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PubMed1992

Left hemispheric activation in depersonalization disorder: a case report.

Depersonalization disorder is classified in DSM-III-R (APA 1987) as a dissociative disorder characterized by altered perception or experience of the self. To date, there are no known reports of the neurobiological features of this disorder. We report clinical and biological correlates in a patient with depersonalization disorder previously unresponsive to a variety of anticonvulsant, monoamine oxidase inhibitor, and tricyclic antidepressant trials, but for whom fluoxetine partially reduced depersonalization symptoms, but not associated anxiety and depression. Neurophysiological, neuroanatomical and neuropsychological findings revealed left hemispheric frontal-temporal activation and decreased left caudate perfusion. These findings suggest a similarity to the neuropsychiatric data reported in obsessive-compulsive disorder patients.

Adult↗
PubMed1993

Depersonalization after marijuana smoking.

Depersonalization and other behavioral and physiological indices were monitored before and after the administration of high- and low-potency marijuana cigarettes and a placebo cigarette in 35 physically and mentally healthy normal volunteers. The cigarettes were administered under double-blind conditions during three visits to the laboratory separated by a minimum of 1 week. Marijuana smoking, but not placebo smoking, was associated with significant depersonalization that was maximal 30 min after smoking the high-potency cigarettes. Other behavioral changes induced by marijuana included disintegration of time sense, sensation of "high," increased state anxiety, tension, anger, and confusion. Respiration, pulse rate, and systolic blood pressure also increased after marijuana smoking. Multiple regression identified temporal disintegration as the most significant predictor of depersonalization.

Adult↗
PubMed2006

The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal.

Depersonalization and derealization occur on a continuum of situations, from healthy individuals to a severely debilitating disorder where the symptoms can persist chronically. Since 1960s, different neurobiological models have been hypothesized and they have been associated with the temporal lobes. Recent advances in the functioning of the limbic system and the application of Geschwind's concept of disconnection in the cortico-limbic networks, pointed the role of the amygdala and its connections with medial prefrontal cortex and anterior cingulate cortex, the same structures that are strictly interlinked with the neurobiology of emotions and affective disorders. In this paper, we hypothesize that depersonalization may represent a clinical index of disease severity, poorer response to treatment and high level of comorbidity, in mood and anxiety disorders, discussing the neurobiology of depersonalization and the available clinical evidence.

Amygdala↗
PubMed2004

Repetitive transcranial magnetic stimulation improves depersonalization: a case report.

Depersonalization disorder is a poorly understood and treatment-resistant condition. This report describes a patient with depersonalization disorder who underwent six sessions of repetitive transcranial magnetic stimulation on the left dorsolateral prefrontal cortex. Repetitive transcranial magnetic stimulation produced a 28% reduction on depersonalization scores.

Adult↗
PubMed2003

Depersonalization disorder: a functional neuroanatomical perspective.

Clinical reports of depersonalization suggest that attenuated emotional experience is a central feature of the condition. Patients typically complain of emotional numbness and some patients ascribe their feelings of unreality to a lack of affective "colouring" in things perceived. Recent neuroimaging and psychophysiological studies support these assumptions as they show both attenuated autonomic responses in depersonalization, and decreased activity within neural regions important for the generation of affective responses to emotive stimuli. Furthermore, findings from neuroimaging studies indicate increased prefrontal cortical activity in depersonalised patients, particularly within regions associated with contextualization and appraisal of emotionally-salient information rather than mood induction per se. Taken together, these finding suggest that symptoms of depersonalization, and in particular emotional numbing, may be related to a reversal of normal patterns of autonomic and neural response to emotive stimuli.

Affect↗
PubMedDate not supplied

Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases.

OBJECTIVES: Depersonalization disorder (DPD) is a chronic condition characterized by the persistent subjective experience of unreality and detachment from the self. To date, there is no known treatment. Lamotrigine as sole agent was not found to be effective in a previous small double-blind, randomized crossover trial. However, evidence from open trials suggests that it may be beneficial as an add-on medication with antidepressants. METHODS: We report here an extended series of 32 patients with DPD in whom lamotrigine was prescribed as an augmenting medication. Most of the patients were receiving selective serotonin reuptake inhibitors. RESULTS: Fifty-six percent (n = 18) of patients had a more than or equal to 30% reduction on the Cambridge Depersonalization Scale score at follow-up. Both maximum dose of lamotrigine used and before treatment Cambridge Depersonalization Scale scores showed positive correlations with the percentage of response. CONCLUSIONS: The results of this trial suggest that a significant number of patients with DPD may respond to lamotrigine when combined with antidepressant medication. The results are sufficiently positive to prompt a larger controlled evaluation of lamotrigine as "add-on" treatment in DPD.

Adolescent↗
PubMed2003

Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases.

