Everybody, it's me, ben and I wanted to do a quick little podcast here about cit training. Sounds good. And so I wanted to ask you, what do you think is there or is there not a difference between cit when people refer to crisis intervention training or crisis intervention team training, but I think the most noticeable difference is that the word team is in one of those, but do you think there's a difference if someone's looking at training courses? I honestly don't know the difference.
So I mean I think this comes up a lot. I know it's a pet peeve to me and I know this has come up because you know there's crisis intervention training that I think anyone can get and a lot of it is communication skills and it's very similar to crisis intervention team training. I just the core concepts of it are slightly different. So a crisis intervention training.
I feel like seeing different places that have it, it is more of like just straight lecture on deescalation skills or mental health and I feel like whenever places have crisis intervention team training, it's more program specific. So you'll have like members of the community presenting, so they look at as a team approach to the training. I don't know if that makes any sense. So would that be c I t t training? It was just bcat trading. You're saying crisis intervention team training?
Yeah, those are two t's. Maybe it would just be cit training.
Oh right.
But when people say tea tray and then they say it's crisis intervention training training makes absolutely no sense. And that happens all the time.
Yeah, yeah.
The second one, the team training. That sounds like what we do here, right? We do. But before it used to just be crisis intervention training and that's still happening in our state. Oh. So other agencies are still using that? Right. So it's just, I mean other places sell that training.
It's crisis intervention training, but you're saying it's more like just a presentation about mostly deescalation and I, I think it's very, I think they're very similar, both sides, but it could be like the objectives on them. One is just strictly, it's just you know, anyone can teach it or some places teaching it and the other one is you're trying to bring the community together to present topics and raise awareness.
Okay. I think one, two, at least for us and a lot of cad programs that do training, it's resource based while the other one doesn't really cover much resources. I know you've been to both for sure. So my cit training you were saying was just crisis intervention training. Right? Right. Which is still done. I can't remember whether there was like outside presenters that came to that.
I think there was, I don't know him, but when you see the term, let's say literature or the news, do you just think of it as d? That just means 40 hours? Honestly, I just thought that like whenever I see it as like, okay, that's what we do is the training we put on. I always wonder how people take it. Yeah, because I know I'm very particular on if it's the cit program, so to me it's a different objective attitude of why you're putting on the training versus just say we do deescalation training.
Right? And to me I guess I look at it differently but maybe I'm just being too picky. Maybe I think that's possible, but I will say that I definitely see the merits in both those trainings. I think both of them are, are good and both of them are useful, but if you could include the community, I think that would be a little bit more helpful. Now, how about if you hear cit training, do you think that should be specific to a time length? Like when you hear it, what do you think it is?
You think that's like any type of training that's mental health or. Yeah, so I, I've seen ours is obviously 40 hours, but I've also seen different agencies do 16 hours, 20 hours, 24 hours. Um, so I guess it's just, it should be based on the needs of your agency. Right? So I think it needs assessment is appropriate to do before you start it and that will help you get a better understanding of how long are your training needs to be. I just think it's so unique when, when people.
I know here locally, I feel like like officers or the political sale, that cit class where there's a cit course when they're referring to anything that's mental health deescalation. Yeah. They didn't know, you know, it's like hey we're going to do a block and autism. Oh it's a cte class. No, it's just a word and we're teaching a class in autism, you know, so they use that. So I think it could be very confusing at people when they hear that. Like what is it to you?
And I think of truth to it as a 40 hour block. But you're right, it varies. Yeah. Hey, what about this? So I was recently doing some research to look at different programs around the country and so we do 40 hours here locally and that's kind of, I guess the gold standard. I'm doing quote marks here and we do that for five, eight hour days. Right. So there's a lot of places that do it in four, 10 hour days. That sounds way. Awesome.
Do. I was just gonna ask, do you think having 10 hours of straight training is doable as a student? Yeah, I do. Do you think that's better than eight hours? To me that seems like a long time. Well, I'm biased because I will admit that for 10th is like my favorite schedule I've ever worked. That's true. So I favor. But to be fair, I haven't done much training 10 hour days except in the military. Um, so I don't know.
It may be too long to keep people's attention and to keep them focused and occupied. It might participate to a theory. My concern. Yeah, because 10 hours, that's a long time to be in a classroom. I mean, and, and it's probably really difficult on the instructors as well because you know, students get breaks, instructors usually don't get that many breaks. You're just preparing for the next class and going over your curriculum and you don't get a lot of breaks as the instructors and your typical.
You're there early and after, so that's probably 12 hour days if not longer. Yeah, but you get Fridays off. I don't know. What if they were Tuesday through Friday? Who would do that saying you never know. They end up would do that. What if it was Friday through Monday, Friday through Monday? I would. I would quit that department, go to somewhere where they're scheduled. Makes Sense.
I'm sure because when I saw that I was like, oh, this is a four day class, so that's where they're doing four days. I thought it was like a 32 hour course and then I was like, why do they stay in 40 hours? It's four days, and I'm like, oh, they are doing 10 hour days. They probably. Sure. It's some like con, like contract with those officers or maybe they're already on that schedule, so just keep them on it. I'm not sure. But yeah, it would be interesting to see if we could do that.
I've always a. that's always surprised me, you know, there's so many different schedules, but training's always seems to be Monday through Friday and I wonder if there's a reason or if it would be beneficial for training to be random. It could be on the weekend. Not only is it only Monday through Friday, it's only during traditional business hours, which doesn't work well for graveyard officers, graveyard people and this one random week you're on day shift. Right.
And had the goal to wake up and you're just dead tired and end the width of the works because Friday evening is typically Saturday. So if you worked Saturday and you were in class on a Friday, you go in that night to having worked graveyard for the majority of my career. I mean the trainings, I was always just, you know, there are not enough resources to have this during graveyard hours or are, you know, it's what, what's the problem?
And I think a lot of times it is the resources you just don't have the resources to put on, you know, a day shift class, the swing shift class in a graveyard class. Right. For most agencies. I think, uh, you know, I've heard things like Nyp ed has all shifts covered, but I mean they're like a small army. Yeah. They have a huge 90, 100 officers, at least $90 million officers, so they're taking over the world. Okay. I don't know if you've heard about this, but yeah, they have tons.
