Showing posts with label Schizophrenia. Show all posts
Showing posts with label Schizophrenia. Show all posts

Friday, October 02, 2015

The Default Network Mode; The Brain's Screensaver

The default mode network (DMN) is a network of brain components active when during daydreaming, self-generated thought, and when not attending to outside stimuli. Marcus Raichle, the discoverer of the DMN, has referred to it as "the orchestrator of the self". It is most active when the brain is at rest or involved in social communication.
 
The concept of brain resting-state network arose from observations made when comparing cerebral perfusion during cognitive processing to that measured during passive baseline conditions such as at rest, that is, when subjects lie in the dark and are instructed to think about nothing in particular (Mevel, 2011).

Raichle first used the term in 2001 to describe the nature of brain activity when it is not engaged in any specific, externally focused task. It's been considered quite an elaborate system, and while there are no definitive functions of the DMN as of yet, some proposed have included internal processes such as self-reflection to diffused passive attention. The DMN is generally inhibited in most cognitive tasks, however, tasks that involve episodic memory does not deactivate the DMN - suggesting a link.

The main hypotheses associated with the DMN and cognitive functions are, the Internal Mentation Hypothesis, and the Sentinel Hypothesis. The Internal Mentation hypothesis holds that DMN is important in introspection and internal attention. The Sentinel Hypothesis argues that the DMN supports a low level ''exploratory'' attention that surveys for unexpected stimuli.

Although some variation occurs, the default network mostly includes medial brain structures, i.e., the ventral medial prefrontal cortex, the posterior cingulate cortex, the inferior parietal lobe, the lateral temporal cortex, the dorsal medial prefrontal cortex, and the hippocampal formation. Probing the functional anatomy of the network in detail reveals that it is best understood as multiple interacting subsystems (Buckner, 2008).


The link between DMN and episodic memory is well established. It is now known that retrieval of episodic memories, whether internally or externally cued; relies on the DMN (Cabeza et al., 2011). Further, dysfunction of both grey matter of DMN nodes as well as white matter connections are implicated in Alzheimer's Disease, a disease with obvious prominent effects on episodic memory. People with early signs of Alzheimer's Disease have unusual resting state signatures, while in Autism; the resting-state networks can be 'hyperconnected'.

People who are depressed show an increase in DMN activity. This is likely to be precisely because what characterizes depression is a sense of constant rumination and negative self-referential mental activity – in neurological terms being stuck in the DMN. (Smith, 2015). Others researchers discovered findings that suggest increased default mode network activation during meditation (Xu et al., 2014), indicating that this activation is related to the relaxed focus of attention, which allows spontaneous thoughts, images, sensations, memories, and emotions to emerge and pass freely, accepting them as part of the meditation process (Xu et al., 2014). The DMN has also been linked with depression (Belleau et al., 2014), schizophrenia (Mingoia et al., 2012), and post traumatic stress disorder (Lanius et al., 2009).

While the functional significance of the DMN remains unknown, converging evidence suggests that the DMN might be critical for self-referential processing (e.g., introspection). Age differences in the ability to deactivate the DMN has been found between older and younger adults, which may reflect the cognitive change experienced in normal aging (Park et al, 2009). The mental activity of the DMN has still not been rigorously assessed to date. Despite the growing amount of knowledge regarding the DMN physiology and anatomy, the cognitive function of this network is still poorly understood (Mevel, 2011).
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''Whatever resting activity is doing, its existence proves one thing - the brain only rests when you're dead'' ~ Miall (2009)

Wednesday, April 01, 2015

Schizophrenia: The Dopamine Hypothesis

Dopamine, a major excitatory neurotransmitter, may play a key role in schizophrenia. According to the dopamine hypothesis, the symptoms of schizophrenia - particularly positive symptoms (e.g. delusions and hallucinations), are produced by over-activity of the dopamine in areas of the brain that regulate emotional expression, motivated behaviour and cognitive functioning.
 
Having "too much" of this neurotransmitter is probably too simplistic; the better term is a functional excess (Lieberman, 1990). This may be caused by a failure of any of the many processes involved in breaking down and re-creating the neurotransmitter, or disruption to the receptor system (such as the receptor functioning "too well"), or there may be problems with re-uptake into the presynaptic membrane.
 
