THE FIGHT OF PATIENT WITH PARANOID SCHIZOPHRENIA DISORDER WITH HIS THE PSYCHIATRIC DIAGNOSIS: A GAME OF "EVERYTHING OR NOTHING"
Keywords:Cybercrime, Paranoid Schizophrenia, Delusional Interpretability, Xenopathic Control, Suicide Risk, Homicide Risk, Impulsive-Unpredictable Behavior
Introduction: "Blue whale challenge" is a large social media phenomenon believed to have originated in Russia in 2015. It is supposed to be a "game" in which the "player" receives 50 tasks from an online administrator. Initial tasks are more inclined towards self-harm and antisocial behavior, the final task being suicide. The name is thought to be derived from "failed whales" that suggest suicide.
Motivation: Although the target audience of this outrages game is mainly adolescents; it has proven to be eminently more harmful among psychiatric patients, of all ages, especially those with psychotic disorders. When psychosis overlaps with an already dangerous online "game", the risks are heightened.
Objectives: Our case study intends to highlight the risks of a 35-year-old patient, a former police officer, diagnosed with paranoid schizophrenia about 15 years ago, difficult to control from therapeutic point of view, which is completely immersed in this "game", in which the tasks are on the border between concrete and delirium.
Methods: Emergency psychiatric hospitalization, medical supervision, daily psychiatric monitoring, psychological evaluation, psychodynamic interview, case study.
Results: The patient deliriously interprets the rules of the game his current task is to go to three different psychiatrists and to prove his health in order to "release" him from his diagnosis of paranoid schizophrenia. He motivates the objective of the challenge with the Blue Whale the "liberation of the soul", the alternative being suicide. He plays "all or nothing", there are no differences in shades between "Beware of donkeys" (children's game), "Blue whale" and "Russian roulette" (games for real men). The patient himself sees either the garbage man who deserves the lethal injection, or Jesus capable of winning the game. His thinking is dominated by the conflict between the concrete and the abstract; the secret of the paranoid patient being the emphatic ability to transform his powerlessness into "I am invincible!", because for this patient "at first it was the word". When he spoke about his previous tasks, he confessed many acts of violence, pseudo- reminiscence with delirious integration in the form of confabulations. In addition, he believes that everyone receives orders from the Blue Whale, including medical staff, which makes difficult to establish a doctor-patient relationship.
Kay J., Tasman A. (2016). Essentials of Psychiatry, Chichester: John Wiley & Sons Ltd
Crichton, P. (1996). Did Othello have the Othello syndrome. The Journal of Forensic Psychiatry, Volume 7, Issue 1, pp.161-169. doi: 10.1080/09585189608409924 DOI: https://doi.org/10.1080/09585189608409924
Kataoka H., Sugie K. (2018). Delusional Jealousy (Othello Syndrome) in 67 Patients with Parkinson’s Disease. Frontiers in Neurology. 9: 129. doi: 10.3389/fneur.2018.00129 DOI: https://doi.org/10.3389/fneur.2018.00129
Tasman, A., Kay, J., Lieberman, J.A., First, M.B., Maj, M. (2008). Psychiatry. Third Edition. John Wiley & Sons, Ltd. DOI: https://doi.org/10.1002/9780470515167
Stahl, S.M. (2005). Essential Psychopharmacology – The Prescriber’s Guide, 2nd edition. New York:Cambridge University Press.
Kaplan, H.I., Sadock, B.J. (2015). Synopsis of Psychiatry, 11th edition. Lippincott Williams & Wilkins Publishing House.
Tellegen, A. (1985). Structures of mood and personality and their relevance to assessing anxiety, with an emphasis on self-report. In A.H. Tuma & J.D. Maser (Eds.), Anxiety and the anxiety disorders. Hillsdale, NJ: Erlbaum.
Clark, D.A., Beck, A.T., Stewart, B. (1990). Cognitive specificity and positive-negative affectivity: Complementary or contradictory view on anxiety and depression? Journal of Abnormal Psychology. 43.
Clark, L.A., Watson, D. (1991). General affective dispositions in physical and psychological health. In C.R. Snyder & D.R. Forsyth (Eds.), Handbook of social and clinical psychology: The health perspective. New York: Pergamon Press
Stahl, S.M. (2013). Essential Psychopharmacology – Neuroscientific Basis and Practical Applications, 4th edition. New York:Cambridge University Press.
Shaw, D.S., Hyde, L. W. & Brennan, L. M. (2012). Early predictors of boy's antisocial trajectories. Development and Psychopathology, 24, 871-888. doi:10.1017/S0954579412000429 DOI: https://doi.org/10.1017/S0954579412000429
Black, D.W. (2015). The Natural History of Antisocial Personality Disorder. Can J Psychiatry. 2015 Jul;60(7):309-14. doi:10.1177/070674371506000703 DOI: https://doi.org/10.1177/070674371506000703
Werner, K.B., Few, L.R., Bucholz, K.K. (2015). Epidemiology, Comorbidity, and Behavioral Genetics of Antisocial Personality Disorder and Psychopathy. Psychiatr Ann. 2015 Apr;45(4):195-199.