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Zheng S, Feng S, Song N, Chen G, Jia Y, Zhang G, Liu M, Li X, Ning Y, Wang D, Jia H. The role of the immune system in depersonalisation disorder. World J Biol Psychiatry 2024; 25:291-303. [PMID: 38679810 DOI: 10.1080/15622975.2024.2346096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/18/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVES Depersonalisation-derealization disorder (DPD) is a dissociative disorder that impairs cognitive function and occupational performance. Emerging evidence indicate the levels of tumour necrosis factor-α and interleukin associated with the dissociative symptoms. In this study, we aimed to explore the role of the immune system in the pathology of DPD. METHODS We screened the protein expression in serum samples of 30 DPD patients and 32 healthy controls. Using a mass spectrometry-based proteomic approach, we identified differential proteins that were verified in another group of 25 DPD patients and 30 healthy controls using immune assays. Finally, we performed a correlation analysis between the expression of differential proteins and clinical symptoms of patients with DPD. RESULTS We identified several dysregulated proteins in patients with DPD compared to HCs, including decreased levels of C-reactive protein (CRP), complement C1q subcomponent subunit B, apolipoprotein A-IV, and increased levels of alpha-1-antichymotrypsin (SERPINA3). Moreover, the expression of CRP was positively correlated with visuospatial memory and the ability to inhibit cognitive interference of DPD. The expression of SERPINA3 was positively correlated with the ability to inhibit cognitive interference and negatively correlated with the perceptual alterations of DPD. CONCLUSIONS The dysregulation of the immune system may be the underlying biological mechanism in DPD. And the expressions of CRP and SERPINA3 can be the potential predictors for the cognitive performance of DPD.
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Affiliation(s)
- Sisi Zheng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Sitong Feng
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Nan Song
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Guangyao Chen
- Traditional Chinese Medicine Department of Rheumatology, China-Japan Friendship Hospital, Beijing, China
| | - Yuan Jia
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Guofu Zhang
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Min Liu
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xue Li
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yanzhe Ning
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Dan Wang
- Inner Mongolia Autonomous Region Mental Health Center, Hohhot, Neimenggu, China
| | - Hongxiao Jia
- Beijing Key Laboratory of Mental Disorders, National Clinical Research Center for Mental Disorders & National Center for Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
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To MN, Schuman-Olivier Z. Integrating choice points into mindfulness training for the dissociative subtype of PTSD: A case report. PSYCHIATRY RESEARCH CASE REPORTS 2024; 3:100218. [PMID: 39026577 PMCID: PMC11257171 DOI: 10.1016/j.psycr.2024.100218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 07/20/2024]
Abstract
Approximately 15-30 % of individuals diagnosed with PTSD experience high levels of dissociation, a condition categorized in the DSM-V as a dissociative subtype of PTSD (PTSD-D). Despite the rising number of studies supporting mindfulness-based interventions (MBIs) for the treatment of PTSD, literature on mindfulness and dissociation remains scarce and discording. While best practices for offering mindfulness for dissociative patients remain unclear, integrating choice points into MBIs may be aligned with trauma-informed principles and effective in countering loss of self-agency associated with trauma. In this article, we present a case study from a larger randomized controlled trial of an individual with PTSD-D who successfully completed an 8-week MBI while displaying active dissociation symptoms throughout the group. Follow-up interviews with stakeholders in the patient's care as well as pre-and post-intervention assessments indicate that the patient had a positive experience with the mindfulness training and improved self-regulation. Analysis of the case study suggests that the mindfulness training may have been safe and effective for this patient due to the integration of choice points throughout the mindfulness training and promotion of structural safety. We expand on this by further discussing six influencing factors that contributed to the outcome of the case study and can serve as a reference for clinicians, researchers, and instructors who wish to offer MBIs safely to patients with PTSD-D.
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Affiliation(s)
- My Ngoc To
- Cambridge Health Alliance, Cambridge, MA, USA
| | - Zev Schuman-Olivier
- Cambridge Health Alliance, Cambridge, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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Hamer R, Bestel N, Mackelprang JL. Dissociative Symptoms in Complex Posttraumatic Stress Disorder: A Systematic Review. J Trauma Dissociation 2024; 25:232-247. [PMID: 38112306 DOI: 10.1080/15299732.2023.2293785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 07/07/2023] [Indexed: 12/21/2023]
Abstract
The 11th revision of the International Classification of Diseases (ICD-11) introduced Complex Posttraumatic Stress Disorder (CPTSD) as a sibling disorder to PTSD. Dissociative symptoms have been implicated in the severity of ICD-11 CPTSD; however, no reviews have investigated how dissociation has been measured in studies investigating CPTSD, nor the relationship between CPTSD and dissociation. This systematic review aimed to identify measures used to assess dissociative symptoms in studies that have assessed CPTSD according to ICD-11 criteria and to synthesize the relationship between these constructs. PsycINFO, PubMed, Scopus and Web of Science were searched on March 31, 2021. Seventeen articles met inclusion criteria. CPTSD was most frequently measured by a version of the International Trauma Questionnaire. Twelve measures were used to assess for dissociative symptoms, the most common being the Dissociative Symptoms Scale and the Dissociative Experiences Scale. The relationship between CPTSD and dissociative symptoms was moderate-to-strong, but inconsistently reported. Further research is needed to determine the most appropriate measure(s) of dissociation in CPTSD.
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Affiliation(s)
- Ruby Hamer
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Australia
| | | | - Jessica L Mackelprang
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Australia
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4
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Farrelly S, Peters E, Azis M, David AS, Hunter ECM. A brief CBT intervention for depersonalisation-derealisation disorder in psychosis: Results from a feasibility randomised controlled trial. J Behav Ther Exp Psychiatry 2024; 82:101911. [PMID: 37716893 DOI: 10.1016/j.jbtep.2023.101911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 08/26/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
BACKGROUND AND OBJECTIVES Depersonalisation/derealisation symptoms are prevalent in psychosis patients, are associated with increased impairment, and may maintain psychosis symptoms. We aimed to establish the feasibility and acceptability of a brief, six session therapy protocol adapted from a Cognitive-Behavioural model of Depersonalisation-Derealisation Disorder (DDD) in participants with psychotic symptoms. METHODS A single-blind, randomised controlled trial was conducted with a treatment-as-usual control condition. Feasibility and acceptability estimates included rates of referral, acceptance, eligibility, consent, satisfaction and improved skills/knowledge to manage depersonalisation. RESULTS Twenty-one individuals were recruited to the trial. Results suggest that the intervention was feasible and acceptable to participants and there is some signal of effect on clinical outcomes. LIMITATIONS There were some challenges in recruitment. Recruitment feasibility estimates from the research register used may not be informative for future trials recruiting directly from teams. CONCLUSIONS Overall, the results suggest that further investigations would be of interest and recommendations for this are made.