Yeah. So what is your take about these trainings being community? So like having members of the community teaching law enforcement. That's awesome. Teaching it, like if they're, if they're, uh, a sme, subject matter expert in whatever they're teaching, I think it's, it's so cool to incorporate them in part of police training. Have you ever seen any downsides to it?
Yeah. Um, sometimes, you know, civilians don't, don't, I don't know how to quite word it, but they don't connect with the officers, you know, just on a vocabulary level. Right. We've had doctors come in and they're talking, talking very doctori. Right. And you're just going to go over officers' heads and very academic literature and fancy words. And if you're not used to teaching officers, we don't make great audience members. Right. That's true.
We, we just kind of sit there, dead pan on our face. I mean we're paying attention, we're learning, but it's not the typical audience that you would get if you are teaching outside of law enforcement. So how do you correct that? So what we do is we, you know, kind of give our presenters civilian presenters, especially if it's their first time a heads up on what to expect, right? We coach him, right?
Maybe things not to say things that will help them connect with the officers, you know, don't be, don't be discouraged if it seems like people aren't participating there, they trust what you say. Right? And I think sometimes you know, civilians may come in with the idea that, you know, what, what do I have to teach officers and officers if they, if they believe you're an expert in that particular area, they want your information, they want to do better at their jobs.
So, and we teach all of our courses and so I can't stress that enough. If you guys have an outside presenter, one, have a relationship with them, like build that rapport and coach them, but be there even if they're teaching the majority interject every now and then and say, oh, what they're saying, this is how you might add, like apply that to. That's a great one. More like this is what they're saying, you know, oh you see it like this. And the terms are different.
Yeah. Sometimes you just have to translate in the car, like always think I'm, you know, whatever you call like your mental health provider. So they use one term and we use a different term in law enforcement, you know, we might just say the hospital or the mental hospital or whatever, but that they'll use the actual term for their facility, which we may not actually be aware of. So that can be hard. And I know a lot of times we've had stuff where we were worried about people's personal agendas.
Yeah. So like they really want to get involved because you know, they might believe that there's an increase or law enforcement's shooting people with mental illness and so they come across in their whole point is like don't shoot people for this or something. So how would you correct that or catch the. So I mean if you can talk to them about what they're going to be teaching and maybe get a get ahold of him before that you might see a turn up there and then you just have to coach them.
Like that's not really going to go over well with officers if it happens during the class. I mean that's tough. I mean, right, you don't want to interrupt him but you know, you'd have to talk to them afterwards or if it gets too bad and you maybe you have to just interrupt him and say hey right. And so if you're having outside presenters one, like you just said, I would really recommend like reviewing their material beforehand or if it's your own course, right?
The curriculum, you know, get feedback from the community but you know, have your objectives laid out. And I think that's one thing I noticed with cit programs just across the nation is like, oh, we need a class on, you know, suicide. So you just ask somebody, hey, come teach you about suicide. That's just very broad, have at least some objectives.
So then you can at least coach that instructor like, Hey, I know you're wanting to talk about use of force, but that's not the part here we really need to cover, you know, proper response to someone who's in a suicide crisis and what are the resources and that can help. Yeah. And I know that bringing civilians into traditional law enforcement training is still kind of almost taboo in law enforcement. It is.
But I will say that for our experience, what we do reviews at the end of every class and our civilian presenters get great reviews and the officers really like them. So if you're on the fence, I mean take precautions, vet them and, and, you know, talk to them. But it can have a great effect on your guys's training. It really can. Um, it looks good to the community. You get more buy into.
And so people are backing officers more because a lot of it's just a misunderstanding, you know, if they're like, oh, you're teaching cops to hurt people, it's like, we'll come and take our class, you'll see we're not doing that or help us teach it, you know, what are you seeing that's not working? But I can't stress like it. I do believe it should be. Yeah. Because I noticed we get worst reviews if it's just a civilian teaching and then you know, but it's not translated in to.
I mean, people don't like to feel like they're idiots. So if someone's using like a medical jargon or literature jargon and no one's corrected them, they're not gonna feel comfortable raising their hand in a classroom, you're like, I have no clue what you're saying. You know, you'll feel like an idiot. Some people do, but it's not that common. Yeah. Yeah. I don't know if I would, I would just pretend like I knew exactly what they're talking about. Right.
I mean you, you just be googling it, you know, and I don't know what made me just, I guess just saying googling, but what is your take, and this is just random. I, we were kind of going off topic now, but with students having laptops, computers and phones out. Awesome. Do you think it should be done? Should not be done? Should be done always. Are you being sarcastic or ruined? I can't, no. I mean like obviously some people are going to like just be playing clash of clans on their phone. Right?
I don't think you can prevent that, but I think if you say, you know, if you wanna if you want to, while we're discussing this, Google what we're talking about and get different points of view on it. I mean I think that's a great atmosphere. I know that a lot of people that sit in for a class or when I come and observe certain topics, I always get that, hey, you know, officers are, you know, your students have their laptops and their phones out.
I don't know if I agree with it and I'm always like, you know, they're always use that in their computer. It's hard on it, you know, they might have to catch up on a report and I don't want them to not be paying attention because they're listening, right? Like all shift long, you're listening to your radio, you're on your computer and you're having to listen to everything. Especially this younger generation. I think they take notes on their computer to take notes on their phone.
They know that's how they work, right? So I know in an academic setting and pretty much everyone in the class as nowadays has the laptop open and like I said, some of them are just not paying attention, doing whatever, but some of them are taking notes and that's the new pen and paper. That's how you know people this generation take notes now, what if someone's listening because I'm sure the tile, this one's going to be like cbt versus cfd. What's the difference?
And let's say they're like, oh, I want it to get cit course. How would you, how would you suggest that one verify a courses valid or accurate or, or. Well done? I have. There's a way. I don't know. I don't think so. Right. Is there like a, there's not a governing body, um, look at their agencies facebook page and see what kind of ratings they look at their yelp. Yeah. I mean, I don't know. I don't know either because I've had people ask before like, Hey, have you heard of this course?