Dopamine Pathways
People diagnosed with schizophrenia have more dopamine receptors on neuron membranes than do non-schizophrenics, and these receptors seem to be over-active to dopamine stimulation (Wong, 1986). Additional support comes from the finding that the effectiveness of antipsychotic drugs used to treat schizophrenia is positively related to their ability to reduce dopamine-produced synaptic activity (Green, 1997).
 
The hypothesis that dopamine and dopaminergic mechanisms are central to schizophrenia has been one of the most enduring ideas about the illness. It was not until the 1970's, however, that the dopamine hypothesis was finally crystallized with the finding that the clinical effectiveness of antipsychotic drugs was directly related to their affinity for dopamine receptors. To date, their have been more than 6800 articles on the topic of dopamine and schizophrenia since 1991.
 
In summary, molecular imaging studies show that presynaptic striatal dopaminergic function is elevated in patients with schizophrenia; however blockade of this heightened transmission, either by decreasing dopamine levels or blocking dopamine transmission, leads to a resolution of symptoms for most patients (Howes, 2009).  

Thursday, May 22, 2014

The Matrix: Was Neo Psychotic?




Auditory Hallucinations
Psychosis is a mental health problem that can  stop the person from thinking clearly, telling the difference between reality and their imagination, and acting in a normal way.

Morpheus: What is "real"? How do you define "real"?

It is a loss of contact with reality that usually includes delusions and hallucinations. Delusions are false beliefs about what is taking place or who one is, such as thinking that someone is plotting against you or that the TV is sending you secret messages. Hallucinations are false perceptions, such as hearing, seeing, or feeling something that is not there. 


Neo: What did she tell you?
Morpheus: That I would find the One. 


Signs of Psychosis
The early stage of psychosis is marked by a difficulty in concentrating, depressed mood, sleep changes - sleeping too much or not enough, anxiety, suspiciousness, withdrawal from family and friends and on-going unusual thoughts and beliefs. While the later stages involve being confused and having impaired reality testing; that is, people are unable to distinguish personal, subjective experiences from the reality of the external world. This can progress onto delusions, hallucinations, disorganized speech (switching topics erratically), difficulty functioning, depression and even suicidal thoughts or actions.
 

Morpheus: I see it in your eyes. You have the look of a man who accepts what he sees because he is expecting to wake up. Ironically, that's not far from the truth.


Causes:

A Psychoactive Aetiology?
A number of medical problems can cause psychosis, including:

- Alcohol and certain illegal drugs (or blue and red pills?)
- Brain diseases, such as Parkinson's  
- Huntington's disease, and certain chromosomal disorders
- Brain tumours or cysts
- Dementia (including Alzheimer's disease)
- HIV and other infections that affect the brain
- Some prescription drugs, such as steroids and stimulants
- Some types of epilepsy
- Stroke







Symptoms:
Psychotic symptoms may include: disorganized thought and speech, false beliefs that are not based in reality (delusions), especially unfounded fear or suspicion, and thoughts that "jump" between unrelated topics (disordered thinking).







Neo: I thought it wasn't real
Morpheus: Your mind makes it real


Exams and tests:
Psychiatric evaluation and testing are used to diagnose the cause of the psychosis. Laboratory testing and brain scans may not be needed, but sometimes can help pinpoint the diagnosis. The type of tests may include; blood tests for abnormal electrolyte and hormone levels, blood tests for syphilis and other infections, drug screens, and sometimes an MRI of the brain.



''Yeah...ehmm...sorry about that''



Possible Complications:
Psychosis can prevent people from functioning normally and caring for themselves. If the condition is left untreated, people can sometimes harm themselves or others (or Trinity).







 Morpheus: You've been living in a dream world, Neo.
 
 
''Your 50 minutes are up young man''
 


Treatment often depends on the cause of the psychosis. It might involve drugs to control symptoms and talk therapy, which can help address the underlying cause of the psychosis.

For example the talking therapy cognitive behavioural therapy has proved successful in helping people with schizophrenia.  Hospitalization is an option for serious cases where a person might be dangerous to himself or others.




''Perhaps we are asking the wrong questions'' ~ Agent Brown 





 
Social support should also be addressed, so as to help support the person with psychosis, who may have social needs such as education, employment or accommodation.


