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PubMed2000

Dissociative Spectrum Disorders in the Primary Care Setting.

Dissociative disorders have a lifetime prevalence of about 10%. Dissociative symptoms may occur in acute stress disorder, posttraumatic stress disorder, somatization disorder, substance abuse, trance and possession trance, Ganser's syndrome, and dissociative identity disorder, as well as in mood disorders, psychoses, and personality disorders. Dissociative symptoms and disorders are observed frequently among patients attending our rural South Carolina community mental health center. Given the prevalence of mental illness in primary care settings and the diagnostic difficulties encountered with dissociative disorders, such illness may be undiagnosed or misdiagnosed in primary care settings. We developed an intervention model that may be applicable to primary care settings or helpful to primary care physicians. Key points of the intervention are identification of dissociative symptoms, patient and family education, review of the origin of the symptoms as a method of coping with trauma, and supportive reinforcement of cognitive and relaxation skills during follow-up visits. Symptom recognition, Education of the family, Learning new skills, and Follow-up may be remembered by the mnemonic device SELF. We present several cases to illustrate dissociative symptoms and our intervention. Physicians and other professionals using the 4 steps and behavioral approaches will be able to better recognize and triage patients with dissociative symptoms. Behaviors previously thought to be secondary to psychosis or personality disorders may be seen in a new frame of reference, strengthening the therapeutic alliance while reducing distress and acting-out behaviors.

Journal Article↗
PubMedDate not supplied

[Effect of reduced concentrations of carbon, nitrogen, and phosphorus in a medium on growth of three dissociants of Pseudomonas aeruginosa].

The effect of lowered concentrations of carbon, nitrogen, and phosphorus sources in the medium on the specific growth rate mu of the R, S, and M dissociants of the hydrocarbon-oxidizing strain Pseudomonas aeruginosa K-2, culture pH, and the population composition was studied. Within the first 16 hours of cultivation in all of the four media tested, the R, S, and M dissociants had virtually identical mu. The maximal values of mu were reached by the 20th h of growth in the basal medium (R and S dissociants) and in the carbon-deficient medium containing 0.4% glucose (M dissociant). The R and M dissociants showed the most rapid decrease in mu in the nitrogen-deficient medium containing 0.55% NaNO3. By the end of cultivation in the basal medium, the pH of the R, S, and M cultures decreased to 6.3, 5.3, and 3.3, respectively. In the case of the carbon-deficient medium, the drop in the culture pH was lower. After a 2.5-day incubation of the S dissociant in the phosphorus-deficient medium containing 0.028% NaH2PO4.2H2O and of the M dissociant in the basal medium supplemented with chalk powder, these dissociants were completely displaced from the media.

Carbon↗
PubMed1976

The indiction by complement of a change in KSCN-dissociable red cell membrane lipids.

During complement lysis of antibody-sensitized sheep erythrocytes (EA) there was a larger loss of membrane phospholipids than during lysis elicited by hypotonic buffer. In addition, membranes prepared from complement-lysed EA had a marked reduction in KSCN (2.4 M)-dissociable membrane cholesterol and phospholipids, as compared to membranes from EA lysed hypotonically. Complement lysis caused a mild reduction in the amount of KSCN-dissociable membrane hexose but no change in the amount of dissociable protein. The impairment in dissociation of membrane lipids was related to the action of C8; it did not occur with membranes from EA that were treated with heat-inactivated (56 degrees C for 30 min) human serum, C4-deficient guinea pig serum, C6-deficient rabbit serum, or the first seven human complement components. EA lysed with limited amounts of complement exhibited a partial impairment in KSCN-dissociable lipids. Membranes from erythrocytes lysed with melittin showed a large increase in dissociation by KSCN of lipids, proteins,and hexoses. Membranes from erythocytes lysed with lysolecithin or phospholipase C showed, in addition to a reduction in dissociable lipid, a much larger reduction in dissociable hexose than a membranes from complement-lysed cells. These profiles of reactivity with 2.4 M KSCN inidcate that the membrane pertubations caused caused by complement may be specific. We conclude that complement-lysis is accompanied by a major rearrangement of membrane cholesterol and phospholipid which could be demonstrated in membranes from cells lysed by only one or very few complement lesions. Therefore, it appears that the lesions induce a propragated change in the lipid organization which extends throughout large areas of the membrane. This change might be responsible for the impairment of membrane permeability that follows the action of complement and results in cell destruction.

