Geser Felix, Mitrovics Tibor C G, Obexer Laura, Streicher Peter, Haybaeck Johannes, Yilmazer-Hanke Deniz
Department of Geriatric Psychiatry and Psychotherapy, Christophsbad Göppingen, 73035 Göppingen, Germany.
Department of Radiology and Neuroradiology, Christophsbad Göppingen, 73035 Göppingen, Germany.
Brain Sci. 2024 Nov 22;14(12):1171. doi: 10.3390/brainsci14121171.
Creativity and the production of artwork can have an impact on the course and treatment of comorbid severe mental illness and neurodegeneration. We report on a 70-year-old male patient with highly original artistic behavior, who suffered from lifelong recurrent major depression and subsequently developed symptoms of progressive bulbar palsy (PBP). In the context of a systematic literature review, we detail the patient's personal and artistic biographies and portray artwork from his artistic portfolio together with his disease history, clinical examination, psychopathological and neuropsychological evaluations, blood and cerebrospinal fluid analyses, neuroimaging, neurophysiological testing, and psychotherapeutic treatment. The patient's 1-2-year history of primarily bulbar motor symptoms and signs aligned with electromyography, showing widespread signs of continuing denervation/chronic neurogenic changes. Slight impairments in semantic fluency, executive control, and visuoconstructive abilities were observed in neuropsychological testing, in conjunction with right-sided medial temporal lobe atrophy in an MRI. He was prescribed medication, including extended-release venlafaxine, trazodone, pramipexole, and zolpidem, and took his medication regularly, usually at high doses. For most of his life, the patient had attributed professional "success" and artistic output to, at times, excessive alcohol consumption. Later, however, his interest in creative work continued despite alcohol reduction and cessation. Psychotherapy grounded him in reality via goal-centered behaviors, making him realize that his physical and mental ailments rather hindered his creative output. In summary, creative behavior can be utilized in the treatment of patients with psychiatric conditions (affective or addictive disorders) and/or neurodegenerative diseases. In the reported case, specific psychopharmacology and psychotherapy that address goal-directed self-efficacy experiences of reality were critical to the patient's treatment.
创造力和艺术作品的创作可能会对伴有严重精神疾病和神经退行性变的病程及治疗产生影响。我们报告了一名70岁男性患者，其具有高度原创性的艺术行为，患有终身复发性重度抑郁症，随后出现进行性延髓麻痹（PBP）症状。在系统文献综述的背景下，我们详细介绍了患者的个人和艺术传记，并展示了他艺术作品集里的作品，同时还介绍了他的疾病史、临床检查、精神病理学和神经心理学评估、血液和脑脊液分析、神经影像学、神经生理学测试以及心理治疗。患者有1 - 2年主要表现为延髓运动症状和体征的病史，与肌电图结果相符，显示出广泛的持续失神经/慢性神经源性改变迹象。神经心理学测试中观察到语义流畅性、执行控制和视觉构建能力略有受损，同时磁共振成像显示右侧内侧颞叶萎缩。给他开了包括缓释文拉法辛、曲唑酮、普拉克索和唑吡坦在内的药物，他通常高剂量规律服药。患者一生中大部分时间将职业“成功”和艺术产出归因于有时过度饮酒。然而，后来尽管减少并停止了饮酒，他对创造性工作的兴趣仍在持续。心理治疗通过以目标为中心的行为使他立足现实，让他意识到自己的身心疾病反而阻碍了他的创作产出。总之，创造性行为可用于治疗患有精神疾病（情感或成瘾性障碍）和/或神经退行性疾病的患者。在所报告的病例中，针对目标导向的现实自我效能体验的特定心理药理学和心理治疗对患者的治疗至关重要。