And like, no cit, but there's not a governing body to say, this is cit. If you're gonna, use that term. I think your best bet is to find somebody that's taken the class and ask them, hey, what about private versus public? I think there's good and bad of both. Um, I think you can have terrible private ones. You could have good private ones. And the same goes for public ones. It just depends on who you have teaching the class and the curriculum, you know? It's such a hard one.
Yeah, I mean that's a good point to ask people that have already taken it in most places. If you were asking, I'm interested in your course, can you give me some references or agencies that have taken it? They should not have any reputable. One would be like, sure, here's a list of places that you can reach out to and ask and I would just definitely, like you were saying, check to see if they're coteaching it.
If the private one has police officers teaching along with private instructors, that's great. That's perfect, but if they're private and they're staying without officers, officers are obviously some subject matter experts in crisis intervention, so I think at some point they need to include law enforcement even if they're a private entity. Now what if, what if someone was wanting to take a class that you teach where you work and they said, hey, can I get a copy reviews?
Would you give it to copy of the reviews? What people write about us? Like, Hey, I'm interested in your course. Can I get. Can I see the reviews students give? You sure can. Yeah, and like schedule. I feel like he can see you schedule your classes.
Yeah, I mean if they asked for my curriculum, I'd give it to them like I think this is valid, you know, I mean we're a public entity where the replacement screen, so if anybody wants to see what we're teaching, I have no problem giving it to them or if another agency asked because they want to teach it, I have no problem giving them a curriculum for that either. It's just I, you know, I think that this information should really be the monopolized. Right. It's the benefit of the community.
They become a demon. This is what you just said, become a demon but also not charged for it. Okay. This is kind of a dual meaning, so become a demon for free. Yeah. No, I 100 percent on a demon. Optimizing knowledge. Yeah. So I was a huge fan of UNMS project echo and I found it. That's what we did see at the echo off of. Yeah, it's a great, it's a great proxy to spread the stuff. Um, I think that's a great point. So if you are looking for it, you can ask.
I don't think that'd be rare or odd to reach out, even if it's a private agency and say, Hey, I'm interested in this course. Can I get a copy of your last reviews in the last four? Um, and look at it hopefully. I mean, no matter what, if they're getting full class sizes, someone's not going to enjoy something. Yeah. I think that's just a given. Right? So you should still see some review that looks bad. So if all of a sudden they're only sending you five reviews and they're all excellent.
Take. Yeah, take that with a grain of salt. Right? If someone just like, sure they send you all of them, you know, if they're being transparent, I think every class has its own theme, right? So sometimes it's like, you know, the students create a theme and they really like it. They worked together. Some classes, like you're saying, it could be shift work, you might have a class full of graveyard officers. They're just exhausted.
Yeah. You know, you might get a little less feedback or someone might be mandated to a class. Sure. And so they're viewing everything negative. So you might see that in some reviews, like we shouldn't have this training, why am I being told about this? But it's a good point if someone is to ask that you would give it to him. Sure. I couldn't see anywhere else not doing it. I know some places will say their stuff is proprietary copyrighted.
So if you're looking for curriculum, they may not, but the schedule or like a syllabus like this is what we'll cover. They should give you. And if they won't give you the curriculum we will suggest the. I mean that's a good point on it, but yeah. See t versus C at all? Interesting stuff. Yeah. I don't know if it's easy to tell. I don't think so. It's kind of a gray area. Yeah. But if you guys have any questions about law enforcement or cit or mental health, by all means, send it to ask it.
Go see it. [inaudible] dot org and we'll cover that in one of the Asca docs as cops. But uh, thanks guys for listening.
Thanks guys.
You're lucky to have Dr Martin presenting on her subject today. I'm going to try to move it on this computer because I'm not trusting the other live computer for that. Unless you can get it going, Jim. And I know after the presentation we have three cases. If we can get to them, I know that, uh, I think dave has a case. State police have a case and then if we have another one we're planning to push that went over to next week. I'm from Lawrence on that and this is working. So on that Dr Martin.
Hi everybody. So I'm Nancy Martin. I'm the medical director of pes. I just took over from Dr in August and Matt asked to speak on something spooky today. And so I chose this topic not because it's spooky, spooky to us, but more we can imagine that would be pretty spooky to experience for people who have delusions, hallucinations, and delusions. So we're going to go ahead and cover those.
So the objectives today is that we're going to describe the differences between delusions, illusions, hallucinations, and I have a number of cases that I'm going to tell you about that will highlight these different. Um, we're also going to discuss the nuances of delusional thought because they can be extensive and then trying to understand the cultural and regional differences between delusional content, which I find personally very interesting.
Please interrupt me at anytime though if you do have questions. The content we're going through. Okay. So let's get right to it. So we're going to start with delusions. I think the majority of the topic is going to be on this because I find it really extensive and really fascinating what people can come up with. But so the definition of a delusion is it's a disturbance of content of thought. So we talk about these, you know, in psychiatry thought content differences or issues.
And so w delusion falls under that category. It's a fixed false belief that's based on incorrect inference about an external reality and it's firmly held despite what almost everyone else believes. And also in the face of irrefutable are obvious proof of evidence to the contrary. So people can have bizarre beliefs that don't fit under this delusional, you know, a thought system. Um, and you tend to think about this being really culturally, culturally related as well.
So, um, for instance, the belief in a god isn't necessarily a delusion because multiple people share that belief. Now, if one person holds a belief that you know, their plant is a god that's a little bit different. Okay? So there are nuances to that, but this is what specifically makes something, a delusion in psychiatry. Talk about these being mood congruent or mood congruent, meaning like, does that fit with how they're presenting? Is the person bothered by it?
Um, and the way that we kind of figure all this out as we explore the content of the delusional system to evaluate that organization and then the patient's conviction of its own validity. Okay? And so delusional conviction really can occur on this continuum and it can sometimes you can figure out how delusional or how much somebody delusional content is in fact impacting them based on their behavior with it.
Solutions can be bizarre, non bizarre, meaning that somebody can think that you know, um, aliens are infesting their gi system or it can be something like, you know, this guy that I work with is in love with me. So that's what we mean with bizarre, bizarre. And then we talk about all of these themes and we try to categorize things in most of medicine, we do this, but try to categorize these delusional thought contents. And so I'm very typical or persecute or paranoid.