Animals↗
PubMed1992

[Effects of antibiotics on the dissociation of platelet adherence in pseudothrombocytopenia].

To elucidate the effects of antibiotics on platelet adherence phenomena, we examined dissociation of platelet adherence in EDTA-dependent pseudothrombocytopenia by adding Kanamycin or Colimycin. We found the rapid dissociation of platelet adherence caused by addition of Kanamycin (20 mg) or Colimycin (20 mg) in 1 ml of EDTA-anticoagulated blood from patients with EDTA-dependent pseudothrombocytopenia. This dissociation was most remarkable in the sample treated within 30 minutes after venipuncture. When the dissociation occurred, no adherent platelet was found on microscopical examinations. Complete blood cell counts and their histogram patterns after dissociation were almost same as those just after venipuncture. The dissociation occurred as soon as the antibiotics were added and remained fairly long time. The dissociation decreased in proportion to the periods of time between venipuncture and addition of antibiotics. The dissociation was caused by many other antibiotics. However, severer damage were found morphologically by adding most of them in both histogram patterns and microscopical examinations than those of aminoglycoside or peptide antibiotics.

Adolescent↗
PubMedDate not supplied

[Obtaining of intrapopulational dissociants of some bacilli and the use of DIR-PCR for their identification].

The paper is the first to suggest methods for rapid obtaining and genotypic identification of phenotypic (colonial-morphological) dissociants of bacterial cultures. For revelation of the potential dissociation ability and obtaining of dissociants, the use of bacterial cyst-like refractile cells (CRC) is recommended. These cells are characterized by enhanced variability; upon their first passage, an abrupt increase in the dissociation index is observed as a result of the emergence of cells that form morphologically different types of colonies. The approaches elaborated were tested with Bacillus cereus, B. subtilis, and B. licheniformis, for which colonial-morphological dissociants of various types were obtained after the first passage of CRC (both of those formed in the developmental cycle of bacteria and of those arising as a result of artificial increase of the concentration of anabiosis autoinducers in the cultivation medium). The genomic distinctions between dissociants of B. cereus and B. subtilis were estimated using polymerase chain reaction with a primer system designed based on the analysis of nucleotide sequences of complete prokaryotic genomes available in the GenBank database (DIR-PCR). The application of the suggested method allowed distinctions between the genomes of dissociants of Bacillus cereus and B. subtilis to be revealed, which is in agreement with the hypothesis that suggests reversible intragenomic rearrangements to be the basis of bacterial dissociation into subpopulations.

Bacillus↗
PubMed1987

Osmometric study of the subunit dissociation of hemoglobin Porto Alegre [beta 9(A6)Ser----Cys] dissulfide polymer.

The hemoglobin Porto Alegre (HbPA) disulfide polymer dodecamer and the HbPA, HbA disulfide polymer octamer subunit dissociation by NaCl was studied by measuring the osmotic pressure of CO-hemoglobin solutions at pH = 6.9 and 20 degrees C. The dissociation equilibrium constants were evaluated from the osmotic pressure data. The subunit dissociation of the two types of disulfide polymers follows a reaction of the type A3 in equilibrium 3A. The HbPA disulfide polymer dodecamer appears to be more susceptible to NaCl induced dissociation than is normal HbA and less resistant to dissociation on protein dilution. The HbPA, HbA disulfide polymer octamer appears to be much more susceptible to dissociation on protein dilution than is the HbPA disulfide polymer dodecamer and normal HbA. The standard free energy of dissociation of the HbPA disulfide polymer at 2 M NaCl is delta GOD(25 degrees C) = 12 kcal/mole. The type of dissociation reaction (A3 in equilibrium with 3A) support the conclusion that the HbPA disulfide polymer has a quaternary molecular structure of a closed ring of three tetramers.

