João Caseiro^I; Otília Queirós^I

^I Department of Child and Adolescent Psychiatry, Centro Hospitalar do Porto. 4099-001 Porto, Portugal. joao_caseiro@hotmail.com; otiliaqueiroz.pedopsiquiatria@chporto.min-saude.pt

ABSTRACT

We describe the clinical cases of two 17 year-old patients presenting a first psychotic episode in which football was central to their delusional beliefs. These two patients were admitted with a five-month’s gap in an inpatient clinic after the intervention of the authorities who conducted them to the emergency room.

Football has become the main global mass entertainment phenomenon of the contemporary European society. Therefore, it’s not surprising that in the year that Portuguese football had its most glorious moment with the Euro Cup victory, the game took part in the delusional beliefs of two young people presenting their first psychotic episode.

With the description of these two clinical cases we intend to emphasise on the relation between socio-cultural features and the content of the delusional beliefs.

Keywords: Adolescent; culture; delusions; football

RESUMO

Descrevemos os casos clínicos de dois adolescentes que apresentaram um primeiro surto psicótico no qual o futebol era uma parte central das suas crenças delirantes. Estes utentes foram admitidos, com um intervalo de cinco meses, na unidade de internamento após a intervenção das autoridades que os conduziram à urgência.

O futebol tornou-se o principal fenómeno de massas da sociedade europeia contemporânea. Assim, não é de estranhar que no ano em que o futebol português atingiu o seu ponto mais alto, com a vitória no Campeonato Europeu de futebol, o jogo tenha sido incluído nas crenças delirantes de dois jovens que apresentam o seu primeiro episódio psicótico.

Com a descrição destes dois casos pretendemos colocar a ênfase na relação entre características socioculturais e os conteúdos dos delírios.

Palavras chave: Adolescente; cultura, delírio, futebol

We report the clinical cases of two adolescents presenting with a first psychotic episode in which football was central to their delusional beliefs, emphasising the influence of socio-cultural features on the contents of the delusional thoughts. To collect the data, the inpatient clinic files were reviewed, and information was extracted.

Clinical Case 1

A 17 years-old male adolescent with no previous contact with the Mental Health Services was admitted in our inpatient clinic from the emergency room (ER). He was conducted to the ER by the authorities after having set fire to a forest near his house and presenting a grossly disorganized behaviour.

In the inpatient clinic the patient presented with persecutory, referential and grandiose delusions. He believed he was being persecuted by the police and that by setting fire to the forest he would be able to confront them as they would come to evaluate the situation.

For more than one occasion he was found under the bed or inside a closet in great anguish. When confronted with this behaviour he reported being hiding from people related to the football team Sport Lisboa e Benfica (SLB): He thought they wanted to harm him after he went to a national championship celebration wearing a Sporting Clube de Portugal (SCP) jersey under his jacket.

His epiphanic moment corresponded to an eye blink by the football player Ricardo Quaresma that he saw in television. He believed that some of the behaviours of not only Quaresma but also Cristiano Ronaldo during the Portuguese national football team games were directed at himself. He had the conviction that Ronaldo imitated his photos on Facebook and that Quaresma had copied some of his best plays, a situation that he found dangerous as this could attract attention on him. He also thought that he could play football better than any of these players.

According to his parents he had presented behavioural changes for the last four months, he showed avolition and started isolating in his bedroom, skipping classes and presenting progressive insomnia. He was a cannabis user and the frequency of his consumptions increased steadily in this period.

In the last month he frequently talked about his fear of being killed and his speech became progressively more disorganized.

No hallucinations were ever found.

Clinical Case 2

A 17 years old adolescent who had no previous contacts with psychiatry was hospitalized in our inpatient clinic from the ER to where he was conducted by the police for severe aggressive behaviour and where an elated mood and a disorganized speech were also observed.

According to his parents he started to present in the last ten days, acute behaviour changes, a verbally aggressive speech with persecutory contents. His parents where the ones who called the police since he was physically aggressive towards them.

When in the inpatient clinic, the patient showed profuse delusions with mainly grandiose but also referential and persecutory contents. He had the firm conviction that he had the ability predict football matches’ results and that he was an outstanding player that would soon sign by a major football team.

He also told us that the polemical SCP President had directed him an eye blink trough the television to invite him to become SCP coach as he knew that under his command the club would achieve success. Not only Leonel Messi but also the best Portuguese players would want him to sign for the team. He considered that SCP President had orchestrated his hospitalization as a punishment for him refusing to coach the team.

Auditory hallucinations were also described, the patient would hear many voices arguing and calling his name.

