Creativity and Mental Illness: A Case Study of a Patient with Progressive Bulbar Palsy

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.