I'm sure you guys run into that a lot grandiose or this inflated sense of self. I'm jealous or somatic jealous being more towards some, a lot of times with older patients who are experiencing major neurocognitive issues contend to start believing that a spouse or a loved one is, you know, I'm engaged in another relationship with somebody else. And that's a jump. Jealous Delusions. Systematic delusions.
There's some overlap with this and hallucinations and we'll get to that, but sematic basically means something involving the body. So like a delusion of being pregnant or a delusion of having you know, aliens in your gi system. Like I said earlier, guilty, nihilistic, and Iran and Iraq are typically ones that we don't see as often presenting, so the pes setting or that you guys might run into these from held beliefs that other people have.
Okay, so that's just the main categories of what delusional thoughts are. There's also this concept, ideas of reference or ideas of influence and we call that ior Ioi and our documentation and that's basically that the. There's a false belief that behavior of others refers to one or that events, objects or other people have some particular unusual significance to them, so references basically saying like the television or radio or internet or some external force has a message for the patient.
Whereas the influences that some person or forces controlling some aspects of the person's behavior probably hear us say that sometimes patients with delusional systems oftentimes have them for the entirety of their life and they're used to having these beliefs dismissed or belittled by friends, family in general society, so they're on guard from for similar reactions from others. Especially when you're encountering them in the field. When people are somewhat reluctant to talk about it.
Because they don't know what's gonna Happen, um, but there is a way that you can question delusions without really revealing belief or disbelief and you certainly want to be careful of that. I'm either making them feel belittled, but then also trying to, you don't ever want to buy into their delusional system or let them know because that can be dangerous in and of itself. So there are ways to ask about it.
And what I've found is that patients tend to speak more freely about their delusional content when they're asked about the emotion that accompanies it rather than the belief itself to saying something to somebody like, wow, it must be really scary that you think that somebody is following you or something like concentrating on how it makes them feel rather than the thought itself. Because again, they're kind of on the garden. So we have a couple of case examples.
I do want to preface all of this with that. There's a number of photographs and there's some artistic work that patients have shared with me and they all have given permission for it. But please don't reproduce these. So on this first case was a 56 year old African American male that I worked with in Atlanta, and I'm sorry, the quality of this isn't very good. This was one of four pieces of paper he drew for me overnight when he was on the inpatient unit. So this is a 54 year old black male.
I'm in the Vietnam War. He was a pilot.
He was, he was, he did something with them within helicopter, I believe, and he had developed a psychotic illness during his time spent in diagnosis schizophrenia and did quite well, um, you know, in his lifetime he was able to obtain a degree in botany and that became a really, um, this from fixated belief, just delusional delusional belief system for him and when he would get really ill, um, you know, he would decompensate such that he would, he would steal plants and animals from people as
part of this delusional content. But at baseline he was a really interesting, very well knowledged. He had a lot of knowledge about buttoning flora and fauna. What was interesting about him, and he had frequent interactions with police there in Atlanta because he had two trailers, one was stuffed full of animals or the skins of animals and then the other was stuffed full of different various types of plants.
And so this was a drawing he did for me trying to explain the water system to me in Atlanta. And a whole lot of this doesn't make sense. You could probably make out some things. There's a DNA double helix strand at the top. There's some other, there's a couple of the Latin names of the binomial system, of nomenclature for some of the plants that he liked.
But I mean, if you can just imagine looking at this giant and looking how things are related, uh, for him in his mind how confusing all of this must be. Um, and so, and how frightening some people might find it, that he has these two trailers just stuffed full of things. Right? But, um, one of the most difficult things about residency for me was realizing that people have the ability legally to be like this, to have this delusional content and belief system. And not be a danger to themselves.
It's bizarre. It's confusing. It looks exhausting to me, but that he, you know, in, in, in, in the majority of his life, he was not a danger to himself or others because of this belief system. Here's another one. This was a younger black female that I saw in Atlanta as well, who was convinced that she was being changed into an alien.
She believed her eyes were turning yellow and that she was every once in awhile abducted this pig figures really interesting to me and it came up, but in a lot of her drawings, along with the bows that you can see at the bottom, so some psychologists would have a lot of fun with this, but you know, she, she had this belief that she was being changed in some way by aliens.
Second,
this is from a man locally that you all probably interacted with in the past. He is a young white male who has a very, very bad treatment resistance, psychotic illness blend. Fortunately with Halloween and Halloween, decorations around the mall has started to fixate on the joker. He saw he went to hot topic around the mall and saw a full sized picture of the joker, and this started to become incorporated into his delusional thought.
So at baseline he comes from a very religious family and um, his ability to study and learn and recite the Bible had, had been something as a child that he was pressured with, with his family. Um, and so, you know, the religious content of his delusional system is very prominent. So he always, he's always feeling that there's this supernatural, either godlike quality or the power of the universe and the planets they have that they had this impact on him.
But, you know, in the last month or two, he's, he's incorporated the joker into that. And so he says, if you know some of the other superman type of characters. And so he said to me the last time he came into pdfs, if superman don't kill the joker, then God will. But what was concerning about his presentation at that time is he said, well, maybe I should become the joker of Albuquerque and kill people.
So you can see how somebody can have this delusional system that if baseline is bizarre and strange, but really not all that threatening and how something small like a Halloween decoration at a mall might impact that and change that at some level as well. So we've talked about three cases of patients who have had psychotic illness and this is a version of psychosis as well. This is a a longer. It's going to be a couple of slides in length about something that's very difficult to treat.
So those patients that we just went over, they had been in a hospital, they had gone to a psychiatrist in this case, these. This is to highlight that these delusional content or belief systems can exist outside of a psychiatrist ever knowing a patient as well. So this is a picture of a plastic bag filled with debris that this woman presented to her dump.
Dermatologist is a 54 year old Caucasian female and she was referred from her primary care doctor with complaints of bugs in her skin and she had been experiencing for the last 18 months. So she brings in this plastic bag filled with this, you know, debris and it's looked at under the microscope and it basically just shows that it's an organic, but there's no parasites, no feces, no eggs, no evidence if there's a bug or parasite.