Hemoglobin A↗
PubMed1980

Formation of a receptor state from which insulin dissociates slowly in hepatic cells and plasma membranes.

125I-insulin dissociated from rat hepatocytes and liver plasma membranes with a time course suggestive of more than a single kinetic process. Dissociation curves were resolved into rapidly and slowly dissociating components. Increasing times of hormone-cell or hormone-membrane incubation prior to the initiation of dissociation increased the proportion of slowly dissociable 125I-insulin and decreased the proportion of rapidly dissociating hormone. The rates of loss of rapidly and slowly dissociating 125I-insulin, 1 to 2 x 10(-3) and 2 to 7 x 10(-5) s-1, respectively, were the same in cell and membrane incubates. The capacity of liver membranes and hepatocytes to bind 125I-insulin in a slowly dissociable state was saturable with respect to insulin concentration (approximately 10(-8) M). The observation of the same physical process in both cells and plasma membranes demonstrates a distinct role for receptors at the exterior surface of target cells in the retention of insulin.

Animals↗
PubMedDate not supplied

Dissociative experiences and disorders among women who identify themselves as sexual abuse survivors.

The purpose of the study was to identify dissociative experiences and disorders among women who are survivors of sexual abuse. Fifty-one women from two different centers who identified themselves as abuse survivors participated in the research interviews. The Dissociative Experiences Scale (DES) and the Dissociative Disorders Interview Schedule (DDIS) were used to collect data. The results indicated that 88.2% of the 51 women had a dissociative disorder of some type. Twenty-eight (54.9%) of the women had a DDIS diagnosis of multiple personality disorder (MPD). The women had high DES scores, a high number of secondary features of MPD, high rates of depression, borderline personality, substance abuse, somatic symptoms, Schneiderian symptoms, ESP/supernatural experiences, suicide attempts, and conversion symptoms. The vast majority of sexual abuse survivors in this sample have extensive dissociative symptomatology and related features. Therapists working with adult sexual abuse survivors should be knowledgeable about dissociation, should thoroughly assess a client's dissociative abilities, and should incorporate these findings into the therapy process.

Adaptation, Psychological↗
PubMedDate not supplied

Development, reliability, and validity of a child dissociation scale.

Dissociation is a complex psychophysiological process that ranges along a continuum from minor, normal dissociation to Axis I psychopathology. High levels of dissociation are associated with increased self-destructive behaviors and other symptoms. Although several validated measures of dissociation exist for adults, no measures are available for children. The Child Dissociative Checklist (CDC) was developed to meet this need and is a reliable and valid observer report measure of dissociation in children. The CDC had a 1-year test-retest reliability coefficient of rho = .69 (N = 73, p = .0001) in a sample of normal and sexually abused girls. The CDC had high discriminant validity among four test samples including: normal control girls, sexually abused girls, boys and girls with dissociative disorder NOS and boys and girls with multiple personality disorder. The CDC is intended as a clinical screening instrument and as a research measure. The CDC is not designed to be used as a diagnostic instrument.

Adolescent↗
PubMed1991

Disintegrated experience: the dissociative disorders revisited.

We present proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders and review the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of two new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. We conclude that further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality.

Depersonalization↗
PubMed2006

Liposomes comprising anionic but not neutral phospholipids cause dissociation of Rac(1 or 2) x RhoGDI complexes and support amphiphile-independent NADPH oxidase activation by such complexes.

