Hypothalamic-pituitary-adrenal axis dysregulation in depersonalization disorder.
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BACKGROUND: The purpose of this preliminary study was to investigate HPA axis function in dissociation. METHODS: Nine subjects with DSM-IV depersonalization disorder (DPD), without lifetime Posttraumatic Stress Disorder (PTSD) or current major depression, were compared to nine healthy comparison (HC) subjects of comparable age and gender. RESULTS: DPD subjects demonstrated significant hyposuppression to low-dose dexamethasone administration and significantly elevated morning plasma cortisol levels when covaried for depression scores, but no difference in 24-hour urinary cortisol excretion. Dissociation scores powerfully predicted suppression whereas depression scores did not contribute to the prediction. CONCLUSIONS: Primary dissociative conditions, such as depersonalization disorder, may be associated with a pattern of HPA axis dysregulation that differs from PTSD and merits further study. (+info)
Separating depersonalisation and derealisation: the relevance of the "lesion method".
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OBJECTIVES: Depersonalisation (DP) and derealisation (DR) are often met with in patients with a wide range of localisable neurological conditions. This suggests that the "lesion method" might be a valid approach to study the neurobiology of DP/DR. However, the fact that anxiety can trigger DP/DR makes it difficult to establish whether the presence of DP/DR in neurological patients is mainly determined by coexisting anxiety or by lesion location. To overcome this difficulty, we suggest the study of neurological phenomena, which although not considered as DP/DR, bear enough phenomenological resemblance with them as to warrant their use as models. METHODS: One patient with "visual hypoemotionality" and another with "hemiasomatognosia" are described in detail together with a selective literature review. RESULTS: Complaints of patients with visual hypoemotionality are indistinguishable from those of patients with "visual derealisation". There is also a phenomenological overlap between "asomatognosia" and the symptom of "body alienation", which is a central feature of depersonalisation. CONCLUSIONS: Phenomenological similarities between visual hypoemotionality and DR suggest that a disruption of the process by means of which perception becomes emotionally coloured may be an underlying mechanism in both conditions. Likewise, phenomenological overlaps with asomatognosia suggest that DP might result from parietal mechanisms disrupting the experience of body ownership and agency. These findings give validity to the notion that DP and DR may have distinct neurobiological mechanisms. (+info)
Depersonalisation disorder: clinical features of 204 cases.
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BACKGROUND: Depersonalisation disorder is a poorly understood and underresearched syndrome. AIMS: To carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic. METHOD: A total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM-IV criteria. RESULTS: The mean age of onset was 22.8 years; early onset was associated with greater severity. There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM-IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. 'Dissociative amnesia' was not prominent. CONCLUSIONS: Depersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted. (+info)
Depersonalization-derealization syndrome induced by reboxetine.
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A high variety of factors have been implicated in the emergence of depersonalisation and derealisation episodes, including different drugs. A case abruptly induced by two applications of reboxetine, a selective and specific norepinephrine reuptake inhibitor, is reported occurring in a 50-year-old woman treated for a major depressive episode. The episode rapidly remitted after discontinuation of reboxetine. Previous data having indicated a role of the serotonin system in the pathophysiology of the phenomenon, a noradrenaline induced serotonin liberation of Raphe neurons is suggested as possible underlying mechanism. (+info)
Interpersonal conflict, social support, and burnout among home care workers in Japan.
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To examine associations between interpersonal relationships in work settings and burnout, a cross-sectional survey was conducted on home care workers in Sapporo, Japan, by using the Maslach Burnout Inventory (MBI) and scales of interpersonal conflict and social support developed by the authors. Questionnaires were distributed among 303 subjects and returned by 243 subjects (80%). Complete answers were obtained from 106 subjects and were used for analysis. In multiple regression analyses, conflict with clients and their families significantly related to emotional exhaustion and depersonalization of the MBI (p<.05). Supervisory conflict significantly related to emotional exhaustion (p<.05), whereas coworker conflict significantly associated with depersonalization (p<.01). It is suggested that conflicts with clients' families, as well as clients, are important indicators for emotional exhaustion and depersonalization of home care workers. (+info)
Out-of-body experience and autoscopy of neurological origin.