So she had self treated her skin with applications of boric acid, mouthwash bleed. She had done just about everything to try and get this stuff off of her. None of it helped, obviously, slipped picture of her abdomen. The one on the far left is her, is her abdomen. Um, you can see a number of things that are normal and abnormal. So you see stretch marks or strategize what we call them a medicine, but then a number of excoriations circular ends linear.
And then she's got the right, you can see the right buttock and the left buttock. What's, what's interesting, what you can know, maybe not the best in these pictures, is that the middle of her back, the center area where her hands can't reach is spared. So this woman believe she was infected with parasites and this is something called delusions of parasitosis or syndrome. And it's really, really difficult to treat because people do not believe they have a thought content issue.
They believe that they're infested with parasites. Luckily she was with the help of her dermatologists and primary care doctor was able to start an anti psychotic medication. And within two months, that's what her abdomen like, sorry, four months. Alright. So I have a graphic image of this. If you have problems with, you know, um, um, medical pictures, this is a, this is a picture of a more severe case of this delusions of parasitosis. So if you have a problem, please do look away.
It's um, it's not, it's not wonderful. Um, so this is the same thing. And you can see the level of self harm. Somebody would go to around this delusional belief system, this person held firm to the idea that they were infected and actually completely removed the top layers of their skin and hair because of it. Yes ma'am. When you see a patient that has a delusional, either removing body parts or to this extreme, is their pain tolerance lowered because of the delusion or.
Because I don't think I would be able to go through that. It's an excellent question. I don't know if that. It's probably been looked at in the functional Mri Studies. I don't know the evidence behind that though. I would imagine so. Of course, when you're getting to this level, this is where we talk about the continuum of a, of a delusional belief system or this person's at harm to themselves.
This person might take out there already taken off of the skin and put themselves at risk for infection complication. So, but yes, I'd imagine so that this is just to really illustrate the strength of these belief systems for people. So I pulled about.
I'm part of this online psychiatry group and I pulled 4,000 psychiatrist about this for you guys because it is an interesting thing to me and I'm sure in your experience in the field you have noticed some really regional are culturally related specific delusions. So anything that you can think of, it's weird for people that can become a delusion. But these are the responses that I got.
So in Los Los Angeles, obviously people have a lot of delusions of grandeur related to the film industry or being famous themselves. I'm in Minneapolis. I didn't know that Pillsbury company is based therapy, but it's common for people to develop a delusion around flower that's tainted with something in one specific. One specific patient had this idea that it was changing with HIV and then delusions around with prince, the artist, memphis, Tennessee.
There's a lot of Elvis delusions, whether somebody is elvis themselves or a child of Elvis or related to him and coming into a lot of money. For me and my training in Atlanta, it was a lot of famous producers and rappers, so we'd have patients coming in and saying that they were Tyler Perry and they knew Tyler Perry or they were little wayne and they want. It costs a lot of military experience.
There's this kind of persistent recurrent delusion that we see about being implanted with a chip during deployment and during their time in the military.
Any experimentation and then a lot of people have been in a lot of va patients I've heard say that they've been given a large amount of substances and Lsd seems to be a pretty prominent one that has happened before and then with women there's obviously just a few to highlight some specifics, but it with women, that delusion of being pregnant can persist for some people. Do you have any to add that you guys have seen related to Albuquerque?
When I see most often, you know, a lot of people, um, that are stocked by a local street gang for like a national gang. Delusionary.
Any others? You guys have noticed
Kevin, a PD. I've had a couple of incidences where people claim that they're, I guess security for the president. That's the only thing and that's what the airport. So they need to travel to see him or that they're in charge of the nuclear codes for the president.
Interesting. Thank you for that.
Any others? Corey? Right. With a said a lot with government agencies like CIA and FBI. Exactly. How about people from outside the state? We're in St Paul. Did you guys actually see this pillsbury stuff? It's actually a minneapolis, that's another side of river street neighbors harassing them, falling down wherever they go. People from different countries hacking into their internet security.
A lot of them have actually gotten back from smart phones to regular phones and they still act into that kind of like a delusion when it comes over. So anyone that we see with a flip phone that we should just automatically assume it's to thank you guys for including those. This is just an interest of mine. I think that, again, imagine this would be really terrifying for people, but then it's also so regional suspects.
So earlier you talked about delusions, delusions, if it's not a culturally acceptable and so one I have a question is how many people does it take for it to be acceptable such as in New Mexico we have had a tendency of north and south they have colts. At what point is that acceptable or not? And then also here, at least with people that have been psychotic, depending on the area, you know, a lot of them will look at it as Alisa being possessed or with some of the native American type of thing.
Right. So there's this religious cultural aspects, religious cultural aspect to things as well. And this is where I think the lines of psychology and psychiatry really what we as a human race really, because you wouldn't want to go as far as saying that like a group of people who are in a call, although that's weird that you wouldn't necessarily call that a delusional system for them.
You wouldn't want to treat them with anti psychotics that people have the ability to make these choices for themselves. And yes, it's are a little bit weird to you, but they might not be weird to this cultural group. Right. So like I want to shy away from saying that, you know, certainly there's cult mentality. They can get really dangerous. And we'll talk a little bit about this in terms of some interesting research that's done around Halloween, around this idea. But yeah, yeah.
If it's, if it's a shared belief system by a number of, of people either religiously or in a society, it's not really considered.
There's also this really fancy French term for something we call, which is like having the madness of to where you can find in sometimes there's a couples or mother and child or father and child, you know, two people or three people, small groups of people who share a delusional content and that can get very scary and very dangerous, especially if you're considering like a mother and a child and mother and a minor having a belief system.
Um, and I think there was a movie that one of the sisters did around this concept. Where do you guys remember the name of it was actually pretty well done and it was about, it was about Felicia who was about to people having a delusional thought system together, but there was active drug use as well.
So does that answer your question? Other questions?
So I'm interested in this aspect too, which is delusions in social media and how, um, you know, some, some of our younger generation, how social media is may impact this and we certainly see it think in psychiatry and the unit, some of the younger patients versus older patients in their content. And so we think about things like fandoms or groups of people who follow some pop pop culture item and how they lead their lives first into the fandom and then into the fiction itself.
And that's either shared by others are supported by others and doing the same thing. But then they start, you know, we start seeing a lot of younger people having these solutions of starting businesses or social media movements that make them the next billionaire famous civil rights leader, a high powered celebrity and that they've done that all through social media sites.