Activation of the phagocyte NADPH oxidase involves the assembly of a membrane-localized cytochrome b559 with the cytosolic components p47(phox), p67(phox), p40(phox), and the GTPase Rac (1 or 2). In resting phagocytes, Rac is found in the cytosol as a prenylated protein in the GDP-bound form, associated with the Rho GDP dissociation inhibitor (RhoGDI). In the process of NADPH oxidase activation, Rac is dissociated from RhoGDI and translocates to the membrane, in concert with the other cytosolic components. The mechanism responsible for dissociation of Rac from RhoGDI is poorly understood. We generated Rac(1 or 2) x RhoGDI complexes in vitro from recombinant Rac(1 or 2), prenylated enzymatically, and recombinant RhoGDI, and purified these by anion exchange chromatography. Exposing Rac(1 or 2)(GDP) x RhoGDI complexes to liposomes containing four different anionic phospholipids caused the dissociation of Rac(1 or 2)(GDP) from RhoGDI and its binding to the anionic liposomes. Rac2(GDP) x RhoGDI complexes were more resistant to dissociation, reflecting the lesser positive charge of Rac2. Liposomes consisting of neutral phospholipid did not cause dissociation of Rac(1 or 2) x RhoGDI complexes. Rac1 exchanged to the hydrolysis-resistant GTP analogue, GMPPNP, associated with RhoGDI with lower affinity than Rac1(GDP) and Rac1(GMPPNP) x RhoGDI complexes were more readily dissociated by anionic liposomes. Rac1(GMPPNP) x RhoGDI complexes elicited NADPH oxidase activation in native phagocyte membrane liposomes in the presence of p67(phox), without the need for an anionic amphiphile, as activator. Both Rac1(GDP) x RhoGDI and Rac1(GMPPNP) x RhoGDI complexes elicited amphiphile-independent, p67(phox)-dependent NADPH oxidase activation in phagocyte membrane liposomes enriched in anionic phospholipids but not in membrane liposomes enriched in neutral phospholipids.

Animals↗
PubMed1996

Structured interview data on 35 cases of dissociative identity disorder in Turkey.

OBJECTIVE: The aim of this study was to describe the clinical features of dissociative identity disorder in a group of Turkish patients as assessed with a structured interview. METHOD: Thirty-five consecutive patients at the dissociative disorders program of a university psychiatric clinic who met the DSM-IV criteria for dissociative identity disorder were included in this study. The subjects were assessed with the Turkish versions of the Dissociative Disorders Interview Schedule and the Dissociative Experiences Scale. A descriptive analysis of the clinical features was carried out. RESULTS: Most (88.6%) of the patients were women. The mean age of the group was 22.8 years. Childhood physical or sexual abuse was reported by 77.1% of the patients. The mean Dissociative Experiences Scale score was 49.1. The patients reported an average of 12.5 somatic symptoms, 6.2 Schneiderian symptoms, 10.0 secondary features of the disorder, 3.8 borderline personality disorder criteria, and 4.1 extrasensory experiences. CONCLUSIONS: Dissociative identity disorder has a stable, consistent set of features throughout North America, in the Netherlands, and in Turkey. Cross-cultural research using standardized assessment measures will be invaluable in further illumination of the validity of this widely neglected psychiatric category.

Borderline Personality Disorder↗
PubMed2000

Dissociative disorders in Dutch psychiatric inpatients.

OBJECTIVE: The goal of this study was to determine the frequency of dissociative disorders in Dutch psychiatric inpatients. METHOD: During a period of 12 months, 122 consecutively admitted adult psychiatric patients were screened with the Dissociative Experiences Scale. Patients scoring 25 and higher and a random selection of patients scoring lower than 25 were blindly interviewed with the Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised. Interviews were scored independently by a blind rater. RESULTS: Ten (8%) of the 122 patients were diagnosed as having a dissociative disorder; two (2%) were diagnosed as having a dissociative identity disorder. Two patients (2%) had factitious dissociative identity disorder. CONCLUSIONS: The rate of dissociative disorders in this group of Dutch patients is comparable to the rates reported in other European studies but lower than rates reported in North American studies.

Adult↗
PubMed1994

Dissociative identity disorder: adaptive deception of self and others.

Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows childhood trauma, and is characterized by rigidification of phenomena that resemble hypnosis. To interpret dissociated aspects of selfhood as autonomous entities is a useful heuristic; but when taken too literally, it leads to three kinds of anomaly: (1) legal: dissociators remain culpable for misdeeds carried out beyond apparent awareness or control; (2) clinical: legitimization sometimes leads not to relief, but to escalating cycles of regressive dependency; and (3) scientific: the form of dissociated entities varies with how they are defined, in ways that are intrinsically motivated and clinically manipulable. These anomalies yield to an evolutionary perspective that views dissociative identity disorder as an evolved strategy of adaptive deception of self and others; e.g., a beaten subordinate avoids further retribution by "pleading illness." Such a deceit best avoids detection when fully experienced; through its intensity and persistence, it becomes real at a new level. One's basic competencies remain intact, however, and are the source of the anomalies described. They can be clinically accessed and empowered, providing the key to therapeutic change when dissociative processes are problematic. Overall, despite clear impairment in subjective awareness and volition, dissociative-disordered individuals are best held fully accountable for the consequences of their actions.