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During an out-of-body experience (OBE), the experient seems to be awake and to see his body and the world from a location outside the physical body. A closely related experience is autoscopy (AS), which is characterized by the experience of seeing one's body in extrapersonal space. Yet, despite great public interest and many case studies, systematic neurological studies of OBE and AS are extremely rare and, to date, no testable neuroscientific theory exists. The present study describes phenomenological, neuropsychological and neuroimaging correlates of OBE and AS in six neurological patients. We provide neurological evidence that both experiences share important central mechanisms. We show that OBE and AS are frequently associated with pathological sensations of position, movement and perceived completeness of one's own body. These include vestibular sensations (such as floating, flying, elevation and rotation), visual body-part illusions (such as the illusory shortening, transformation or movement of an extremity) and the experience of seeing one's body only partially during an OBE or AS. We also find that the patient's body position prior to the experience influences OBE and AS. Finally, in five patients, brain damage or brain dysfunction is localized to the temporo-parietal junction (TPJ). These results suggest that the complex experiences of OBE and AS represent paroxysmal disorders of body perception and cognition (or body schema). The processes of body perception and cognition, and the unconscious creation of central representation(s) of one's own body based on proprioceptive, tactile, visual and vestibular information-as well as their integration with sensory information of extrapersonal space-is a prerequisite for rapid and effective action with our surroundings. Based on our findings, we speculate that ambiguous input from these different sensory systems is an important mechanism of OBE and AS, and thus the intriguing experience of seeing one's body in a position that does not coincide with its felt position. We suggest that OBE and AS are related to a failure to integrate proprioceptive, tactile and visual information with respect to one's own body (disintegration in personal space) and by a vestibular dysfunction leading to an additional disintegration between personal (vestibular) space and extrapersonal (visual) space. We argue that both disintegrations (personal; personal-extrapersonal) are necessary for the occurrence of OBE and AS, and that they are due to a paroxysmal cerebral dysfunction of the TPJ in a state of partially and briefly impaired consciousness. (+info)
Fluoxetine therapy in depersonalisation disorder: randomised controlled trial.
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BACKGROUND: Despite anecdotal reports that serotonin reuptake inhibitors may improve depersonalisation, there is no proven efficacious treatment for depersonalisation disorder. AIMS: To investigate the efficacy of fluoxetine in the treatment of depersonalisation disorder. METHOD: Fifty-four people who met DSM-IV criteria for depersonalisation disorder were recruited through newspaper advertisements, and 50 were randomised to a 10-week, double-blind trial of fluoxetine 10-60 mg/day or placebo. Primary outcome measures were the Dissociative Experiences Scale-Depersonalisation Factor, the Depersonalization Severity Scale and the Clinical Global Impression-Improvement (CGI-I) scale. RESULTS: Intention-to-treat analysis revealed that fluoxetine (mean dosage 48 mg/day) was not superior to placebo except for a clinically minimal but statistically significantly greater improvement in CGI-I score in the fluoxetine group prior to covarying for anxiety and depression (2.9 v. 3.6). Depersonalisation was significantly more likely to improve if comorbid anxiety disorder improved. CONCLUSIONS: Fluoxetine was not efficacious in treating depersonalisation disorder, despite the commonly reported clinical use of serotonin reuptake inhibitors for this condition. (+info)
Linking out-of-body experience and self processing to mental own-body imagery at the temporoparietal junction.
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The spatial unity of self and body is challenged by various philosophical considerations and several phenomena, perhaps most notoriously the "out-of-body experience" (OBE) during which one's visual perspective and one's self are experienced to have departed from their habitual position within one's body. Although researchers started examining isolated aspects of the self, the neurocognitive processes of OBEs have not been investigated experimentally to further our understanding of the self. With the use of evoked potential mapping, we show the selective activation of the temporoparietal junction (TPJ) at 330-400 ms after stimulus onset when healthy volunteers imagined themselves in the position and visual perspective that generally are reported by people experiencing spontaneous OBEs. Interference with the TPJ by transcranial magnetic stimulation (TMS) at this time impaired mental transformation of one's own body in healthy volunteers relative to TMS over a control site. No such TMS effect was observed for imagined spatial transformations of external objects, suggesting the selective implication of the TPJ in mental imagery of one's own body. Finally, in an epileptic patient with OBEs originating from the TPJ, we show partial activation of the seizure focus during mental transformations of her body and visual perspective mimicking her OBE perceptions. These results suggest that the TPJ is a crucial structure for the conscious experience of the normal self, mediating spatial unity of self and body, and also suggest that impaired processing at the TPJ may lead to pathological selves such as OBEs. (+info)