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Affiliation(s)
- Simone Farrelly
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK.
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London, UK; South London and Maudsley NHS Foundation Trust (SLaM), PICuP (Psychological Interventions Clinic for outpatients with Psychosis), UK.
| | - Matilda Azis
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychosis Studies, London, UK.
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK.
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5
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Boysen GA. Dissociative Identity Disorder: A Review of Research From 2011 to 2021. J Nerv Ment Dis 2024; 212:174-186. [PMID: 38412243 DOI: 10.1097/nmd.0000000000001764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
ABSTRACT Dissociative identity disorder (DID) has historically been one of the most controversial topics in the study of psychopathology. Building on a previous review of empirical research on DID from 2000 to 2010, the present review examined DID research from 2011 to 2021. The research output included 56 case studies and 104 empirical studies. Within the empirical studies, approximately 1354 new cases of DID emerged, which resulted in an average samples of approximately 20. Reanalysis of previous samples was standard in the literature with only 40% of reported cases being new. Studies emerged from dozens of countries across the world, but the majority of cases were from Western counties, especially the United States. Diagnosis primarily relied upon validated measures, but 74% of all new cases came from six research groups. Overall, research on DID is steady but methodologically limited in ways that make generalization, especially about etiology, difficult.
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Affiliation(s)
- Guy A Boysen
- Department of Psychology, McKendree University, Lebanon, Illinois
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6
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Tanaka R, Ando S, Kiyono T, Minami R, Endo K, Miyashita M, Yamasaki S, Kanata S, Fujikawa S, Hiraiwa-Hasegawa M, Nishida A, Kasai K. The longitudinal relationship between dissociative symptoms and self-harm in adolescents: a population-based cohort study. Eur Child Adolesc Psychiatry 2024; 33:561-568. [PMID: 36882639 PMCID: PMC10869437 DOI: 10.1007/s00787-023-02183-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Previous studies have reported that dissociative symptoms (DIS) are associated with self-harm (SH) in adolescents. However, most of these studies were cross-sectional, which limits the understanding of their theoretical relationship. We aimed to investigate the longitudinal relationship between DIS and SH in the general adolescent population. We used data from the Tokyo Teen Cohort study (N = 3007). DIS and SH were assessed at times 1 and 2 (T1 and T2) (12 years of age and 14 years of age, respectively). DIS were assessed using the parent-report Child Behavior Checklist (CBCL), and severe dissociative symptoms (SDIS) were defined as a score above the top 10th percentile. The experience of SH within 1 year was assessed by a self-report questionnaire. The longitudinal relationship between DIS and SH was examined using regression analyses. Using logistic regression analyses, we further investigated the risk for SH at T2 due to persistent SDIS and vice versa. DIS at T1 tended to predict SH at T2 (odds ratio (OR) 1.11, 95% CI 0.99 to 1.25, p = 0.08), while SH at T1 did not predict DIS at T2 (B = - 0.03, 95% CI - 0.26 to 0.20, p = 0.81). Compared with adolescents without SDIS, those with persistent SDIS had an increased risk of SH at T2 (OR 2.61, 95% CI 1.28 to 5.33, p = 0.01). DIS tended to predict future SH, but SH did not predict future DIS. DIS may be a target to prevent SH in adolescents. Intensive attention should be given to adolescents with SDIS due to their increased risk of SH.
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Affiliation(s)
- Riki Tanaka
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan.
| | - Shuntaro Ando
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Tomoki Kiyono
- Department of Psychiatry, Teikyo University Mizonokuchi Hospital, Kanagawa, Japan
| | - Rin Minami
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Kaori Endo
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Mitsuhiro Miyashita
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Syudo Yamasaki
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Sho Kanata
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinya Fujikawa
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
| | - Mariko Hiraiwa-Hasegawa
- School of Advanced Science, SOKENDAI (Graduate University for Advanced Studies), Kanagawa, Japan
| | - Atsushi Nishida
- Research Center for Social Science and Medicine, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, Japan
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Rabellino D, Thome J, Densmore M, Théberge J, McKinnon MC, Lanius RA. The Vestibulocerebellum and the Shattered Self: a Resting-State Functional Connectivity Study in Posttraumatic Stress Disorder and Its Dissociative Subtype. CEREBELLUM (LONDON, ENGLAND) 2023; 22:1083-1097. [PMID: 36121553 PMCID: PMC10657293 DOI: 10.1007/s12311-022-01467-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
The flocculus is a region of the vestibulocerebellum dedicated to the coordination of neck, head, and eye movements for optimal posture, balance, and orienting responses. Despite growing evidence of vestibular and oculomotor impairments in the aftermath of traumatic stress, little is known about the effects of chronic psychological trauma on vestibulocerebellar functioning. Here, we investigated alterations in functional connectivity of the flocculus at rest among individuals with post-traumatic stress disorder (PTSD) and its dissociative subtype (PTSD + DS) as compared to healthy controls. Forty-four healthy controls, 57 PTSD, and 32 PTSD + DS underwent 6-min resting-state MRI scans. Seed-based functional connectivity analyses using the right and left flocculi as seeds were performed. These analyses revealed that, as compared to controls, PTSD and PTSD + DS showed decreased resting-state functional connectivity of the left flocculus with cortical regions involved in bodily self-consciousness, including the temporo-parietal junction, the supramarginal and angular gyri, and the superior parietal lobule. Moreover, as compared to controls, the PTSD + DS group showed decreased functional connectivity of the left flocculus with the medial prefrontal cortex, the precuneus, and the mid/posterior cingulum, key regions of the default mode network. Critically, when comparing PTSD + DS to PTSD, we observed increased functional connectivity of the right flocculus with the right anterior hippocampus, a region affected frequently by early life trauma. Taken together, our findings point toward the crucial role of the flocculus in the neurocircuitry underlying a coherent and embodied self, which can be compromised in PTSD and PTSD + DS.
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Affiliation(s)
- Daniela Rabellino
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada.
- Imaging, Lawson Health Research Institute, London, ON, Canada.