 
 
 
 
 
  
 
 
Agent Smith: It seems that you've been living two lives. One life, you're Thomas A. Anderson, program writer for a respectable software company. You have a social security number, pay your taxes, and you... help your landlady carry out her garbage. The other life is lived in computers, where you go by the hacker alias "Neo" and are guilty of virtually every computer crime we have a law for. One of these lives has a future, and one of them does not.

''The need to prove who you are will vanish once you know who you are''
~ Pierre
 
 
 
 
Similar to Parkinson's Disease and Schizophrenia, dopamine levels are thought to be too high during psychosis, or better, there is a 'functional excess' of dopamine in the person's brain. This can affect memory, emotion, social behaviour and self-awareness.












Bizarre delusions are often experienced during psychosis.

Examples of psychotic delusions include the paranoid type - more likely to be associated with schizophrenia - and delusions of grandeur.










''Sure ye do''

Delusions of grandeur: clearly false but strongly held beliefs in having a special power or authority - the person with psychosis may, as examples, believe that they are a world leader, very rich, that they are able to bring dead people back to life, or that they can control the weather.
 
While the classic hallmarks of psychosis are hallucination and delusion, other symptoms persist in disorders such as schizophrenia - known as negative symptoms. That is, cognitive and motivational impairments, which can be disabling and do not respond to drug treatment.




I think he saw me...
 
 
Paranoid delusions: these may cause the person with psychosis to be unduly suspicious of individuals or organisations, believing them to be plotting to cause them harm. Such delusions can be very frightening and may result in unusual behaviour to avoid things - for example, staying out of a room with certain devices in it, believing them to be controlling thoughts, or locking up the front door with an excessive number of padlocks.
 





Similar to Eric Bui and colleagues examining Borderline Personality Disorder and Darth Vader (2010), it is interesting to compare a disorder with something relevant, in an attempt to try and identify with it. While one is the work of fiction and the other a real life debilitating disorder, slight overlap can be seen and the crude comparisons hopefully elucidate the disorder a little.
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Freudenreich O, Weiss AP, Goff DC. Psychosis and schizophrenia. In: Stern TA, Rosenbaum JF, Fava M, Biederman J,    Rauch SL, eds. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Philadelphia, Pa: Mosby Elsevier; 2008:chap 28.
 
Katherine Darton, Mind. Psychotic experiences. London, UK: Mind, 2011. Information published online, accessed November 21st, 2013.

MedlinePlus. Psychosis. Bethesda, MA, US: National Library of Medicine, National Institutes of Health, Department of Health and Human Services.
 
NHS Choices. Causes of psychosis. London, UK: National Health Service.
 
Van Os J, Kapur S. Schizophrenia. The Lancet, 2009, volume 374, number 9690, pages 635-645 (DOI: 10.1016/S0140-6736(09)60995-8).

WHO. Chapter V: Mental and behavioural disorders. In: International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Geneva, Switzerland: World Health Organization, 2010.
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''Minds that have withered into psychosis are far more terrifying than any character of fiction''
                                                                                                                                   ~ Christian Baloga

Wednesday, April 09, 2014

First-Generation and Second-Generation Antipsychotics

Antipsychotic medication (or neuroleptics) are an effective treatment for people with schizophrenia. In 1952, Henri Laborit, a surgeon in Paris, was looking for a way to reduce surgical shock in his patients. Much of the shock came from the anaesthesia, and if he could find a way to use less, his patients could recover quicker. He knew that shock was a result of certain brain chemicals so he looked for a chemical to counteract these.
 
His administration of a drug called Chlorpromazine had a marked effect on his patients. Previously restrained and often violent patients could now make contact with others and be left without supervision. It seemed to have a calming effect without sedating his patients. It was then trialled for a number of psychiatric disorders. Some being successful, however there were side effects and drawbacks to the drug which were revealed in the passing years.
 
Following the introduction of first-generation (typical) antipsychotics (FGAs) in the early 1950s, there was a radical change in the therapeutic regimens for schizophrenia.
 
But, as noted, it soon became apparent that these antipsychotics produced serious side effects including extrapyramidal symptoms (EPS) - a distressing and debilitating movement disorder. The extrapyramidal system itself is a neural network that is part of the motor system.
 