Awareness↗
PubMed1993

Dissociative experiences and trauma in eating disorders.

This study explores the relationship between traumatic experiences and dissociative phenomena in a large group of eating disorder patients (N = 98). Traumatic experiences were assessed by means of a self-report questionnaire and a clinical interview; dissociative experiences were assessed with the newly developed self-reporting Dissociation Questionnaire (DIS-Q). About 25% of the patients reported to have experienced traumatic events in their personal life and this subgroup had significantly higher scores on the DIS-Q, compared with normal control subjects. About 12% of our patient sample mentioned dissociative experiences to a degree as high as in a group of patients with dissociative disorders. Amnesia turned out to be the most specific characteristic in trauma-induced dissociation. These data suggest that trauma-induced dissociative experiences may play an important role in the development of a subgroup of patients with an eating disorder.

Adolescent↗
PubMed2005

A taxometric investigation of dissociation in Vietnam veterans.

There is long-standing debate about whether elevated dissociative symptoms are common in posttraumatic stress disorder (PTSD) or whether there is a distinct subtype of cases with elevated dissociation. The current investigation examined the latent structure of dissociative symptoms in a sample of 316 male, trauma-exposed Vietnam veterans, 76 of whom were diagnosed with current PTSD. Three taxometric procedures (MAMBAC, MAXEIG, and MAXCOV) were performed on three indicator sets drawn from the Dissociative Experiences Scale. Taxometric analyses consistently revealed a taxon (subtype) of highly dissociative individuals. The taxon members had significantly more severe posttraumatic symptoms and were more often diagnosed with current PTSD than were non-taxon members. Among participants with a current PTSD diagnoses, only 32% belonged to the dissociative taxon, suggesting that there is a subtype of severe PTSD with elevated dissociation.

Adult↗
PubMed2006

Prevalence and victimization correlates of pathological dissociation in a community sample of youths.

This study explored the relationships among a variety of victimization experiences and dissociative symptoms in a community probabilistic household sample (n=891) of youths (11-17 years old) in Puerto Rico. To measure dissociative symptoms, the authors selected eight items from the Adolescent Dissociative Experiences Scale (Armstrong, Putnam, Carlson, Liber, & Smith, 1997) that are indicative of pathological forms of dissociation. Victimization factors associated with dissociation were investigated with bivariate logistic regression followed by multiple logistic regression. The results indicated that 44 (4.9%) youths experienced pathological dissociative symptoms. Forty-three (98%) of those youths experienced victimization. Logistic regression analyses indicated that the risk of pathological dissociation was significant among those participants who reported severe forms of physical abuse and those who were exposed to violence.

Adolescent↗
PubMed1993

Relation of dissociative phenomena to levels of cerebrospinal fluid monoamine metabolites and beta-endorphin in patients with eating disorders: a pilot study.

Dissociation is made manifest by a failure to integrate thoughts, feelings, memories, and actions into a unified sense of consciousness. Although dissociation is presumed to be a special state of consciousness manifested by state-dependent memory and physiology, the psychobiology of dissociation is poorly understood. In this study, we examined cerebrospinal fluid levels of the major monoamine metabolites and beta-endorphin in patients with eating disorders (11 with anorexia nervosa, 16 with bulimia nervosa), while they were acutely ill. Dissociative capacity was measured using the Dissociative Experiences Scale (DES). We provide evidence that neurochemical changes in dopaminergic, serotonergic, and opioid systems may be associated with the clinical expression of dissociation in patients with eating disorders during the acute phase of their illness. These preliminary results are compatible with previous studies of neurochemical disturbances in the eating disorders and suggest that future work in dissociation should specifically include examination of these neurobiologic systems.

Adolescent↗