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.
| | - Janine Thome
- Department of Theoretical Neuroscience, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
- Clinic for Psychiatry and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Maria Densmore
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
| | - Jean Théberge
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Medical Biophysics, Western University, London, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
- Mood Disorders Program and Anxiety Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Ruth A Lanius
- Department of Psychiatry, Western University, University Hospital, (Room C3-103), 339 Windermere Road, London, ON, N6A 5A5, Canada
- Imaging, Lawson Health Research Institute, London, ON, Canada
- Department of Neuroscience, Western University, London, ON, Canada
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Flaws D, Patterson S, Bagshaw T, Boon K, Kenardy J, Sellers D, Tronstad O. Caring for critically ill patients with a mental illness: A discursive paper providing an overview and case exploration of the delivery of intensive care to people with psychiatric comorbidity. Nurs Open 2023; 10:7106-7117. [PMID: 37443430 PMCID: PMC10563417 DOI: 10.1002/nop2.1935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 03/22/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
AIM To address the need for additional education in the management of mental illness in the critical care setting by providing a broad overview of the interrelationship between critical illness and mental illness. The paper also offers practical advice to support critical care staff in managing patients with mental illness in critical care by discussing two hypothetical case scenarios involving aggressive and disorganised behaviour. People living with mental illness are over-represented among critically unwell patients and experience worse outcomes, contributing to a life expectancy up to 30 years shorter than their peers. Strategic documents call for these inequitable outcomes to be addressed. Staff working in intensive care units (ICUs) possess advanced knowledge and specialist skills in managing critical illness but have reported limited confidence in managing patients with comorbid mental illness. DESIGN & METHODS A discursive paper, drawing on clinical experience and research of the authors and current literature. RESULTS Like all people, patients with mental illnesses draw on their cognitive, behavioural, social and spiritual resources to cope with their experiences during critical illness. However, they may have fewer resources available due to co-morbid mental illness, a history of trauma and social disadvantage. By identifying and sensitively addressing patients' underlying needs in a trauma-informed way, demonstrating respect and maximising patient autonomy, staff can reduce distress and disruptive behaviours and promote recovery. Caring for patients who are distressed and/or display challenging behaviours can evoke strong and unpleasant emotional responses. Self-care is fundamental to maintaining a compassionate approach and effective clinical judgement. Staff should be enabled to accept and acknowledge emotional responses and access support-informally with peers and/or through formal mechanisms as needed. Organisational leadership and endorsement of the principles of equitable care are critical to creation of the environment needed to improve outcomes for staff and patients. RELEVANCE TO CLINICAL PRACTICE ICU nurses hold an important role in the care of patients with critical illnesses and are ideally placed to empower, advocate for and comfort those patients also living with mental illness. To perform these tasks optimally and sustainably, health services have a responsibility to provide nursing staff with adequate education and training in the management of mental illnesses, and sufficient formal and informal support to maintain their own well-being while providing this care. PATIENT AND PUBLIC INVOLVEMENT This paper is grounded in accounts of patients with mental illness and clinicians providing care to patients with mental illness in critical care settings but there was no direct patient or public contribution.
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Affiliation(s)
- Dylan Flaws
- Caboolture HospitalCabooltureQueenslandAustralia
- Critical Care Research GroupThe Prince Charles HospitalChermsideQueenslandAustralia
- Queensland University of TechnologyBrisbane CityQueenslandAustralia
| | - Sue Patterson
- Critical Care Research GroupThe Prince Charles HospitalChermsideQueenslandAustralia
- School of DentistryUniversity of QueenslandBrisbane CityQueenslandAustralia
| | - Todd Bagshaw
- Caboolture HospitalCabooltureQueenslandAustralia
- The Prince Charles HospitalChermsideQueenslandAustralia
| | - Kym Boon
- Caboolture HospitalCabooltureQueenslandAustralia
| | - Justin Kenardy
- School of PsychologyUniversity of QueenslandBrisbane CityQueenslandAustralia
- Jamieson Trauma InstituteRoyal Brisbane and Women's HospitalHerstonQueenslandAustralia
| | - David Sellers
- The Prince Charles HospitalChermsideQueenslandAustralia
| | - Oystein Tronstad
- Critical Care Research GroupThe Prince Charles HospitalChermsideQueenslandAustralia
- The Prince Charles HospitalChermsideQueenslandAustralia
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9
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Verdi EK, Katz AC, Gramlich MA, Rothbaum BO, Reger GM. Impact of dissociation on exposure therapy for PTSD outcomes and Adherence among U.S. Military service members. J Psychiatr Res 2023; 166:86-91. [PMID: 37751659 DOI: 10.1016/j.jpsychires.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023]
Abstract
Emotional engagement is necessary for successful exposure therapy for posttraumatic stress disorder (PTSD), but dissociation is considered a barrier to emotional engagement. Virtual reality exposure therapy (VRE) uses multi-sensory virtual environments to increase emotional engagement during exposure therapy, and average treatment outcomes are comparable to traditional exposure therapy. However, individual factors (e.g., depression) can predict differential responses to VRE. Studies have yet to investigate whether VRE would be more effective in treating patients with dissociation compared to traditional PE. This secondary analysis of a randomized clinical trial explores whether dissociation predicts treatment outcomes to exposure therapy among active-duty soldiers (N = 108) diagnosed with PTSD. We also examine whether individuals reporting dissociative symptoms demonstrated differential treatment responses to VRE and PE. Results indicated a significant two-way interaction between dissociation and time in treatment, such that dissociation blunted the negative relationship between time and PTSD symptoms. Dissociation was not associated with treatment session attendance or drop out. Results also revealed no significant effect of treatment group (PE or VRE) on the relationship between dissociation and PTSD symptoms. Findings contribute to a body of literature supporting the potential clinical and research utility of a dissociative subtype of PTSD.
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Affiliation(s)
- Erin K Verdi
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA.
| | - Andrea C Katz
- VA Puget Sound Health Care System, Seattle Division, 1660 S Columbian Way, Seattle, WA, 98174, USA.
| | - Michael A Gramlich
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA.
| | - Barbara O Rothbaum
- Emory University School of Medicine, 1648 Pierce Dr NE, Atlanta, GA, 30307, USA.
| | - Greg M Reger
- VA Puget Sound Health Care System, American Lake Division, 9600 Veterans Drive Southwest, Tacoma, WA, 98493, USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
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10
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Thumtecho S, Wainipitapong S, Tantakitti P. Transient depersonalisation/derealisation syndrome from tramadol. BMJ Case Rep 2023; 16:e254909. [PMID: 37280010 PMCID: PMC10254872 DOI: 10.1136/bcr-2023-254909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
Depersonalisation/derealisation (DD) syndrome is often associated with severe traumatic experiences and the use of certain medications. Our patient reported experiencing a transient DD phenomenon a few hours after taking 37.5 mg of tramadol, together with etoricoxib, acetaminophen and eperisone. His symptoms subsided upon tramadol discontinuation, suggesting the possibility of tramadol-induced DD. A study of the patient's cytochrome P450 (CYP) 2D6 polymorphism, which mainly metabolises tramadol, indicated normal metaboliser status with reduced function. The concomitant administration of the CYP2D6 inhibitor, etoricoxib, would have led to higher concentrations of the serotonergic parent tramadol, providing an explanation for the patient's symptoms.