AIMS: To examine demographic and clinical features of a group of patients reporting chronic depersonalization (DP) following illicit drug use, and to assess whether depersonalization arising in these circumstances constitutes a distinct clinical syndrome. DESIGN: Case-control comparison using self-reports, standardized questionnaires and clinical assessments in a specialized clinic. SETTING: A tertiary referral depersonalization clinic and research unit affiliated to a psychiatric hospital and research centre. PARTICIPANTS: A total of 164 individuals with chronic DP symptoms who had been in contact with the clinic. Forty of these individuals related the onset of symptoms to an episode of illicit drug use. MEASUREMENTS: A wide range of demographic and clinical variables measured using questionnaires and standardized rating scales. FINDINGS: The drug-induced DP group were significantly younger and had a preponderance of males compared to the non-drug group. Certain clinical and phenomenological differences were found between these groups, but in general the groups are strikingly similar. This is reinforced by the fact that when the drug-induced group was compared with an age and sex-matched subset of the non-drug group, differences between groups largely disappeared. CONCLUSIONS: Drug-induced DP does not appear to represent a distinct clinical syndrome. The neurocognitive mechanisms of the genesis and maintenance of DP are likely to be similar across clinical groups, regardless of precipitants.

Adolescent↗
PubMed1982

Depersonalization in the light of Brentano's phenomenology.

The symptoms of depersonalization are examined in the light of the phenomenological views evolved by Franz Brentano. He had come to the conclusion that our conscious experiences are primarily directed towards objects (contents) that are 'phenomenal' or 'intentional' in the sense that they do not necessarily have counterparts in the external world. In experiencing such an object, a person becomes simultaneously aware of himself as a mentally active ego. In depersonalized individuals, there emerges a mentally active ego of a subsidiary kind which has some autonomy of action and is hazily glimpsed in introspection. The clinical symptoms of depersonalization vary according to the mental activities engaged in by the subsidiary ego. These mental activities may be exteroceptive (leading to derealization), interoceptive (leading to desomatization), or introspective (leading respectively to de-ideation, de-emotivity, or automatization).

Consciousness↗
PubMed2006

Narcissistic regulation of the self and interpersonal problems in depersonalized patients.

BACKGROUND: Psychoanalytical theories coincide in understanding depersonalization (DP) as a disorder of narcissistic self-regulation. DP is described as an ego defense against overwhelming shame resulting in a splitting of an observing ego detached from the experiencing self. In contrast to a behavioral-cognitive theory on DP, which suggests that the catastrophic appraisal of normal transient DP maintains the disorder, psychodynamic approaches stress that DP is an important defensive function for the individual. We examine this psychodynamic aspect more closely as it relates to narcissistic self-regulation and interpersonal behavior in depersonalized patients. SAMPLING AND METHODS: Thirty-five patients with pathological DP are compared with 28 patient controls concerning their narcissistic self-regulation and interpersonal behavior. For the assessment, we used the German Narcissism Inventory and the Inventory of Interpersonal Problems. The two groups were controlled for sociodemographic data, comorbidity with a personality disorder, and the General Severity Index of the Symptom Check List-90-R. RESULTS: Bonferroni-corrected group comparison showed that the depersonalized patients are characterized by perceiving themselves as helpless, hopeless, socially isolated and worthless, perceiving others as bad and disappointing, and that they avoid interpersonal relations and reality significantly more than other patients with equal symptom severity. CONCLUSIONS: Treatment approaches on DP should take the issue of low self-esteem, pervasive shame and the related defensive social avoidance into account. Further empirical research on psychodynamic concepts of DP is warranted also for the sake of linking modern neurobiological findings with clinical experience.

Depersonalization↗
PubMed1976

Self-induced depersonalization syndrome.

The author reports two cases in which depersonalization occurred during the waking consciousness of individuals who had engaged in meditative techniques designed to alter consciousness. Psychiatrists should be aware of this phenomenon, as the number organizations in the "consciousness movement" is increasing, and should ask people manifesting depersonalization about any involvement in activities leading to altered states of consciousness. In some cases it might be appropriate to refer such patients to responsible groups that teach altered consciousness by meditation as an egosyntonic desirable state. The author cautions against the use of phenothiazines in cases where depersonalization is a prominent feature.

Adult↗
PubMed1981

Prolonged depersonalization after marijuana use.

The author describes four cases of prolonged depersonalization that occurred months after marijuana use. Each occurred in the setting of a stressful life event. Depersonalization is a common experience during acute intoxication with marijuana, and these cases suggest that after the patients had experienced depersonalization, external stressors and intrapsychic factors may have contributed to its continued use as a defense mechanism.

Adolescent↗
PubMed1987

Desipramine: a possible treatment for depersonalization disorder.

Primary depersonalization disorder is believed to be resistant to treatment. However, we report the successful treatment of a case with desipramine and suggest that, because there is a link between depersonalization and anxiety disorders, tricyclic antidepressants may prove effective for depersonalization.

Adolescent↗
PubMed1999

[The psychopathology of depersonalization depression].

77 patients (29 men, 48 women) at the age of 17-51 years with depersonalisation depression (DD) of nonpsychotic level with duration 6 months and longer. Such depressions were psychopathologically characterized by close connection between affective and depersonalizing components of the syndrome. The depressive component manifested with a mild hypothymia with dissociation between subjective severity and objective self-estimation, vulnerability to provoking factors, inversion of somatic symptoms that permit to evaluate affective disorders as "atypical depression" (according to DSM-IV). Peculiarities of depersonalizing component were relatively low degree of the alienation phenomena and their psychopathic (hysteric) colour. Personal status of the patients before disease's manifestations was characterized by some signs of accentuation of a self-consciousness sphere and corresponded to borderline disorders. The conclusion was made about the existence of a particular type of DD in which symptom complexes, relatively independent (affective and depersonalizing), had a mutual affinity; so they united according to mechanism of pathologic synergism. This type of depression is only one of variants of DD.

Adolescent↗
PubMed1975

The significance of depersonalization in the life and writings of Joseph Conrad.

Through reference to his letters and fiction, this paper attempts to demonstrate how Conrad made use of depersonalization in order to cope with the childhood loss of his parents and to avoid, whenever possible, psychotic regression. Genetic and dynamic aspects of depersonalization are noted along with the relationship between dream and depersonalization.

Depersonalization↗
PubMedDate not supplied

[Oxidative modification of blood proteins in patients with psychiatric disorders (depression, depersonalization)].

We determined the oxidative modification of proteins (spontaneous and metal-catalysing oxidation, MKO) and the level of corticosteroids in patients with the depersonalization and depression. For detecting oxidative modification of plasma proteins we measured the concentration of protein carbonyl groups formed with 2,4dinitrophenylhydrazine 2,4dinitrophenylhydrazone derivatives; the formation of dityrosine by fluorescence method; protein aggregation and fragmentation. Polyacrylamide gel electrophoresis with sodium dodecyl sulfate (SDS)-PAGE in the presence beta-mercaptoethanol was used to determine the aggregation or fragmentation of proteins by oxygen radicals (OH). Acid-soluble peptides were analised as products of the fragmentation oxidative modification proteins. The level of the corticosteroids was determined using HPLS. The increase of the concentration of protein carbonyl groups in blood plasma of patients with mental disorders. In patients with depersonalization we determined the increase of the bityrosyl cross-link, and different degrees of fragmentation compared with depressive patients. The cortisol level was decreased and corticosterone was increased in the blood plasma of patients with depersonalization. In depressive patients the cortisol level was increased and corticosterone was decreased is discussed. We discussed the role oxidative modification proteins in the disturbance of the corticosteroid and opioid receptors functions in the patients with mental disorders.

Adult↗
PubMed2002

[Personal peculiarities of epileptic patients with depersonalization in the interictal period].

Depersonalization states, expressed in interictal period, were analyzed in 23 patients. Depersonalization state occurs only in patients with partial complex seizures with epileptic focus in the temporal areas of the right hemisphere and in the mediobasal frontal areas of the left hemisphere. Also, compared to healthy subjects, schizoid personality features by MMPI and Rorshach psychological tests were found in these patients. The depersonalization states studied were defined as neurotic ones, because they manifested after psychotraumatic situation and did not recur after psychotherapy.

Depersonalization↗
PubMedDate not supplied

[Anxiety, depression, stress in "depersonalization" and "derealization"].

We quote the terms "depersonalization" and "derealization" though meaningless in an absolute sens, and feel it is suitable to define them as: "The diminishing of the feeling of significance experiences (vivencia) of the ego and of the reality". Theme of the communication: twofold: Remember a frequent omission--with important exceptions--is a lack of focus on the terrible pathos which acquires a certain intensity this syndrome. I have working in this direction since 1960 and specifically since 1988 with a total of 3.592 patients affective and obsessive-compulsive, from which I selected 242, with "depersonalization" and "derealization" syndromes. 60 of them clinically severe. As assessed by the clinical phenomenological method. The observation time varied from three months and aigth and half years. "Under the auspices of egodistonia with a correct judgement of reality" in following areas: Environmentally (speak of "symptom of Tantalus"...). In the diminishing of sense of body. The patient involuntary memory. In the area of thought. In the area of the perception of time. Independent of those other stress situation which are known to a accompany the appearance of the syndrome of the "depersonalization" and "derealization" we think that this may produce at times symptoms of post-traumatic stress.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidepressive Agents↗
PubMed1993

[The psychophysiological aspects of depersonalization disorders in schizophrenia].

The examination included 75 schizophrenics with clinical evidence of depersonalization. Three types of depersonalization were identified: personal, psychofunctional and sensory. The personal type is characterized by the sense of loss of the identity and individual features of the psychic "self"; the psychofunctional type--by the loss of the identity or some psychic functions, psychic performance as a whole; the latter type--by the loss of the identity or some special sensations. Basing on the above variants of depersonalization, 3 basic syndromes including it are suggested: affective-depersonalizational with depressive-depersonalizational and depersonalizational-thymopathic variants, depersonalizational-phobic, depersonalizational-hypochondriac.

Affective Disorders, Psychotic↗