Brain illness and creativity: Mechanisms and treatment risks

Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Canadian journal of psychiatry. Revue canadienne de psychiatrie (Impact Factor: 2.55). 03/2011; 56(3):132-43.
Source: PubMed

ABSTRACT Brain diseases and their treatment may help or hurt creativity in ways that shape quality of life. Increased creative drive is associated with bipolar disorder, depression, psychosis, temporal lobe epilepsy, frontotemporal dementia, Parkinson disease treatments, and autism. Creativity depends on goal-driven approach motivation from midbrain dopaminergic systems. Fear-driven avoidance motivation is of less aid to creativity. When serotonin and norepinephrine lower motivation and flexible behaviour, they can inhibit creativity. Hemispheric lateralization and frontotemporal connections must interact to create new ideas and conceptual schemes. The right brain and temporal lobe contribute skill in novelty detection, while the left brain and frontal lobe foster approach motivation and more easily generate new patterns of action from the novel perceptions. Genes and phenotypes that increase plasticity and creativity in tolerant environments with relaxed selection pressure may confer risk in rigorous environments. Few papers substantively address this important but fraught topic. Antidepressants (ADs) that inhibit fear-driven motivation, such as selective serotonin reuptake inhibitors, sometimes inhibit goal-oriented motivation as well. ADs that boost goal-directed motivation, such as bupropion, may remediate this effect. Benzodiazepines and alcohol may be counterproductive. Although dopaminergic agonists sometimes stimulate creativity, their doing so may inappropriately disinhibit behaviour. Dopamine antagonists may suppress creative motivation; lithium and anticonvulsant mood stabilizers may do so less. Physical exercise and REM sleep may help creativity. Art therapy and psychotherapy are not well studied. Preserving creative motivation can help creativity and other aspects of well-being in all patients, not just artists or researchers.

