The reality show: a new phenomenological variant of psychosis

Reality: una nuova variante fenomenologica della psicosi

A. D’Agostino, A. Castelnovo, S. Cavallotti, S. Scarone 

Department of Health Sciences, University of Milan, Italy; Department of Mental Health AO San Paolo, Milano, Italy


Surprisingly few delusional themes are known to recur in psychosis. However, cultural variables determine specific contents within the delusions. The terms “Truman syndrome” and “Truman Show delusion” have been used to describe a novel content emerging in Western civilization. We describe the first case outside of English-speaking countries that appears to exemplify the transition from prodromal syndrome to a full-blown psychotic disorder.

Case report

A male patient came to our attention several years after the beginning of symptoms who had never received prior psychiatric treatment. Initially suspicious and elusive, after partial response to antipsychotic treatment, he began to reveal a complex delusional system within which his life was captured by hidden cameras for a television show. Aside this general grandiose thematic, he believed his parents were not real but rather actors in a script like most of his relatives and friends. During acute symptomatic exacerbations he was convinced of being poisoned at home and led a withdrawn and isolated lifestyle. Although he never agreed with a formal diagnosis of schizophrenia and was rarely compliant to medication, he was able to doubt most of his delusions outside of the acute phase, and gave a detailed description of what can be viewed as the prodromal phase of his illness. The case is discussed with reference to currently available neurobiological and phenomenological explanations of the development of delusions.

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