So I can't tell him to tell you how many people in my residency training I met who said that they were the next rapper and that they would actually share things on youtube or share things on instagram. And they would have some following from it.
And they really believed that meant they were the next lane, there's this really interesting idea that where there's the blur of obsession behind wanting to be and follow somebody and like have an admiration for celebrity, but then it turned into a dilution.
And so these are sort of the people that you see who are arrested for stalking a celebrity where it becomes this, you know, and maybe initially with some obsession with them and then it turned into a delusional system for them about how special that person was or that person loving them. Okay. Any questions about delusions? Right. Well that's good. Let's get into the nations. So this is different. It might kind of feel similar, but it's, it is quite different in psychiatry.
Hallucinations are our false sensory perceptions that occur in the absence of a revelent irrelevant external stimulation. And so we categorize these according to your senses. And so when people talk about hearing voices, seeing things or having a somatics type of feeling that's different from the delusion, which is that fixed false belief. And the overlap for me is always with what's the sematic delusion verses what's a sematic hallucination and that's a little bit difficult.
Um, so that, that idea or that concept of you guys have all felt your stomach rumble and having your, your intestines, the motility of them moving and that sensation that comes along with it that could get interpreted, interpreted as somebody who's delusional, that they're being snakes in the belly. Right? And so that would still, that would be considered a delusion still, whereas the hallucination might be this. Sorry, I'm sorry. I said the opposite.
So that would be a hallucination of sematic hallucination, whereas the delusion is going to be more like a more fixed continuous thing. Okay. Um, so let's just kind of March the day. So auditory and visual are the most common that we see in primary psychotic illnesses. When we start getting into these other three, we start thinking of organic reasons that somebody is having a hallucination. So auditory is that obviously this false perception of sound voices or music.
Um, and it's the absence of that sensory input. Okay. And that's the most common. And we're gonna run through a little bit of what is a primary psychotic hallucination versus a substance induced versus the malingering or a fake auditory hallucination, visuals, the false perception of site. And then tactile obviously is the physical experience. Um, I don't tend to, to, you know, hear these a whole lot from primary psychotic illness illnesses.
Um, if we see these a lot with alcohol withdrawal and we really start to worry about that as a part of something we call it delirium tremens.
When somebody starts to have tactile hallucinations, that's a really dangerous spot for them to be in olfactory or this false perception of smell and odors is always suggested that the medical etiology, because of where the olfactory nerves lie in the brain, they typically start to see somebody who has an old factory perception or a hallucination is having something wrong with their temporal lobe or the part of the brain that's towards the side, either seizures, lesions or Parkinson's.
Um, and you know, the description of olfactory hallucinations for me has always been something smelling really foul. Like they've never been good, which is unfortunate. And then gustatory or the false perception of of taste can be common as well, especially in seizures. So you people who have seizure disorder in a predictable or before they have a seizure state can describe this. I'm like burned sugar taste or a metallic taste or a salty taste.
So those last three really are indicative oftentimes have there been something medically wrong rather than a primary psychotic.
Okay. So when we ask about auditory hallucinations specifically, we're always asking about volume and clarity of the voices, whether they're continuous or intermittent, whether they're inside or outside the voice of the head, the number of voices involved, whether those voices talk to themselves, the gender of the voices, if they have command in quality in nature, meaning like Julia tell the person to do something if they're familiar and then any insight they have into them.
Yeah, these voices were there all the time or yeah, I have no idea what these are. So this helps us to kind of understand somebody, what they're experiencing. But it also helps us to understand the differences between something like primary psychotic auditory hallucinations versus, um, you know, substance induced mood lingered.
So people who have primary psychosis and dish, they describe auditory hallucinations, oftentimes described those voices being of both sexes, that they're spoken in the person's native language, that they're very clear and coherent voices and about 30 to 50 percent of the time have commanded type quality.
We see this as kind of a danger sign when somebody has a baseline hallucinations and then they'd beat a, become a command in nature that that tends to be a signal to us that there's the compensated psychosis and at the commands usually match the patient's speech pattern. So like you're not going to have somebody who knows very concrete and provides one word responses. Having voices that tell them these complex sentences.
You just said that baseline with these a of tourism destinations is that you're spending that someone consistently has auditory. So depending on their illness, because when I say primary psychosis, I'm talking about a group of diagnostic categories. I'm talking about schizophrenia. I'm talking about brief psychotic disorder. I'm talking about schizophrenia form, I'm talking about, we're talking about all these diagnoses, but I mean that somebody has a primary psychotic illness.
Psychosis is the most prominent part of their mental health issue
that makes sense.
And then the commands are not complex in nature and this is helpful and you know, um, you know, with forensic psychiatry and trying to determine this is somebody saying these symptoms because the voice is not going to tell you to stick your hand in the air and then bend over and touch the floor or the, that they're just not like that. When people have described them who then primary psychotic almost, it's not that way.
Adopting tends to be derogatory in nature or telling them to do one simple task. So is substance induced auditory hallucinations. There are some nuances. They don't tend to be as clear and coherent and they'll be described as noises, music, unintelligible voices. It's very uncommon for somebody who has a substance induced auditory hallucination to act on commands. If they're present, they'll describe the voices as being outside of the head rather than originating from inside.
And then they feel that the individuals are addressed indirectly, meaning kind of being talked about rather than talk to. And there's a reality testing around those voices may or may not be intact. And that really depends, um, you know, if somebody's actively using or not with alcohol use specifically, we tend to see like some derogatory voices or comments of people's everyday life and spiritual content. And then about 40 percent of them don't accept the voices as real.
So somebody just asked Corey, thanks for the question. Um, the voices that are mostly commands, are they bad things? Yeah. So that's an interesting question and that's also something that we're asking of the patient. So if somebody's having are endorsing command, auditory hallucinations, when they're not saying their commands type, you have to kind of infer that we say to the voices ever tell you to do something. And if they say yes, then we say it like what?
And sometimes they'll be like, oh, to eat a sandwich. And then sometimes I'll sit. And so you know, we're all, we're all obviously checking for safety around that. And then if somebody experiences command type auditorium, the stations to tell them to do bad things, we want to ask what's the likelihood of you acting on them too? Okay. So we, we kind of asked a number of questions around those.