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    • "Others have emphasized noradrenergic mechanisms to achieve similar network dynamics (McClure et al., 2006). We believe this view advances conceptualization of the role of DA in creative cognition beyond models in which DA was suggested to have a unitary function by facilitating " working memory " or " mental associations " (Flaherty, 2011), or " flexibility " as manifest in higher-order personality traits (DeYoung, 2006). This theory may help provide a neural systems basis for the theory that creativity results from Blind Variation and Selective Retention (BVSR) (Campbell, 1960; Simonton, 2011a,b). "
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    ABSTRACT: Complexity theorists have suggested that production "on the edge of chaos" is important to self organization and evolutionary change in thermodynamic systems, biology, and economics. We apply this heuristic to cognitive systems and neural network activation states, which can vary from an ordered (predictable) regime, to a chaotic (unpredictable) regime. Evolutionary cytoarchitectonic theory specifies complementary anatomical systems governing stability and flexibility. Psychopathology is associated with shifts in the regulation of stability and flexibility, and may yield both increased redundancy and increased entropy within the same individual. We suggest this fits existing literature showing: (a) examples of exceptional creativity in individuals with mental illness, without an overall increase in creative achievement associated with "madness" (b) increases in creative achievement among relatives of people with mental illness, or people with milder syndromes, for whom increased flexibility or stability is less disabling; and (c) effects of pharmacological manipulations, suggesting an inverted-U function resembling the Yerkes-Dodson Law, possibly linked to tonic and phasic dopaminergic transmission.
    Frontiers in Psychology 09/2014; 5:1104. DOI:10.3389/fpsyg.2014.01104 · 2.80 Impact Factor
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    • "Slepian and Ambady (2012) found that subjects performed better on cognitive tasks related to creativity when moving their arms in fluid movements compared with not moving their arms. Longer term studies have found that chronic exercise also seems to increase creativity, but that is on the time scale of weeks or months (Flaherty, 2011). Putting together all of these observations with our own results, we suggest that people should not be concerned that walking while thinking will impair their cognitive performance. "
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    ABSTRACT: When humans walk in everyday life, they typically perform a range of cognitive tasks while they are on the move. Past studies examining performance changes in dual cognitive-motor tasks during walking have produced a variety of results. These discrepancies may be related to the type of cognitive task chosen, differences in the walking speeds studied, or lack of controlling for walking speed. The goal of this study was to determine how young, healthy subjects performed a spatial working memory task over a range of walking speeds. We used high-density electroencephalography to determine if electrocortical activity mirrored changes in cognitive performance across speeds. Subjects stood (0.0 m/s) and walked (0.4, 0.8, 1.2, and 1.6 m/s) with and without performing a Brooks spatial working memory task. We hypothesized that performance of the spatial working memory task and the associated electrocortical activity would decrease significantly with walking speed. Across speeds, the spatial working memory task caused subjects to step more widely compared with walking without the task. This is typically a sign that humans are adapting their gait dynamics to increase gait stability. Several cortical areas exhibited power fluctuations time-locked to memory encoding during the cognitive task. In the somatosensory association cortex, alpha power increased prior to stimulus presentation and decreased during memory encoding. There were small significant reductions in theta power in the right superior parietal lobule and the posterior cingulate cortex around memory encoding. However, the subjects did not show a significant change in cognitive task performance or electrocortical activity with walking speed. These findings indicate that in young, healthy subjects walking speed does not affect performance of a spatial working memory task. These subjects can devote adequate cortical resources to spatial cognition when needed, regardless of walking speed.
    Frontiers in Human Neuroscience 05/2014; 8:288. DOI:10.3389/fnhum.2014.00288 · 2.99 Impact Factor
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    • "Many case reports confirm exacerbation or revelation of creative art work in PD patients treated by dopamine replacement therapy (DRT) and especially dopamine agonists (10–13). Very thoughtfully and exhaustive reviews sustain strongly the link between dopaminergic treatment and awakening of creativity in PD, but to date, there is only case report and no group study permitting to support this assertion (6, 14). Deep brain stimulation (DBS) of the subthalamic nucleus (STN) allows reduction of DRT by 50% on average, maintaining a stable and relatively good motor state (15). "
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    ABSTRACT: Background: Parkinson's disease (PD) is characterized by reduced flexibility, conceptualization, and visuo-spatial abilities. Although these are essential to creativity, case studies show emergence of creativity during PD. Knowledge about the role of dopamine in creativity so far only stems from a few case reports. We aim at demonstrating that creativity can be induced by dopaminergic treatments in PD, and tends to disappear after withdrawal of dopamine agonists. Methods: Eleven consecutive creative PD patients were selected from candidates for subthalamic nucleus deep brain stimulation (STN DBS) surgery, and compared to 22 non-creative control PD patients. Motor disability (UPDRS III), cognition (Frontal score, Mattis scale), and behavior (Ardouin scale) were assessed before surgery and 1 year after. Results: Before surgery, whereas cognitive and motor assessments were similar between groups, dopamine agonist (but not levodopa) dosages were higher in creative patients (p = 0.01). The Ardouin scale revealed also a specific psycho-behavioral profile of creative patients which had higher scores for mania (p < 0.001), hobbyism (p = 0.001), nocturnal hyperactivity (p = 0.041), appetitive functioning (p = 0.003), and ON euphoria (p = 0.007) and lower scores for apathy and OFF dysphoria (p = 0.04 for each). Post-operative motor, cognitive, and behavioral scores as dopaminergic treatment dosages were equivalent between groups. Motor improvement allowed for a 68.6% decrease in dopaminergic treatment. Only 1 of the 11 patients remained creative after surgery. Reduction of dopamine agonist was significantly correlated to the decrease in creativity in the whole population of study (Spearman correlation coefficient ρ = 0.47 with confidence index of 95% = 0.16; 0.70, p = 0.0053). Conclusion: Creativity in PD is linked to dopamine agonist therapy, and tends to disappear after STN DBS in parallel to reduction of dopamine agonists, which are relatively selective for the mesolimbic D3 dopamine receptors.
    Frontiers in Neurology 04/2014; 5:55. DOI:10.3389/fneur.2014.00055
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