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Affiliation(s)
- Suthimon Thumtecho
- Division of Toxicology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Sorawit Wainipitapong
- Department of Psychiatry and Center of Excellence in Transgender Health, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
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11
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Laricchiuta D, Garofalo C, Mazzeschi C. Trauma-related disorders and the bodily self: current perspectives and future directions. Front Psychol 2023; 14:1166127. [PMID: 37275691 PMCID: PMC10235635 DOI: 10.3389/fpsyg.2023.1166127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/28/2023] [Indexed: 06/07/2023] Open
Abstract
Trauma-related disorders are debilitating psychiatric conditions that influence people who have directly or indirectly witnessed adversities. Dramatic brain/body transformations and altered person's relationship with self, others, and the world occur when experiencing multiple types of traumas. In turn, these unfortunate modifications may contribute to predisposition to trauma-related vulnerability conditions, such as externalizing (aggression, delinquency, and conduct disorders) problems. This mini-review analyzes the relations between traumatic experiences (encoded as implicit and embodied procedural memories) and bodily self, sense of safety for the own body, and relationship with others, also in the presence of externalizing conducts. Furthermore, an emerging research area is also considered, highlighting principles and techniques of body-oriented and sensorimotor therapies designed to remodel bodily self-aspects in the presence of trauma, discussing their potential application with individuals showing externalizing problems.
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12
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Dissoziation: ein transdiagnostisches Phänomen. DIE PSYCHOTHERAPIE 2023. [PMCID: PMC9982778 DOI: 10.1007/s00278-022-00641-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Der Begriff der Dissoziation wurde in frühen Anfängen der Neurosenlehre verwendet, hat sich seither gewandelt und ist Ausgangspunkt vieler Kontroversen. Unter Dissoziation wird i. Allg. die Abspaltung sonst integrierter Gedächtnis‑, Bewusstseins‑, Identitäts- und Wahrnehmungsfunktionen (eigene Person und Umwelt) verstanden. Dissoziation ist ein klinisches Kriterium von Belastungsstörungen und der emotional instabilen Persönlichkeitsstörung; dissoziative Symptome haben sind ebenfalls als Phänomene bei anderen Erkrankungen hochrelevant. Differenzialdiagnostisch ist Schizophrenie bedeutsam. Die Unterscheidung zwischen Dissoziation von Detachment- und Kompartmentalisationstyp sowie die Berücksichtigung möglicher Traumatatypen können die Entwicklung von Krankheitsmodellen unterstützen. Die Behandlung basiert auf akkurater Diagnostik, einschließlich Biografie und Beziehungen. Komplexe Dissoziationslagen erfordern eine komplexe Therapie, weil neben der psychischen Integration weitere psychosoziale Bedarfe zu bedienen sind.
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Dimitrova LI, Dean SL, Schlumpf YR, Vissia EM, Nijenhuis ERS, Chatzi V, Jäncke L, Veltman DJ, Chalavi S, Reinders AATS. A neurostructural biomarker of dissociative amnesia: a hippocampal study in dissociative identity disorder. Psychol Med 2023; 53:805-813. [PMID: 34165068 PMCID: PMC9975991 DOI: 10.1017/s0033291721002154] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 02/12/2021] [Accepted: 05/11/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND Little is known about the neural correlates of dissociative amnesia, a transdiagnostic symptom mostly present in the dissociative disorders and core characteristic of dissociative identity disorder (DID). Given the vital role of the hippocampus in memory, a prime candidate for investigation is whether total and/or subfield hippocampal volume can serve as biological markers of dissociative amnesia. METHODS A total of 75 women, 32 with DID and 43 matched healthy controls (HC), underwent structural magnetic resonance imaging (MRI). Using Freesurfer (version 6.0), volumes were extracted for bilateral global hippocampus, cornu ammonis (CA) 1-4, the granule cell molecular layer of the dentate gyrus (GC-ML-DG), fimbria, hippocampal-amygdaloid transition area (HATA), parasubiculum, presubiculum and subiculum. Analyses of covariance showed volumetric differences between DID and HC. Partial correlations exhibited relationships between the three factors of the dissociative experience scale scores (dissociative amnesia, absorption, depersonalisation/derealisation) and traumatisation measures with hippocampal global and subfield volumes. RESULTS Hippocampal volumes were found to be smaller in DID as compared with HC in bilateral global hippocampus and bilateral CA1, right CA4, right GC-ML-DG, and left presubiculum. Dissociative amnesia was the only dissociative symptom that correlated uniquely and significantly with reduced bilateral hippocampal CA1 subfield volumes. Regarding traumatisation, only emotional neglect correlated negatively with bilateral global hippocampus, bilateral CA1, CA4 and GC-ML-DG, and right CA3. CONCLUSION We propose decreased CA1 volume as a biomarker for dissociative amnesia. We also propose that traumatisation, specifically emotional neglect, is interlinked with dissociative amnesia in having a detrimental effect on hippocampal volume.
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Affiliation(s)
- Lora I. Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sophie L. Dean
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Yolanda R. Schlumpf
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | | | - Ellert R. S. Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Vasiliki Chatzi
- Department of Biomedical Engineering, King's College London, London, UK
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - Dick J. Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Antje A. T. S. Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Barreda-Ángeles M, Hartmann T. Experiences of Depersonalization/Derealization Among Users of Virtual Reality Applications: A Cross-Sectional Survey. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2023; 26:22-27. [PMID: 36595349 DOI: 10.1089/cyber.2022.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Previous research shows that virtual reality (VR) users may experience symptoms of depersonalization/derealization (DPDR) immediately after use. However, the impact of long-term VR use on these symptoms has not been analyzed so far. In a preregistered study, we conducted an online survey among a bigger sample of VR users (N = 754) to investigate the relationship between time of use during the past 6 months and the presence of DPDR symptoms. The results support the absence of a linear association between time of VR use and the presence of symptoms, when controlling for other factors. DPDR symptoms are more frequent among younger female users and in those who experience higher levels of embodiment during use. Secondary analyses show that symptoms are more common among newer users and among those who engage in longer sessions. These findings suggest that current common VR experiences are not a cause of long-term DPDR symptoms for the majority of users, yet also encourage further research about specific cases where VR use might trigger DPDR experiences in the long term.
