Skip to main content Accessibility help
×
Home
Hostname: page-component-568f69f84b-h2zp4 Total loading time: 0.337 Render date: 2021-09-19T01:01:27.168Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

‘Truman’ signs and vulnerability to psychosis

Published online by Cambridge University Press:  02 January 2018

Paolo Fusar-Poli
Affiliation:
Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. Email: p.fusar@libero.it
Oliver Howes
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, UK
Lucia Valmaggia
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, UK
Philip McGuire
Affiliation:
Institute of Psychiatry, De Crespigny Park, London, UK
Rights & Permissions[Opens in a new window]

Abstract

Type
Columns
Copyright
Copyright © Royal College of Psychiatrists, 2008 

Prospective studies indicate that individuals meeting a range of clinical criteria such as attenuated psychotic symptoms, brief psychotic episodes or functional decline and family history of schizophrenia have a high risk of being in the prodromal phase of a psychotic disorder. Reference Rossler, Riecher-Rossler, Angst, Murray, Gamma, Eich, van Os and Gross1 However, these studies do not differentiate between different symptom characteristics. Understanding the phenomenology of attenuated psychotic symptoms may aid the discrimination of truly prodromal from low-risk individuals.

Mr M.A., a 26-year-old postman, presented with the feeling there was something subtle going on around him that others knew about but he didn't. He had a vague sense that people around him were ‘acting’, he was the focus of their interest and they knew a secret that was being kept from him. Furthermore he felt ‘detached from the environment’ and had a sense the world was slightly unreal, as if he was the eponymous hero in the film The Truman Show. He was preoccupied with the belief that he was the focus of something that he couldn't quite understand. At no point did his conviction reach delusional intensity. There was no evidence of hallucinations, thought disorder, odd behaviour or other features of psychosis. The symptoms met the criteria for an ‘at risk mental state’, which is associated with a 25–45% risk of developing psychosis in the next 12 months. Over the ensuing 9 months these preoccupations became more pronounced; he developed grandiose and persecutory delusions, and marked thought disorder. He was diagnosed with DSM–IV schizophrenia. Following treatment with quetiapine 150 mg twice daily these delusions and the thought disorder have resolved, although he continues to experience occupational impairment and has not been able to return to work.

In this case Mr M.A. had a preoccupying belief that the world had changed in some way that other people were aware of, which he interpreted as indicating he was the subject of a film and living in a film set (a ‘fabricated world’). This cluster of symptoms, which we have termed the ‘Truman syndrome’, is a common presenting complaint in individuals attending the OASIS clinic for people who may be in the prodromal phase of schizophrenia. Underlying the phenomenology of these symptoms are several features that are consistent with theories of delusion formation resulting from a process of aberrant salience. Reference Kapur, Mizrahi and Li2 First, there is the sense that the ordinary is changed or different, and that there is particular significance in this. This is coupled with a searching for meaning, which, in this case, results in the ‘Truman explanation’. The third feature is a profound alteration of subjective experience and of self-awareness, resulting in an unstable first-person perspective with varieties of depersonalisation and derealisation, disturbed sense of ownership, fluidity of the basic sense of identity, distortions of the stream of consciousness and experiences of disembodiment. Reference Sass and Parnas3 We suggest that these experiences characterise the earliest clinical manifestation of aberrant salience leading to delusion formation. The qualitative phenomenology of the prodrome has not been widely studied, but may, as in this case, be a useful indicator of impending psychosis.

References

1 Rossler, W, Riecher-Rossler, A, Angst, J, Murray, R, Gamma, A, Eich, D, van Os, J, Gross, VA. Psychotic experiences in the general population: a twenty-year prospective community study. Schizophr Res 2007; 92: 114.CrossRefGoogle ScholarPubMed
2 Kapur, S, Mizrahi, R, Li, M. From dopamine to salience to psychosis-linking biology, pharmacology and phenomenology of psychosis. Schizophr Res 2005; 79: 5968.CrossRefGoogle Scholar
3 Sass, L, Parnas, J. Self, consciousness, and schizophrenia. Schizophr Bull 2003; 29: 427–44.CrossRefGoogle Scholar
Submit a response

eLetters

No eLetters have been published for this article.
You have Access
13
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

‘Truman’ signs and vulnerability to psychosis
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

‘Truman’ signs and vulnerability to psychosis
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

‘Truman’ signs and vulnerability to psychosis
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *