Mediagenic Psychosis in Dementia: A Case Report

Mediagenic Psychosis in Dementia: A Case Report

To the Editor: We present the case of a 90-year-old man with Alzheimer’s dementia and normal pressure hydrocephalus who exhibited new-onset delusional pseudotranssexualism in the context of mediagenic psychosis. We conducted a search of PubMed and Google Scholar (no search restrictions) using the terms media psychosis, delusion of sex change, sexual metamorphosis, pseudotranssexualism, and media psychosis and dementia. The former 3 terms yielded no relevant results; pseudotranssexualism yielded 2 articles1,2 on schizophrenia. During our literature search, we identified the term mediagenic psychosis in 2 articles1,2 (1 article1 was not in the English language). Mediagenic psychosis refers to the incorporation of emotionally laden stressful news items from the media into patients’ delusional systems.3,4

Case report. Mr A is a heterosexual man in treatment for dementia for the past 6 years. Two years ago, around the same time that a television show portraying a transsexual celebrity aired, he began making passing comments that he was a woman, which initially the family did not find concerning. The comments then progressed to more elaborate stories over the next few months. He began to talk of having had male to female gender reassignment surgery 30 years prior and that he had given birth to 3 other children who now live in a foreign country. He repeatedly offered to disrobe to prove to his family that he no longer had a penis, believed his breasts were larger, and was concerned that his medications might change him from a woman back to a man. His daughters both confirmed that these assertions were untrue, and he had no surgical evidence of previous gender reassignment surgery. He expressed no other delusional thoughts, including paranoia, erotomania, delusions of misidentification, or further persecutory delusions, and did not seem distressed by this gender confusion. Mr A’s elaborate reports of being a woman lasted 6-8 months, after which they gradually abated according to his children.

We were unable to obtain brain imaging for Mr A due to his declining health condition. We continued medical management of his Alzheimer’s disease and normal pressure hydrocephalus. His delusions were not particularly distressing to him, and any inappropriate behaviors were managed conservatively as would be in dementia patients.

Mediagenic psychosis has been observed in previous case reports.3,4 In initial reports,3 these delusions were centered on ongoing wars; later reports4 described paranoia toward the internet at the time of the internet’s emergence.

Commonly reported delusional content in dementia includes paranoid delusions and delusions of persecution, theft, and infidelity5; delusions of erotomania6 and pregnancy7 are less common. Delusional pseudotranssexualism has been reported in schizophrenia8 but, to our knowledge, has not been reported in dementia. Mr A’s delusions appear to be triggered by ongoing media coverage of transsexualism. The process by which delusional thought content is generated remains unknown. Theories based on neuroanatomical correlates, hemispheric dominance, and cerebral lateralization pertaining to the development and content of delusions have been proposed but are not yet completely understood.5 Our patient’s case lends further evidence to the role of concurrent sociocultural and political issues in shaping delusional thought content in psychosis.

References

1. Borras L, Huguelet P, Eytan A. Delusional "pseudotranssexualism" in schizophrenia. Psychiatry. 2007;70(2):175-179. PubMed CrossRef

2. Brüne BM. "Pseudotranssexualism" in schizophrenic psychosis. Psychiatr Prax. 1996;23(5):246-247. PubMed

3. Talmon Y, Abrahams A, Guy N. Mediagenic psychoses [in Hebrew]. Harefuah. 1994;127(1-2):13-16, 63. PubMed

4. Catalano G, Catalano MC, Embi CS, et al. Delusions about the internet. South Med J. 1999;92(6):609-610. PubMed CrossRef

5. Cipriani G, Danti S, Vedovello M, et al. Understanding delusion in dementia: a review. Geriatr Gerontol Int. 2014;14(1):32-39. PubMed CrossRef

6. Brüne M, Schröder SG. Erotomania variants in dementia. J Geriatr Psychiatry Neurol. 2003;16(4):232-234. PubMed CrossRef

7. Cipriani G, Di Fiorino M. Delusion of pregnancy: an unusual symptom in the context of dementia. Am J Alzheimers Dis Other Demen. 2015;30(4):341-345. PubMed CrossRef

8. Borras L, Huguelet P, Eytan A. Delusional "pseudotranssexualism" in schizophrenia. Psychiatry. 2007;70(2):175-179. PubMed CrossRef

Noha Abdel Gawad, MDa

[email protected]

Garima Arora, MDa

aUniversity of Texas Health Science Center at Houston, Houston, Texas

Potential conflicts of interest: None.

Funding/support: None.

Patient consent: The patient’s family provided verbal consent to publish this case report, and information has been de-identified to protect anonymity.

Published online: April 19, 2018.

Prim Care Companion CNS Disord 2018;20(2):17l02184

To cite: Gawad NA, Arora G. Mediagenic psychosis in dementia: a case report. Prim Care Companion CNS Disord. 2018;20(2):17l02184.

To share: https://doi.org/10.4088/PCC.17l02184

© Copyright 2018 Physicians Postgraduate Press, Inc.