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Affiliation(s)
- Miguel Barreda-Ángeles
- Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Tilo Hartmann
- Department of Communication Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Zheng N, Ou Y, Li H, Liu F, Xie G, Li P, Lang B, Guo W. Shared and differential fractional amplitude of low-frequency fluctuation patterns at rest in major depressive disorders with or without sleep disturbance. Front Psychol 2023; 14:1153335. [PMID: 37034932 PMCID: PMC10075231 DOI: 10.3389/fpsyg.2023.1153335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 03/01/2023] [Indexed: 04/11/2023] Open
Abstract
Objective Sleep disturbances (SD) are commonly found in patients with major depressive disorder (MDD). This study aims to explore the influence of SD symptoms on clinical characteristics in patients with MDD and to investigate the shared and distinct fractional amplitude of low-frequency fluctuation (fALFF) patterns in these patients with or without SD symptoms. Methods Twenty-four MDD patients with SD symptoms (Pa_s), 33 MDD patients without SD symptoms (Pa_ns) and 32 healthy controls (HCs) were included in this study. The fALFF and correlation analyses were applied to analyze the features of imaging and clinical data. Results Pa_s showed more severe anxiety and depression than Pa_ns. Compared with Pa_ns, Pa_s exhibited increased fALFF value in the left precuneus. Patients shared abnormal fALFF in the frontal-occipital brain regions. There was a positive correlation between fALFF values of the left precuneus and sleep disturbance scores (r = 0.607, p = 0.0000056734) in all patients in addition to a negative correlation between fALFF values of the left MOG/cuneus and HAMD-17 total scores (r = -0.595, p = 0.002141) in Pa_s. The receiver operating characteristic (ROC) results of the fALFF could be used to discriminate Pa_s from Pa_ns with a specificity of 72.73% and a sensitivity of 70.83%. Conclusion Pa_s displayed more serious anxiety and depression symptoms. Patients shared abnormal fALFF in the frontal-occipital brain regions, which may be a common characteristic for MDD. And increased fALFF value in the left precuneus might be a specific neuroimaging feature of MDD patients with SD symptoms.
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Affiliation(s)
- Nanxi Zheng
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yangpan Ou
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huabing Li
- Department of Radiology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Feng Liu
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Guojun Xie
- Department of Psychiatry, The Third People's Hospital of Foshan, Foshan, Guangdong, China
| | - Ping Li
- Department of Psychiatry, Qiqihar Medical University, Qiqihar, Heilongjiang, China
| | - Bing Lang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- *Correspondence: Bing Lang,
| | - Wenbin Guo
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Wenbin Guo,
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Muacevic A, Adler JR, Owolabi OJ, Garg T, Ezenagu UE, Apata EO, Abdefatah Ali M, Omar Z, Chaudhry HA, Khan A. A Rare Presentation of Shared Phenomenon in Dissociative Disorders in Extreme of Ages: A Report of Two Cases. Cureus 2022; 14:e32911. [PMID: 36699802 PMCID: PMC9871685 DOI: 10.7759/cureus.32911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2022] [Indexed: 12/26/2022] Open
Abstract
Conversion disorders (CD) are changes in sensorimotor activity experienced by an individual due to an external event. Patients may experience "pseudoseizures" accompanied by the presence or absence of loss of consciousness. Disorders of movement and sensation is the term used to classify the various kinds of CDs in the International Classification of Diseases, Tenth Revision (ICD-10) diagnostic manual, and they are the rarest among all dissociative disorders. We will discuss two instances that are particularly rare. The first includes an older couple, starting with the wife, who had nervousness, heightened worry, intrusive thoughts, heavy perspiration, palpitations, headaches, and problems sleeping. She was prescribed 10 mg once-daily escitalopram. She stopped taking her medication and had facial and hand problems. The patient's 65-year-old husband started having strange hand and face movements and lost consciousness. The pair was hospitalized willingly and had radiographic (MRI and non-contrast computerized tomography {NCCT} head), nerve conduction, and neurological tests to rule out a movement issue. No inquiry or inspections uncovered anything unusual. The second case involves a mother and her 13-year-old son, who was taken to a psychiatric unit after urinating on a religious shrine. His mother had the same issue and couldn't urinate for days. Both patients were given 25 mg of paroxetine and benzodiazepines for anxiety and sleeplessness. After a week of medicine and psychotherapy after identifying stressors, both cases improved.
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An Experimental Study of Subliminal Self-Face Processing in Depersonalization-Derealization Disorder. Brain Sci 2022; 12:brainsci12121598. [PMID: 36552058 PMCID: PMC9775423 DOI: 10.3390/brainsci12121598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/13/2022] [Accepted: 11/17/2022] [Indexed: 11/25/2022] Open
Abstract
The self-perception or self-experience of patients with depersonalization/derealization disorder (DPD) is altered, leading to a profound disruption in self-awareness. The main aim of the study is to explore the characteristics of subliminal self-face processing in DPD patients. To our knowledge, this is the first experimental study that has measured and evaluated subliminal self-processing in DPD. To better understand this, we examined the ability of patients with DPD and healthy controls (HC) to identify pictures of faces using an experimental paradigm of breaking continuous flash suppression. There were 23 DPD outpatients from Beijing Anding Hospital, Capital Medical University and 23 matched HC who participated in this experiment. The time needed for a face to break into awareness was taken as the measure of participants' subliminal processing of that face. The results indicated that there were significant differences between the DPD patients and HC in subliminal reaction times to different faces. Under experimental conditions, the average reaction response of self-face recognition in the HC group was significantly faster than for a famous face. However, this difference was not observed in DPD patients, which means that DPD patients did not show the processing advantage of their own faces as did the HC. The results suggest a deficit in subliminal self-face processing in DPD.
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Modesti MN, Rapisarda L, Capriotti G, Del Casale A. Functional Neuroimaging in Dissociative Disorders: A Systematic Review. J Pers Med 2022; 12:jpm12091405. [PMID: 36143190 PMCID: PMC9502311 DOI: 10.3390/jpm12091405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Dissociative disorders encompass loss of integration in essential functions such as memory, consciousness, perception, motor control, and identity. Nevertheless, neuroimaging studies, albeit scarce, have suggested the existence of particular brain activation patterns in patients belonging to this diagnostic category. The aim of this review is to identify the main functional neuroimaging correlates of dissociative disorders. Methods: we searched the PubMed database to identify functional neuroimaging studies conducted on subjects with a diagnosis of a dissociative disorder, following the PRISMA guidelines. In the end, we included 13 studies in this systematic review, conducted on 51 patients with dissociative identity disorder (DID), 28 subjects affected by depersonalization disorder, 24 with dissociative amnesia, and 6 with other or not specified dissociative disorders. Results: Prefrontal cortex dysfunction seems prominent. In addition, changes in the functional neural network of the caudate are related to alterations of identity state and maintenance of an altered mental status in DID. Another role in DID seems to be played by a dysfunction of the anterior cingulate gyrus. Other regions, including parietal, temporal, and insular cortices, and subcortical areas were reported to be dysfunctional in dissociative disorders. Conclusions: Prefrontal dysfunction is frequently reported in dissociative disorders. Functional changes in other cortical and subcortical areas can be correlated with these diagnoses. Further studies are needed to clarify the neurofunctional correlations of each dissociative disorder in affected patients, in order to identify better tailored treatments.
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Affiliation(s)
- Martina Nicole Modesti
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Ludovica Rapisarda
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Gabriela Capriotti
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Antonio Del Casale
- Unit of Psychiatry, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Correspondence:
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Battineni G, Chintalapudi N, Hossain MA, Losco G, Ruocco C, Sagaro GG, Traini E, Nittari G, Amenta F. Artificial Intelligence Models in the Diagnosis of Adult-Onset Dementia Disorders: A Review. Bioengineering (Basel) 2022; 9:bioengineering9080370. [PMID: 36004895 PMCID: PMC9405227 DOI: 10.3390/bioengineering9080370] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/25/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The progressive aging of populations, primarily in the industrialized western world, is accompanied by the increased incidence of several non-transmittable diseases, including neurodegenerative diseases and adult-onset dementia disorders. To stimulate adequate interventions, including treatment and preventive measures, an early, accurate diagnosis is necessary. Conventional magnetic resonance imaging (MRI) represents a technique quite common for the diagnosis of neurological disorders. Increasing evidence indicates that the association of artificial intelligence (AI) approaches with MRI is particularly useful for improving the diagnostic accuracy of different dementia types. Objectives: In this work, we have systematically reviewed the characteristics of AI algorithms in the early detection of adult-onset dementia disorders, and also discussed its performance metrics. Methods: A document search was conducted with three databases, namely PubMed (Medline), Web of Science, and Scopus. The search was limited to the articles published after 2006 and in English only. The screening of the articles was performed using quality criteria based on the Newcastle–Ottawa Scale (NOS) rating. Only papers with an NOS score 7 were considered for further review. Results: The document search produced a count of 1876 articles and, because of duplication, 1195 papers were not considered. Multiple screenings were performed to assess quality criteria, which yielded 29 studies. All the selected articles were further grouped based on different attributes, including study type, type of AI model used in the identification of dementia, performance metrics, and data type. Conclusions: The most common adult-onset dementia disorders occurring were Alzheimer’s disease and vascular dementia. AI techniques associated with MRI resulted in increased diagnostic accuracy ranging from 73.3% to 99%. These findings suggest that AI should be associated with conventional MRI techniques to obtain a precise and early diagnosis of dementia disorders occurring in old age.
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Affiliation(s)
- Gopi Battineni
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
- Correspondence: ; Tel.: +39-3331728206
| | - Nalini Chintalapudi
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Mohammad Amran Hossain
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Giuseppe Losco
- School of Architecture and Design, University of Camerino, 63100 Ascoli Piceno, Italy
| | - Ciro Ruocco
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Getu Gamo Sagaro
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Enea Traini
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Giulio Nittari
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
| | - Francesco Amenta
- Clinical Research Centre, School of Medicinal and Health Products Sciences, University of Camerino, 62032 Camerino, Italy
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Jungilligens J, Paredes-Echeverri S, Popkirov S, Barrett LF, Perez DL. A new science of emotion: implications for functional neurological disorder. Brain 2022; 145:2648-2663. [PMID: 35653495 PMCID: PMC9905015 DOI: 10.1093/brain/awac204] [Citation(s) in RCA: 61] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/28/2022] [Accepted: 05/20/2022] [Indexed: 01/11/2023] Open
Abstract
Functional neurological disorder reflects impairments in brain networks leading to distressing motor, sensory and/or cognitive symptoms that demonstrate positive clinical signs on examination incongruent with other conditions. A central issue in historical and contemporary formulations of functional neurological disorder has been the mechanistic and aetiological role of emotions. However, the debate has mostly omitted fundamental questions about the nature of emotions in the first place. In this perspective article, we first outline a set of relevant working principles of the brain (e.g. allostasis, predictive processing, interoception and affect), followed by a focused review of the theory of constructed emotion to introduce a new understanding of what emotions are. Building on this theoretical framework, we formulate how altered emotion category construction can be an integral component of the pathophysiology of functional neurological disorder and related functional somatic symptoms. In doing so, we address several themes for the functional neurological disorder field including: (i) how energy regulation and the process of emotion category construction relate to symptom generation, including revisiting alexithymia, 'panic attack without panic', dissociation, insecure attachment and the influential role of life experiences; (ii) re-interpret select neurobiological research findings in functional neurological disorder cohorts through the lens of the theory of constructed emotion to illustrate its potential mechanistic relevance; and (iii) discuss therapeutic implications. While we continue to support that functional neurological disorder is mechanistically and aetiologically heterogenous, consideration of how the theory of constructed emotion relates to the generation and maintenance of functional neurological and functional somatic symptoms offers an integrated viewpoint that cuts across neurology, psychiatry, psychology and cognitive-affective neuroscience.
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Affiliation(s)
- Johannes Jungilligens
- Correspondence to: Johannes Jungilligens University Hospital Knappschaftskrankenhaus Bochum Department of Neurology In der Schornau 23-25 44892 Bochum, Germany E-mail:
| | | | - Stoyan Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
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Parry S, Eve Z, Myers G. Exploring the Utility and Personal Relevance of Co-Produced Multiplicity Resources with Young People. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:427-439. [PMID: 35600531 PMCID: PMC9120276 DOI: 10.1007/s40653-021-00377-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 06/15/2023]
Abstract
Multiplicity, the experience of more than one self in the body, is an under-researched area of young people's mental health. The aim of this study was to explore the perspectives of experts-by-experience within a community sample regarding two specific resources: a co-produced self-help guide about multiplicity for adolescents, and a set of guidelines for supporting someone who identifies as 'multiple'. 34 participants (Mage= 22.06, 2.26 SD; 15F, 1M, 18NBG) completed an online survey consisting of open-ended and Likert scale questions to assess the language, utility, transferability and therapeutic impact of the materials. Descriptive statistics and a Foucauldian-informed Narrative Analysis were employed to analyse responses, producing a summary of utility and two narrative chapters. The emergent chapters, 'Breaking the Stigma' and 'Recognising the Many', highlight the need for greater understanding and awareness of multiplicity, with psychoeducation materials viewed as helpful. Inclusive language can reduce stigma and normalise multiplicity as a response to trauma. With greater understanding, practitioners and researchers can collaborate with young people through trauma wise care, providing multiplicity sensitive language and support. Overall, the term 'parts' was viewed as problematic by the participants as it could imply the plural system is not coexisting as a whole. Additionally, opinions varied as to how much diagnostic language could and should be used to describe multiplicity; linguistically and conceptually. Importantly, compassion was seen as particularly essential for younger selves within the system; older in their years and presence, but often more vulnerable within the societies in which the system resides.
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Affiliation(s)
- Sarah Parry
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
| | - Zarah Eve
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
| | - Gemma Myers
- Department of Psychology, Manchester Metropolitan University, Brooks Building, Manchester, M15 6GX UK
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22
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The challenge of being present with yourself: Exploring the lived experience of individuals with complex dissociative disorders. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2021.100250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Bækkelund H, Ulvenes P, Boon-Langelaan S, Arnevik EA. Group treatment for complex dissociative disorders: a randomized clinical trial. BMC Psychiatry 2022; 22:338. [PMID: 35578194 PMCID: PMC9112598 DOI: 10.1186/s12888-022-03970-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment. METHODS Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group-treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation. The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties. RESULTS Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period. CONCLUSION In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning. TRIAL REGISTRATION Clinical Trials ( NCT02450617 ).
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Affiliation(s)
- Harald Bækkelund
- Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway. .,Section for Implementation and Treatment Research, Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
| | - Pål Ulvenes
- grid.5510.10000 0004 1936 8921Research Institute, Modum Bad Psychiatric Hospital, Vikersund, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway
| | | | - Espen Ajo Arnevik
- grid.55325.340000 0004 0389 8485Section for clinical addiction research, Oslo University Hospital, Oslo, Norway
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Reinders AATS, Dimitrova LI, Schlumpf YR, Vissia EM, Nijenhuis ERS, Jäncke L, Chalavi S, Veltman DJ. Normal amygdala morphology in dissociative identity disorder. BJPsych Open 2022; 8:e70. [PMID: 35287776 PMCID: PMC8935907 DOI: 10.1192/bjo.2022.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Studies investigating the structure of the amygdala in relation to dissociation in psychiatric disorders are limited and have reported normal or preserved, increased or decreased global volumes. Thus, a more detailed investigation of the amygdala is warranted. Amygdala global and subregional volumes were compared between individuals with dissociative identity disorder (DID: n = 32) and healthy controls (n = 42). Analyses of covariance did not show volumetric differences between the DID and control groups. Although several unknowns make it challenging to interpret our findings, we propose that the finding of normal amygdala volume is a genuine finding because other studies using this data-set have presented robust morphological aberrations in relation to the diagnosis of DID.
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Affiliation(s)
- Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Lora I Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; and Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
| | - Yolanda R Schlumpf
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland; and Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | | | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Switzerland; and Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Switzerland
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, The Netherlands
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Arzy S, Kaplan R. Transforming Social Perspectives with Cognitive Maps. Soc Cogn Affect Neurosci 2022; 17:939-955. [PMID: 35257155 PMCID: PMC9527473 DOI: 10.1093/scan/nsac017] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 12/17/2021] [Accepted: 03/07/2022] [Indexed: 01/29/2023] Open
Abstract
Growing evidence suggests that cognitive maps represent relations between social knowledge similar to how spatial locations are represented in an environment. Notably, the extant human medial temporal lobe literature assumes associations between social stimuli follow a linear associative mapping from an egocentric viewpoint to a cognitive map. Yet, this form of associative social memory doesn't account for a core phenomenon of social interactions in which social knowledge learned via comparisons to the self, other individuals, or social networks are assimilated within a single frame of reference. We argue that hippocampal-entorhinal coordinate transformations, known to integrate egocentric and allocentric spatial cues, inform social perspective switching between the self and others. We present evidence that the hippocampal formation helps inform social interactions by relating self versus other social attribute comparisons to society in general, which can afford rapid and flexible assimilation of knowledge about the relationship between the self and social networks of varying proximities. We conclude by discussing the ramifications of cognitive maps in aiding this social perspective transformation process in states of health and disease.
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Affiliation(s)
- Shahar Arzy
- Faculty of Medicine and the Department of Cognitive Sciences, Hebrew University of Jerusalem, Jerusalem 91120, Israel
- Department of Neurology, Hadassah Hebrew University Medical School, Jerusalem 91120, Israel
| | - Raphael Kaplan
- Correspondence should be addressed to Raphael Kaplan, Department of Basic Psychology, Clinical Psychology, and Psychobiology, Universitat Jaume I, Avinguda de Vicent Sos Baynat, Castelló de la Plana, Spain. E-mail:
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Shayganfard M. Are Essential Trace Elements Effective in Modulation of Mental Disorders? Update and Perspectives. Biol Trace Elem Res 2022; 200:1032-1059. [PMID: 33904124 DOI: 10.1007/s12011-021-02733-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
The emergence of mental disorders is associated with several risk factors including genetic and environmental susceptibility. A group of nutrients serves an especially important role in a number of essential neurodevelopmental processes through brain areas promoting the high degree of brain metabolism during early life, although almost all nutrients are needed. These include macronutrients and micronutrients (e.g., iron, magnesium, zinc, copper, selenium). Numerous nutritional psychiatry trials have been performed to examine the correlation of many individual nutrients with mental health, such as essential trace elements. The increased accumulation or lack of such components will facilitate an alternative metabolic pathway that can lead to many diseases and conditions of neurodevelopment. Mental functions have biochemical bases, so the impairment of such neurochemical mechanisms due to lack of trace elements can have mental effects. In psychological conditions such as depression, anxiety, schizophrenia, and autism, scientific studies demonstrate the putative role of trace element deficiency. Therefore, given the critical roles played by essential trace elements in the neurodevelopment and mental health, the effect of these elements' intake on the modulation of psychological functioning is reviewed.