According to Altschuler one of the first descriptions of delusions was made by Gogol in his 1835 short story Diary of a madman where the main character presents with a grandeur delusion, believing he is the king of Spain.¹ In the second decade of the 20^th century, Southard was the first to publish an effort to evaluate the contents of delusions; he investigated possible association between delusional content and organic disease, that he could not prove.²

Most samples that analyse delusional content reveal that persecutory are the most frequent, being grandiose, somatic or religious contents also common. If this order seems to be stable over time, there are some variations in the frequencies.²

After 1950 studies report an increase in the frequency of persecutory and self-reference delusions.^2,3 The authors of these studies found two plausible causes for this. First, the influence of Kurt Schneider work and second, the Cold War and related technological developments. As these studies were retrospective and based in case reports in different periods, the diffusion of Schneiderian ideas that were very influential in the field of psychiatry in this period, namely the first-rank symptoms, might have led to an increase in the description of these specific delusional contents.³

Some of the contents tend to reflect the culture at that time, as Stompe et al refer, there was a focus on syphilis in the early 1900s, nazis during the World War II, communists during the Cold War and technology in recent years.⁴

In another study, in a Slovenian schizophrenic population between 1881 and 2000, it was also concluded that delusional contents are correlated with historical events.³ Radio and television spread were correlated with an increase in delusions of control and urbanization, which possibly lead to an increase in persecutory contents.

When comparing samples from Japan, Germany and Austria, patients from Europe were more likely to have individually oriented persecutory contents and Japanese more group oriented delusions of reference.⁵ This also indicates that culture influences the delusional contents.

To our knowledge there is no study analysing the delusional contents of Portuguese patients.

Despite some authors claiming that delusion type can be associated with patients’ response to treatment this has be interpreted with caution.^2,6 Debowska et al report that patients with thought-broadcasting delusions followed by patients with delusions of grandeur were more likely to present lower treatments acceptance rates when compared with patients with other types of delusions.⁶ The authors present as a possible cause for this the lower insight and capacity of judgement these patients present.

The two patients were admitted in the inpatient clinic with a gap of approximately five months and shared many features. First, the fact that they were both Sporting Clube de Portugal (SCP) supporters and that their epiphanic moment corresponded to an eye blink seen in television. Secondly, apart from their persecutory delusional belief they both presented grandiose delusions as they thought that they could play football better than Cristiano Ronaldo. They presented with a dangerous behaviour that required police intervention, and serious impairment of their judgment. Due to the absence of insight and refusal of treatment one of these patients was kept hospitalized under court order.

Football has become the main global mass entertainment phenomenon of the contemporary European society. Therefore, it’s not surprising that, in the year that the Portuguese football had its most glorious moment with the Euro Cup victory, the game took part in the delusional contents of two young people presenting their first psychotic episode.

With the description of these two clinical cases we intend to emphasise the fact that there seems to be a clear relation between socio-cultural features and some of the contents of delusional beliefs.

1. Altschuler EL. One of the oldest cases of schizophrenia in Gogol´s diary of a madman. British Medical Journal. 2001; 323:22-9.         [ Links ]

2. Cannon BJ, Kramer LM. Delusion content across the 20th century in an American psychiatric hospital. International Journal of Social Psychiatry. 2012; 58:323-7.         [ Links ]

3. Škodlar B, Dernovšek MZ, Kocmur M. Psychopathology of schizophrenia in Ljubljana (Slovenia) from 1881 to 2000: changes in the content of delusions in schizophrenia patients related to various sociopolitical, technical and scientific changes. International Journal of Social Psychiatry. 2008; 54:101-11.         [ Links ]

4. Stompe T, Ortwein-Swoboda G, Ritter K, Schanda, H. Old wine in new bottles? Psychopathology. 2003; 36:6-12.         [ Links ]

5. Tateyama M, Asai M, Hashimoto M, Bartels M, Kasper S. Transcultural study of schizophrenic delusions. Psychopathology. 1998; 31:59-68.         [ Links ]

6. Debowska G, Grzywa A, Kucharska-Pietura K. Insight in paranoid schizophrenia: It’s relationship to psychopathology and premorbid adjustment. Comprehensive Psychiatry. 1998; 39:255-60.         [ Links ]

João Caseiro
Department of Child and Adolescent Psychiatry
Centro Hospitalar do Porto
Largo Professor Abel Salazar
4099-001 Porto
Email: joao_caseiro@hotmail.com

Received for publication: 19.07.2017
Accepted in revised form: 02.11.2017