Along with extrapyramidal symptoms, other side effects of FGAs included;
- Neuroleptic Malignant Syndrome (NMS), a rare, but life-threatening idiosyncratic reaction to the medication. The syndrome is characterised by muscle rigidity, fever and a sudden raised body temperature which can be fatal. Incidence rates range from 0.02 to 3%. 
- Drowsiness, dry mouth, weight gain, constipation, depression.
 
To prevent EPS, second-generation (a-typical) antipsychotics were developed. These newer medications differed from FGAs primarily on the basis of their reduced risk of inducing EPS (Yamamoto  & Inada, 2012).
 
Neuroleptics work via the blockade of dopamine receptors. Dopamine is one of several transmitters that act on the central nervous system, and numerous dopamine receptors have been found in the extrapyramidal system. Dopamine D2 receptors are those most strongly associated with the efficacy of antipsychotics.
 
Second-generation antipsychotics are effective against psychosis and, at therapeutic doses, seldom cause EPS. Their therapeutic effects are attributable to central antagonism of both serotonin and dopamine receptors, and also possibly to relatively loose binding to D2 receptors (Lehan, 2004).
 
Controversy still lingers over the efficacy of first and second generation antipsychotics. Second generation antipsychotics were seen as an advance in drug treatment 20 years ago when they were developed, as they had additional benefits and fewer adverse effects. However, the invention of second-generation drugs have been regarded by some as invention only, a clever manipulation by the drug industry for marketing purposes, and there is often selective publication of trials that can skew the evidence in favour of a drug preferred by the investigators. Leucht and colleagues (2008) compiled a meta-analysis titled, 'Second-generation versus first-generation antipsychotic drugs for schizophrenia'. There were 150 trials examined. In 95 of them, the second-generation antipsychotic was compared with the high-potency first-generation antipsychotic Haloperidol. The use of Haloperidol showed a bias in favour of the second-generation drugs. Because this first-generation drug is likely to be associated with a high rate of EPS. They also avoided comparison with a medium-potency FGA, because these drugs are just as efficacious as the second-generation drug.

 
Antipsychotic drugs differ in their potencies and have a wide range of adverse effects, with nothing that clearly distinguishes the two groups. The only second-generation antipsychotic that is better than other drugs in resisting schizophrenia is clozapine. Nevertheless, it is argued that second-generation drugs have no special a-typical characteristics, that they are no more effective, do not improve specific symptoms, are less cost effective, and have no clearly different side effects than first-generation drugs (The Lancet, 2009).


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Monday, April 07, 2014

Schizophrenia

Unlike the disruptions of mental tranquillity that disturb everyone from time to time, schizophrenic episodes represent a severe departure from normal mental functioning. The disorder has a distinctly biological character, suggesting that its fierce psychotic episodes reflect physiological alterations in normal brain function.

Schizophrenia is the diagnostic term for a family of severe mental disorders that involve psychotic features - a loss of contact with reality - and a widespread deterioration of the level of mental functioning affecting multiple psychological processes (Kandel, 1991). The disorder always involves delusions, hallucinations, or characteristic disturbances in the form of thought. By definition, schizophrenic disorders are relatively long lasting: brief, isolated psychotic episodes are not classified as schizophrenic. Schizophrenia, strictly defined, has an incidence of approximately 1 in 200. Rates of schizophrenia are generally similar from country to country - about 1 percent of the population. There are variations - but the variance is difficult to track due to differing measuring standards in many countries, etc. It is equally common in men and women.

Delusions are a major abnormality in the content of thought. Schizophrenic delusions - false beliefs about external reality - are often persecutory, as in the belief that a television newscaster is making fun of the viewing individual. Other typical delusions are more bizarre: The individual may believe that his or her thoughts are being broadcast so that everyone nearby can hear them, or that other people are inserting thoughts and their behaviour is controlled by others, perhaps by radio waves. Such delusional beliefs represent a marked failure in assessing reality.

Characteristic abnormalities in the form of thought also frequently occur. Most common is a loosening of associations , in which ideas shift from one topic to another in an apparently unrelated manner. When this is severe, speech becomes incoherent.

Hallucinations - perception without external stimulation of the sensory systems - are also characteristic of schizophrenia. Most hallucinations are auditory, involving voices that may make insulting statements or provide a continuing critical commentary on the individual's behaviour. Tactile and somatic hallucinations, such as the perception of snakes crawling inside the abdomen, also occur. However, visual hallucinations are less common.

