August 31, 2011

Misdiagnosis, misinformation, and the psychology of acceptance

Dutch psychologists examined the case of a 58-year old woman misdiagnosed with Alzheimer's disease.

The woman sought a neurologist during a particularly stressful time in her life, revealing that her mother suffered from the disease.

Her brain scan revealed hypofrontality (reduced activity) in her forebrain, and performance on a cognitive impairment exam was estimated as "poor," without having actually taken the exam.

The woman's condition deteriorated significantly, wherein she became permanently confused and, eventually, suicidal.

Months later, after contacting an Alzheimer's helpline, the woman was encouraged to consult a different neurologist for a second opinion. A brain scan and memory test came back as normal—the neurologist attributed her first scan to hypofrontality associated with depression. Despite these good results, the woman remained deeply troubled.

Years later, Merckelbach and colleagues in the Netherlands interviewed the woman, who still reports intrusive thoughts about her memory lapses and misdiagnoses.

The researchers believe the effect of misdiagnoses are on par with implanting false memories (Inception, anyone?).

To examine this hypothesis, researchers recruited 78 undergraduates to take a psychological symptoms questionnaire. After a distraction, researchers went through some of the students' answers with them individually, whereby researchers inflated two of the answers regarding anxiety. For instance, if a student indicated that he "never" felt test anxiety, the researcher discussed with him during the session how he "sometimes" had test anxiety. The subject then explained the answer they'd given.

Interestingly, 63% of subjects failed to notice that their answer had been changed, and proceeded to describe their experiences.

Ten minutes later and one week later, all students re-took the same questionnaire. At both time points, this 63% of students gave higher ratings to the altered items, suggesting that misinformation about a physical or mental state can shape how people actually feel.

Merckelbach et al. note that their findings may have significant implications in terms of how medical professionals interact with patients, suggesting that they should avoid mentioning the spectrum of symptoms for disease or disorder during early interactions with patients. This may reduce false or inflated perceptions of the patients' feelings.

Anything to avoid the case of the Alzheimer's-misdiagnosed woman, I say.

Merckelbach, H., Jelicic, M., and Jonker, C. (2011). Planting a misdiagnosis of Alzheimer's disease in a person's mind. Acta Neuropsychiatrica. DOI: 10.1111/j.1601-5215.2011.00586.x

Photo courtesy Diva Domination. Originally reported by BPS Research Digest.

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