Disney Plus Dream Job: Lady and the Tramp

Introduction

Faculty, residents, and students at my university are participating in the Disney Plus Dream Job and watching 30 Disney films in 30 days. Welcome to our Day #13 blog post! Course directors successfully incorporated the 30 films (and shows) into our preexisting curriculum that teaches psychiatry to future physicians through film and other aspects of popular culture. Views Through the Psychiatrist’s Lens will publish daily blogs throughout the 30-day Disney Plus Dream Job. Our thirteenth blog is on the 1955 film, Lady and the Tramp.

Synopsis

Lady and the Tramp (1955) is a musical romance produced by Walt Disney based on the story of “Happy Dan, The Cynical Dog” by Ward Greene. The animated story of puppy love is about a Cocker Spaniel named Lady who meets and has romantic interludes with a stray mutt named Tramp.

At the time of this posting, the film holds a rating of 7.3 out of 10 on IMDb and a tomatometer rating of 93% on Rotten Tomatoes.

How it relates to the field of psychiatry

With so many perspectives to consider, this blog will focus on Trusty, a bloodhound and Jock’s best friend who has lost his sense of smell. Anosmia is the clinical term describing the inability to smell and is estimated to afflict 3% of the US population older than the age of 40 (1) and may also result from various respiratory illnesses (as one would expect). Medication side effects can also lead to olfactory defects. Consistent with pathologies that affect breathing (B) being common causes of anosmia, the implicated medications are the ABC’s …and Z of anosmia: ACE inhibitors and anti-thyroid drugs, Beta blockers, Calcium channel blockers such as dihydropyridine, and intranasal Zinc This blog will take a look at some potential causes of anosmia that relate to psychiatric disorders (with the exception of rhino-sinusitis below) and take into account other signs manifested in Trusty to uncover what ails the old Bloodhound. While Trusty is the focus of clinical attention, the psychiatric conditions that can cause anosmia may be remembered by the acronym TRAMP, the eponymous character of the 1955 Disney classic.

Tramp

Traumatic Brain Injury (TBI) is a common cause of anosmia as trauma to the head can cause damage to the nose or sinuses leading to a mechanical blockage and obstruction. Olfactory neurons have regenerative capabilities so anosmia due to TBI may be temporary depending on the area and extent of the injury (2).

tRamp

Rhino-sinusitis, rhinitis, and nasal polyps cause anosmia through inflammation of the mucosa as well as direct obstruction. While not a psychiatric or neurological condition, they account for the majority (50% to 70%) of anosmia cases and are therefore included here.

trAmp

Studies have found an association between anosmia and neurodegenerative disorders such as Alzheimer disease (AD). AD is a Major Neurocognitive Disorder hallmarked by the slow onset and gradual progression of impairment in two or more cognitive domains. The course differentiates Major Neurocognitive Disorder from other conditions defined through an acute onset and fluctuating course such as delirium. In this way, the case study of Lady and The Tramp distinguishes from that of Lady Macbeth.

traMp

Multiple sclerosis (MS) is a chronic autoimmune disease that attacks myelinated axons in the central nervous system affecting different anatomic locations. MS-related anosmia is related to lesions in the olfactory regions in the brain including the inferior frontal and temporal lobes (3).

tramP

While neurodegenerative diseases such as AD may cause anosmia, studies have also linked the lowered ability to perceive smell with increased risk of neurodegenerative diseases. The highest association is between anosmia and the later development of Parkinson disease, dementia with Lewy bodies, and multisystem atrophy.

Conclusions

Given Trusty’s co-occurring memory loss, his anosmia is most likely due to Alzheimer’s disease. The pathophysiology of AD includes the deposition of plaques in the hippocampus, a subcortical structure that helps to encode memories. AD is the most common neurodegenerative disorder and the sixth most common cause of death in the US (4) and evidently a significant source or morbidity among bloodhounds (not really).