The emotions of the schizophrenic patient are usually flattened or inappropriate. ''Flattened'' means a loss of emotional intensity: the patient speaks in a monotone, the face is expressionless, and the patient reports that normal feelings are no longer experienced. At other times, emotion may be present but is inappropriate to the circumstance.

The combination of symptoms leads to a gross distortion of the person's interactions with the real world. There is a deterioration in functioning, resulting in part from a preoccupation with internal thoughts and fantasies. In many cases, the acute active phase of florid schizophrenic symptoms persists for a prolonged period. It may be followed by a relative remission of symptoms, but a complete return to normal function is extremely unusual. In fact, such a recovery calls into question the original diagnosis of schizophrenia.

Despite the bizarre and florid nature of the schizophrenic symptoms, there is still considerable controversy as to the nature of the disorder. Many investigators believe that schizophrenia is not a single disease but forms a group of related psychotic disorders.

In schizophrenia, there seems to be an inheritable predisposition or susceptibility to the disorder. In the general population, the risk of schizophrenia is less than 1 percent. However, this risk is much greater for relatives of schizophrenics. The parents of a schizophrenic child have about a 5 percent risk of schizophrenia, the siblings of a schizophrenic have about a 10 percent risk, and the children of a schizophrenic parent have about a 14 percent chance of developing the disorder. If both parents are schizophrenic, the child has a risk factor of about 50 percent.


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''If you talk to God, you are praying; If God talks to you, you have schizophrenia.''
                                                                                                         ~ Thomas Szasz

Monday, December 16, 2013

Christmas Carol Favourites - The Therapist and his Client

Schizophrenia ~ Do You Hear What I Hear?

Depressed ~ Driving Off A Cliff For Christmas...

Post Traumatic Stress Disorder ~ Grandma Got Run Over By A Reindeer...

Compulsive Gambler ~ Run Rudolph Run!!!

Passive Aggressive ~ All of the other reindeer used to laugh and call him names...

Agoraphobia ~ Hiding Behind The Christmas Tree, At The Christmas Party Hop...

Multiple Personality Disorder ~ We Three Queens Disoriented Are...

Alcoholic ~ All I Want For Christmas Is........To Get Sh*t-Faced!

Dementia ~ I Think I'll Be Home For Christmas...

Pyromaniac ~ Later on...we'll conspire...as we dream by the fire...

Tourette's ~ Jingle F**K! Jingle B****CKS!

Morbidly Obese ~ It's Beginning To Look A Lot Like...Diabetes !

Narcissistic ~ Hark The Herald Angels Sing About Me...

Body Dysmorphic ~ All I Want for Christmas.......is 6% Body-Fat And A Nose Job

Paranoid ~ Santa Claus Is Coming To.....Get Me !

Hypochondriac ~ He's making a complaint, He's checking it twice, He's not very happy with his doctor's advice...

Erotomania ~ The Twelve Dicks of Christmas...

Sadistic ~ Jingle Bells, Baseball Bats With Holes, The Safety Word is Sleigh...

Masochistic ~ Rudolph the Red-Arsed Reindeer...

Antisocial Personality Disorder ~ Last Christmas, I gave you my heart, the very next day you called me a scumbag, a maggot...

Social Phobia ~ Here Comes Santa Claus...Hide!

Borderline Personality Disorder ~ Thoughts Of Roasting On An Open Fire...

Personality Disorder ~ You Better Watch Out, I'm Gonna Cry, I'm Gonna Pout, Maybe I'll Tell You Why...

Insomniac ~ I'm.....Dreaming About....Sh*t All...


Manic ~ Deck The Halls and Walls and House and Lawn and Streets and Stores and Offices....


Obsessive Compulsive Disorder ~ Jingle Bells One, Jingle Bells Two, Jingle Bells Three, Jingle Bells Four, Jingle Bells Five, Jingle Bells Six, Jingle Bells Eight...Sh*t!...Jingle Bells One...


ADHD ~ He's Making A List, And Checking It Twice, Gonna Find Out...Do I Want Chicken Curry And Rice?

Exhibitionist ~ All I Want For Christmas...Is A Full Frontal !
 