Jimmy slips with St Paul so that they have a call frequently with the 90 year old woman who calls about being able to smell peppers that she's medically cleared. And I will actually say that we've had a lot of follow ups with elderly when it comes to hallucinations, a smell, but I don't know if it's just because it sticks out, but they're on and that's where they stick in their head. There's that one woman I went with, you smells blood on it is a common with elderly.
I mean it's really to me indicative of them having some organic etiology behind it, like it, it's not common in a primary psychotic illness for people to tell you that. Um, so to me it would, it would kind of alert me to think maybe we need to do neuroimaging on somebody to make sure that there's not a big mass lesion and dementia patients is kind of, you see that a lot. You do see some old factory hoops nation.
So if we're on a call and someone's like, this one particularly is call it a lot about these odd smells and we see them, who is it that we should give them a recommendation to go to
primary care? Yeah. And if they have a psychiatrist for that to be psychiatrist can advocate for the person getting any necessary medical workup and it might be unfounded, but it might, it might be, you might not get anything from it, but to meet with this person is, you know, this, this is a new symptom and they're complaining of that specific one that I wouldn't want to do more extensive medical workup with them.
Okay.
So visual hallucinations were always asking about the type and then kind of the qualities behind people. So behind the description of what they're seeing. So our people full size or are they in black and white or are they in color, did they occur with falling asleep or when they're awake and that became an important self. Talk to you in a minute about what we call normal hallucinations and then how fast they develop. Is this really.
There's some nuance between primary psychosis substance induced. So I have to say visual hallucinations are just not as common as auditory hallucinations and primary psychosis. And so this is just helpless. So with visualizations and primary psychosis, people are usually full size, are usually in color opening or closing, one size doesn't matter, doesn't make the visual hallucination go away and they can appear suddenly we're a substance induced.
Um, and by that, I'm sorry, I probably should explain that. I mean when somebody is intoxicated or has persistent psychotic symptoms with the absence of drug, um, which is a terrifying thing that can happen for people because they're typically less, um, well-described to their shadows. Flashing lights though the object. Very vivid colors or shapes, particularly with drugs like lsd or um, you know, a lot of the serotonin surge type of medications or drugs.
There's fitness of objects and then there's this, um, this concept of either small or really big things so like the description and the little green men is just not what that doesn't occur in primary psychosis. And so that can, that can be helpful when somebody is malingering symptoms as a way of gaining some other thing. Maybe admission to a hospital or disability lingered. Hallucinations. Typically they're, they're very atypical. Can't describe them. And in they're very big.
Okay. So this group of non pathological nations is probably something you have all experienced and wondered, oh my gosh, what does this mean? I'm not developing schizophrenia. These are all normal hallucination. So we categorize them. Yes. A quarter. Ryan, the APD has a question about the substance induced ones can also be from. It's a great question. Yes. So there are a group of medications, the classes of medications that can cause disturbances of mood or psychotic thinking.
The one that I always think about our, um, um, our steroid medications. So prednisone is a really good medication for a lot of things that can make people, really, they can make them mannequin, can make them depressed, it can make them psychotic. And so yes, there are medications that are prescribed that can cause, um, psych psychotic symptoms, but we don't actually call that substance induced psychosis. So substance induced would be something like an illicit substance causing psychotic.
Okay.
So, um, so yeah, so these non pathological, this nation, we have two categories, will fun fancy words, one's called hypnagogic hallucinations, which occur when we're falling asleep and that's normal. That's part of the brain going from state to sleeping state and then hypnopompic hallucinations or with somebody wake up. So who's nations occurring? Um, as you're coming out of that dream state and into the awakened state. And those are all non pathological but can be weird for people.
You guys experienced those before. It'd be abnormal if you hadn't come talk to me after. Okay. So we talk about, you know, we talked about delusions and hallucinations and then we kind of get into this area of illusions. And psychology is, this is a really interesting area of psychology and so we talk about some being pathologic and some non pathologic, but the what makes this different from and delusions, perceptual misinterpretation of a real external stimuli.
So there's some external thing that's there and our brain misinterprets it. And so just as we've kind of categorized the rest of these delusions and hallucinations, the same thing for Ellucian. So there's optical illusions and some people really like these and get behind these walls will show you a couple, but it's that the brain creates a visual interpretation of an object in the environment and then forms, forms of precept or an idea of what the brain comes up with.
So if there's any gap in that, your brain attempts to fill it and we'll go over that. So one of them is the bees. Old colors might seem different due to adjacent colors. There's auditory hallucinations and illusions. And this is really interesting. I think that's been studied in a lot of composers, especially Beethoven seemed to have a lot of these where there's a perception of sound that's not present in the students that there is a sound stimulus, but what that person hears, it's not there.
So these are called kind of impossible sounds. You can get a phd in this specific topic when it comes to. I mean you really can, and in music theory and composition, so I'm not going to give you a whole lot of examples, but if you want to like go down into a rabbit hole over this weekend, look at this. It's really cool. And Beethoven seem to have a lot of these. And then tactile hallucinations or illusions.
And so that's an example of that is um, a phantom limb where there's this perception of pain or other festivals, sensation where a patient has had actually had a removed like an arm or leg or a digit and they still feel a sensation. Okay? So who knows about the dress? What color is this guy's look? Hashtag blue, black, hashtag white gold. So this is people who don't know about this.
This, this, this, this, this like, you know, Internet sensation back in February of 2015 were a woman and I think it was in England's posted this, so she was for a wedding and the family was having an argument about this, about what color it was, and within a couple of days I think there were 10 million tweets about this and it became this like Internet sensation and it's a really great, a really great example of what a visual illusion is for our brains.
And so there's a number of neuroscientists who commented on this and it's really, it's a great example of how the human brain perceives color and then chromatic abduct adaptation. So I'm going to try my best to explain this, but this is kind of a nice way for us to all see what other people might be seeing. When I look at this picture, I see white and gold, but yeah. So that's why it became this Internet sensation, is that, how could you possibly see this other thing?
Okay. And so this is, this is what other people might be the trying to describe this, is that there's, the neuroscientists have gone over this that basically said that, you know, your visual system is looking at something, you're trying to discount what's called the chromatic bias of the daylight access. So either people discount the blue and you see white and gold or you just count the gold and you see blue and black.
