# Physician reinforcement of somatic delusions in schizophrenia: a case report and narrative review - URL: https://alisanburak.com/en/wcp-2026-posterler/ev0574 - Language: en - Last updated: not specified - Page title: Physician reinforcement of somatic delusions in schizophrenia: a case report and narrative review | WCP 2026 Summary > Well-intentioned, validating medical documents reinforced somatic delusions in a patient with schizophrenia, iatrogenically worsening the course of the illness. This page was translated automatically from Turkish. [Read the original](https://alisanburak.com/wcp-2026-posterler/ev0574) This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it. EV0574 E-PosterPsychosis and SchizophreniaCase report and narrative review # Physician reinforcement of somatic delusions in schizophrenia: a case report and narrative review PHYSICIAN REINFORCEMENT OF SOMATIC DELUSIONS IN SCHIZOPHRENIA: CASE AND NARRATIVE REVIEW Presenter: Joeseph Kramkowski Country: United States of America Institution: Endeavor Health (University of Chicago affiliation) Well-intentioned, validating medical documents reinforced somatic delusions in a patient with schizophrenia, iatrogenically worsening the course of the illness. The study aims to examine whether physicians can inadvertently reinforce delusional beliefs and whether clinical documentation can worsen outcomes in psychotic disorders. The method combined the case of a 50-year-old man diagnosed with schizophrenia who had prominent somatic delusions with a PubMed search using the queries 'BADE schizophrenia' and 'iatrogenic AND medically unexplained symptoms'; a total of 44 articles (28 related to BADE and 16 to iatrogenic effects) were assessed, and 10 articles were included in the narrative review after screening. In this case, the primary care physician wrote letters in 2018 endorsing the patient's supplement regimen and requesting its continuation on psychiatric wards, in 2021 reporting the dangers of psychotropic medications, and in 2025 documenting diagnoses of building-related syndrome, myalgic encephalomyelitis, toxic mold, and multiple chemical sensitivity; the patient used these letters and the results of organic acid and mycotoxin tests as evidence for his delusions. When the 2025 letter was withdrawn on the grounds that it validated his somatic delusions, the patient's paranoia increased, he developed the belief that the insurance company had contacted his physicians, and his distrust of healthcare professionals deepened; his functioning declined from independent living to nursing home care, and more than 35 inpatient admissions over the course of his illness had nearly exhausted his lifetime psychiatric inpatient coverage. The review described BADE (Bias Against Disconfirmatory Evidence) as a specific cognitive deficit independent of mental ability, memory, IQ, and executive functioning; it was reported to be more pronounced during periods of active delusions, to be a marker of the current psychotic state rather than a stable trait, to extend beyond specific delusions and affect thinking more broadly, and to be specific to delusions in schizophrenia, in contrast to obsessive-compulsive disorder (OCD). The review also reported that, in one study, patients assigned excessive weight to confirmatory evidence, that uncertainty and high volatility in decision-making were associated with paranoid thinking, and that physician validation of medically unexplained symptoms worsened long-term outcomes. The authors emphasize that requests for documentation in patients with active delusions may exacerbate somatic delusions even when they appear harmless, that somatic complaints must nevertheless be taken seriously, and that collaboration with other specialties is necessary before providing documentation. Limitations include reliance on a single case, the difficulty of distinguishing delusional belief from secondary gain, the absence of a formal BADE assessment, and the narrow scope of the search terms. [View the original poster](https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/2072) How to cite this study APA 7: Schmiedeknecht, M., Medina-Echeverria, J., Goldenberg, A., & Kramkowski, J. (2026, September 23-26). Physician reinforcement of somatic delusions in schizophrenia: case and narrative review [E-poster]. 26th WPA World Congress of Psychiatry (WCP 2026), Stockholm, Sweden. https://cslide.ctimeetingtech.com/wcp26/attendee/eposter/file/2072 Vancouver: Schmiedeknecht M, Medina-Echeverria J, Goldenberg A, Kramkowski J. Physician reinforcement of somatic delusions in schizophrenia: case and narrative review [e-poster]. 26th WPA World Congress of Psychiatry (WCP 2026); 2026 Sep 23-26; Stockholm, Sweden. 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