 
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 ''The main reason Santa is so jolly is because he knows where all the bad girls live''                                                                                                                ~ George Carlin

Sunday, August 11, 2013

Delusions and other Irrational Beliefs


The Working Dead
Cotard delusion (or Walking Corpse Syndrome):

A false belief that one does not exist or has died. Patients often believe that they turned into the walking dead. A relatively rare condition that was first described by Dr. Jules Cotard in 1882. Cases have been reported in patients with mood disorders, psychotic disorders, and medical conditions.




''O, beware, my lord, of jealousy;
It is the green-ey'd monster, which doth mock
The meat it feeds on.''  
Delusional jealousy (or Morbid jealousy):

 
A person with this delusion falsely believes that a spouse or lover is having an affair, with no proof to back up their claim. Morbid jealousy is a favourite topic among novelists and dramatists. ''Othello'' being a classic example.






Delusion of guilt or sin (or delusion of self-accusation):
This is an ungrounded feeling of remorse or guilt of delusional intensity.



Somatic delusion:
Heisenberg had bigger problems than Hank
A delusion whose content pertains to bodily functioning, bodily sensations, or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal, or changed. A specific example of this is Delusions of Parasitosis: a delusion in which one feels infested with insects, bacteria, mites, spiders, lice, fleas, worms, or other organisms. Affected individuals may also report being repeatedly bitten.



Grandiose religious delusion:
The belief that the affected person is a god, or chosen to act as a god. A prominent topic in Freud's Schreber case study.



Capgras delusion (or Capgras syndrome):
''TOASTY!!''
 
A disorder in which a person holds a delusion that a friend, spouse, parent, or other close family member has been replaced by an identical-looking impostor. It has been described in psychiatric and neurological diseases. The onset of Capgras syndrome occurs at a significantly younger age and can be associated with psychiatric disease, cerebrovascular events, and illicit drug use (Josephs, 2007). See the film Changeling (2008) Well worth a watch!



Delusion of mind being read: The false belief that other people can know one's thoughts.





Delusions of persecution:

A delusion (common in paranoia) that others are out to get you and frustrate and embarrass you or inflict suffering on you; a complicated conspiracy is frequently imagined. Delusions of persecution are also common in schizophrenics, especially those suffering from paranoid schizophrenia.





Delusion of reference: The person falsely believes that insignificant remarks, events, or objects in one's environment have personal meaning or significance. Some schizophrenics may believe that current events are happening "for" them or because of something they did. Others may believe that the things strangers or celebrities do or say are meant as a message especially for them


Delusions of grandeur or megalomania:

Delusions of inflated worth, power, knowledge, identity. You may think you are a rock star, an actor or having a special relationship with a deity or famous person.  some schizophrenics may believe they are influential people from the past, such as Jesus Christ .







Any minute now...

Delusion of Reprieve:

Defined in psychology as a victim's false sense of hope in believing they will be pardoned in the last hour rather than meet their fatal end. It was poignantly discussed by Austrian psychiatrist and Holocaust survivor Viktor Frankl, in his inspiring book 'Man's Search for Meaning' (1946). 




Delusion of control: This is a false belief that another person, group of people, or external force controls one's general thoughts, feelings, impulses, or behaviour.


Erotomania
 
Famously described in Ian McEwan's novel Enduring Love, it is a delusion in which someone falsely believes another person is in love with them. The target may often be a celebrity or another high-status person, but people with Erotomania may also develop fixations on random strangers and acquaintances.  Erotomania has also been termed de Clerambault’s syndrome, after the French psychiatrist who identified the behaviour. A minority of people may attempt to injure or kill people who they perceive as standing in the way of their relationship with the object of their affection this has been sensationalized in films such as Fatal Attraction.



Reduplicative paramnesia (RP)



Reduplicative paramnesia is the delusional belief that a place or location has been duplicated, existing in two or more places simultaneously, or that it has been 'relocated' to another site. RP is thought to result from an organic rather than psychiatric cause.

It is one of the delusional misidentification syndromes and, although rare, is most commonly associated with acquired brain injury, particularly simultaneous damage to the right cerebral hemisphere and to both frontal lobes.
 
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''We live and we die and anything else is just a delusion'' ~ Chuck Palahniuk, Choke