Okay. So, um, yeah, it's, it's a, it's a really nice example of the visual illusion for people. Here's another one that's shared a lot. What do you all see here? Now you can see one, what do you see first? What is your brain? See First, and then if you look hard enough, you can oftentimes see the other, right? The idea behind a visual illusion that one sticks out to you first. And your brain interprets that first digital first.
So again, if you want to like lose yourself down on Internet rabbit hole, just start looking these up. They're pretty fun. It's really interesting. Okay. And so, you know, again, when Matt asked me to do this lecture, I think the only thing that's about all of this is that when patients is experiencing symptoms, you want to, you know, we're doing our best to try and help them to understand them, but also to help them live a life with them.
And so that's what spooky about this, but just to say a little sticky words about Halloween that it's a really interesting time for psychologists to study behavior because there's this idea of costumes and crowds equal anonymity in this, you know, d, individualization, and that oftentimes results in antisocial. So you guys are busy, I'm sure on Halloween. I'd love to see your numbers. I'm the psychologist back in the 19 seventies.
That's a really interesting study around Halloween and candy and wanted to research how factors, three factors specifically influenced peoples and children's, but people he met children's willingness to steal extra candy. So if I want you to come away with anything from those lecture, it's don't leave candy out for people to take one piece because they walked.
So what they did in this study is they identify, they haven't identified a group or an anonymous condition than a group size and responsibility, and so they basically have like a regular house, but it was set up to be observed how many pieces of candy people stole. So if the kids came in as an individual in the study participants that the organizer would ask them some identifying information like which house do you have, what's your name? And then others, they would not ask that information.
Um, and then sometimes with a group they would say you're responsible to make sure that no other children take more than one. Um, and these were the results they got. So basically, as you can see within the graph that being in a group being anonymous, greatly increase the likelihood that steel extra community. So the kids who are alone and identified stole seven point percent of the time. Whereas kids who were anonymous group stole 57 point seven percent.
Essentially they get a grant for that research. That was in 70 years. No Way. It was just so, um, that's all I have for you all today. What, what questions come up or comments and a question about is there any kind of treatment medication or other treatment that actually helps with someone that's experiencing hallucinations and someone that is living with the experiences which. Well, absolutely, I mean we like to think so in psychiatry.
Yeah, because we've got the group of antipsychotic medications and we can classify them according to when you kind of come out and then some of the side effects that they cost. You hear a lot about first generation and second generation antipsychotic medications and that's the first line treatment for people who have divisions. Unfortunately, delusional belief systems are really, really hard to target.
Um, and oftentimes medications don't work for that, but um, you know, antipsychotics do work really well to lower intensity of the types of hallucinations people. You'll meet people who have schizophrenia and say that they never can get rid of their nations, but if they can lower them in terms of volume or they can find other ways of distracting themselves and they'll know then you know, some people have really good insight and knowing like, my voice hasn't gotten louder.
I need to go to the hospital. Does that answer your question? The people we see with aps. What about ghosts and paranormal? Where does that. It's a whole nother lecture. Cory. I could have. We could have designed one just on that, but again, but this. I don't want to.
I want to shy away from this being part of the delusional system for people because it's a cultural, you know, as a culture and certainly religious groups and cultural groups can really believe in ghosts and paranormal belief systems. I think where you start to get into trouble as how, how that impacts your life.
Like if somebody believes in ghosts, but the next step preoccupies everything about their wife or they can no longer hold the job, they, they can't have a meaningful relationship with another person. That sort of thing that, that, that might, you know, I see that. That's not a really serious question. That is a serious question. What other questions?
Good. I'm glad.
Well, thank you all for your attention. I appreciate you letting me talk to you today. Thank you. Thank you. That was really good.
Okay.
They still the difference between the substance substance induced one versus mental health as the first time I've ever heard it broken down like that. Well we considered both mental health and I don't wanna like I don't want to discount. I don't want to discount or when somebody is intoxicated with the substance that is a real for them and even though the etiology of the origination of the symptom is very different and it might mean very different treatment that, that that's really.
That is really frightening for them and could be potentially dangerous to the public. So although there's this difference, I don't want anybody to walk away from a lecture thinking that I'm saying one is more important than the other.
They're both in law enforcement when it comes to the use, they might be better served in criminal justice setting, some kind of possibly like drug court versus being taken to an emergency center if they're going to get, you know, they don't benefit from inpatient treatment. And this is kind of a topic of debate a lot.
We'll have people come into pes who are intoxicated with methamphetamines specifically and who are very agitated and they're usually agitated because they want to leave and then you run into this, do we medicate this person? Do we forced medications on this person who cannot keep their stuff together and probably can't keep their stuff together when they leave either and force them to stay or do we let them go and hope that they do okay outside?
Because once you forced medications on somebody to the muscle, you're really, you're like, you know, you're, you're basically condemning them to a sentence of 48 hours and four to eight hours in pdf. You don't want to let somebody go right after the medication. Um, so that's kind of a constant debate in ps two is can this patient, can they leave here and not hurt themselves or other people? So it's a hard. It's a hard question to answer.
How does that fall into the categories of delusions or anything? A really good question that people will do certain things in there. They're normally accepted things that we do in our society, like knock on wood, that's a super superstitious belief that if you don't do, if you don't knock on wood or touch wood as people say in Britain, that something bad is going to happen to you. So this is again a continuum.
The people can experience this and have a normal, healthy, non pathologic life of having the superstitious thoughts or it can become part of either a psychotic symptoms, psychotic illness or obsessive compulsive disorder. Superstitious thought occur curl lot and obsessive compulsive disorder. And that's when things just get in the way of you having a normal life.
So believing that you need to walk, you know I'm a certain way to work, that you need to drive a certain way to work and then if that some of that gets impacted in some way that you like, your day will come when it actually affects your job, not your job, your life, because people have tons of superstitions, are still playing the game, but you can't do something lucky pair of socks, because I was going to talk to you guys. What do they call it in Britain? Don't say that.
That's a lawsuit waiting to learn that the hard way didn't like prevalent and in sports.
That's awesome. The.