend in wherever they end up. Initially, a person experiencing the condition may appear completely normal but with time however, with time the victim realizes something is wrong. After recovery from fugue, previous memories usually return intact, but there is complete amnesia for the fugue episode.

Commonly, individuals who experience the onset of dissociative fugue are found wandering in a dazed or confused state, unable to recall their own identity or recognize their own relatives or daily surroundings.

Often, the fugue state remains undiagnosed until the individual has emerged from it and can recall their real identity. It is estimated to affect just 0.2% of the population, nearly all of them adults.

Dissociative fugue must not be confused with Dissociative Identity Disorder, Wanderlust and Malingering.

Causes of Dissociative Fugue:

• Severe stress associated with traumatic events like war, abuse, accidents, disasters or extreme violence.
• Major life stresses (abandonment, death of a loved one, financial troubles)
• Tremendous internal conflict (turmoil over guilt-ridden impulses, apparently unresolvable interpersonal difficulties, criminal behaviors).

The frequency of dissociative fugue tends to increase during stressful or traumatic periods, such as during wartime or after a natural disaster.

Signs and symptoms:

• Sudden and unplanned travel away from home
• Inability to recall past events or important information from the person’s life
• Confusion or loss of memory about his or her identity, possibly assuming a new identity to make up for the loss
• Patient may present alert and oriented only to self.
• Reasoning and judgment are lacking, and insight is poor.
• An increased finding of violent or homicidal ideation is present, but suicidal ideation is lacking.

Treatment:

Patients with dissociative fugue often recover spontaneously. However treatment involves:

• Psychotherapy with additional hypnosis and psychopharmacology in order to allow integration of feelings, anxieties associated with the fugue, and recovery techniques
• Medication and cognitive therapies in combination

In th Book “Mad Travelers”:

“Mad Travelers” is the title of a book by Dr. Ian Hacking. The incidents described in his book began in the 1880′s in France then spread to Germany, Italy and Russia. Those events are accepted as the first recognized cases of Dissociative Fugue.

Real life story of Dissociative Fugue:

Jeffrey Alan Ingram, 40, was diagnosed in Denver with dissociative fugue, a type of amnesia.

When Jeff Ingram realized he did not belong in Denver he made public appeals on TV programs for anyone who might know his identity. His fiance’s brother saw him and called her. 2 Denver police detectives accompanied him on a flight back to Olympia, Washington to be reunited with Penny. He had previous episodes in 1995, disappearing for  9 months, ending up in a Seattle hospital. This time (September, 06) he started a trip to Alberta, Canada to visit a friend dying of cancer.

He had awoken in Denver with $8 and no memory of how he got there or who he was. He wandered the streets until he was picked up and placed in a hospital for testing. His memories of the former life are all missing. His car, a greenish-blue colored Neon, is still missing. The ability to cook is gone as well as his driving skills.

Experts insist the stress of dealing with a friend’s pending death caused the fugue episode.

Read more @ http://www.msnbc.msn.com/id/15373503/ns/us_news-life/