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Affiliation(s)
- Mehran Shayganfard
- Department of Psychiatry, Arak University of Medical Sciences, Arak, Iran.
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Lynn SJ, Polizzi C, Merckelbach H, Chiu CD, Maxwell R, van Heugten D, Lilienfeld SO. Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework. Annu Rev Clin Psychol 2022; 18:259-289. [PMID: 35226824 DOI: 10.1146/annurev-clinpsy-081219-102424] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- Steven Jay Lynn
- Psychology Department, Binghamton University, Binghamton, New York, USA;
| | - Craig Polizzi
- Psychology Department, Binghamton University, Binghamton, New York, USA;
| | - Harald Merckelbach
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Chui-De Chiu
- Department of Psychology, Chinese University of Hong Kong, Hong Kong, China
| | - Reed Maxwell
- Department of Psychiatry, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Dalena van Heugten
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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Channeling: A Non-pathological Possession and Dissociative Identity Experience or Something Else? Cult Med Psychiatry 2022; 46:161-169. [PMID: 34212272 PMCID: PMC9034997 DOI: 10.1007/s11013-021-09730-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/25/2022]
Abstract
Channeling experiences are often compared with Dissociative Trance/Possession Disorders and Dissociative Identity Disorders and more recent diagnostic criteria presented in the DSM 5 and ICD-11. From this comparison, it emerges quite clearly that, for most cases, channeling can either be considered an exceptional non-ordinary mental experience or a non-pathological Dissociative Trance/Possession experience. If this characterization is valid, the next step is to understand the origin of channeling experiences. Are they an expression of channeler's unconscious or voluntary mental mechanisms, or real connections with "other discarnate entities"? Given their peculiar characteristics, channeling experiences offer a unique opportunity for a scientific investigation and in particular, the origin of the information received by the channelers.
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Deen A, Biedermann SV, Lotzin A, Krüger-Gottschalk A, Dyer A, Knaevelsrud C, Rau H, Schellong J, Ehring T, Schäfer I. The dissociative subtype of PTSD in trauma-exposed individuals: a latent class analysis and examination of clinical covariates. Eur J Psychotraumatol 2022; 13:2031591. [PMID: 35273782 PMCID: PMC8903748 DOI: 10.1080/20008198.2022.2031591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND A dissociative subtype of posttraumatic stress disorder (D-PTSD) was introduced into the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) but latent profiles and clinical correlates of D-PTSD remain controversial. OBJECTIVE The aims of our study were to identify subgroups of individuals with distinct patterns of PTSD symptoms, including dissociative symptoms, by means of latent class analyses (LCA), to compare these results with the categorization of D-PTSD vs. PTSD without dissociative features according to the CAPS-5 interview, and to explore whether D-PTSD is associated with higher PTSD severity, difficulties in emotion regulation, and depressive symptoms. METHOD A German sample of treatment-seeking individuals was investigated (N = 352). We conducted an LCA on the basis of symptoms of PTSD and dissociation as assessed by the CAPS-5. Moreover, severity of PTSD (PCL-5), difficulties in emotion regulation (DERS), and depressive symptoms (BDI-II) were compared between patients with D-PTSD according to the CAPS-5 interview and patients without dissociative symptoms. RESULTS LCA results suggested a 5-class model with one subgroup showing the highest probability to fulfill criteria for the dissociative subtype and high scores on both BDI and DERS. Significantly higher scores on the DERS, BDI and PCL-5 were found in the D-PTSD group diagnosed with the CAPS-5 (n = 75; 35.7%). Sexual trauma was also reported more often by this subgroup. When comparing the dissociative subtype to the LCA results, only a partial overlap could be found. CONCLUSIONS Our findings suggest that patients with D-PTSD have significantly more problems with emotion regulation, more depressive symptoms, and more severe PTSD-symptoms. Given the results of our LCA, we conclude that the dissociative subtype seems to be more complex than D-PTSD as diagnosed by means of the CAPS-5.
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Affiliation(s)
- Aljosha Deen
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sarah V Biedermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annett Lotzin
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Anne Dyer
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Christine Knaevelsrud
- Department of Clinical Psychology and Psychotherapy, Free University Berlin, Berlin, Germany
| | - Heinrich Rau
- Psychotrauma Centre, German Armed Forces Hospital Berlin, Germany
| | - Julia Schellong
- Department of Psychotherapy and Psychosomatic Medicine, Technical University Dresden, Dresden, Germany
| | | | - Ingo Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Centre for Interdisciplinary Addiction Research, University of Hamburg, Hamburg, Germany
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Frazzini V, Cousyn L, Navarro V. Semiology, EEG, and neuroimaging findings in temporal lobe epilepsies. HANDBOOK OF CLINICAL NEUROLOGY 2022; 187:489-518. [PMID: 35964989 DOI: 10.1016/b978-0-12-823493-8.00021-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Temporal lobe epilepsy (TLE) is the most common type of focal epilepsy. First descriptions of TLE date back in time and detailed portraits of epileptic seizures of temporal origin can be found in early medical reports as well as in the works of various artists and dramatists. Depending on the seizure onset zone, several subtypes of TLE have been identified, each one associated with peculiar ictal semiology. TLE can result from multiple etiological causes, ranging from genetic to lesional ones. While the diagnosis of TLE relies on detailed analysis of clinical as well as electroencephalographic (EEG) features, the lesions responsible for seizure generation can be highlighted by multiple brain imaging modalities or, in selected cases, by genetic investigations. TLE is the most common cause of refractory epilepsy and despite the great advances in diagnostic tools, no lesion is found in around one-third of patients. Surgical treatment is a safe and effective option, requiring presurgical investigations to accurately identify the seizure onset zone (SOZ). In selected cases, presurgical investigations need intracerebral investigations (such as stereoelectroencephalography) or dedicated metabolic imaging techniques (interictal PET and ictal SPECT) to correctly identify the brain structures to be removed.
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Affiliation(s)
- Valerio Frazzini
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Louis Cousyn
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France
| | - Vincent Navarro
- AP-HP, Department of Neurology and Department of Clinical Neurophysiology, Epilepsy and EEG Unit, Reference Center for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France; Sorbonne Université, Paris Brain Institute, Team "Dynamics of Neuronal Networks and Neuronal Excitability", Paris, France.
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31
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Lahav Y. Suicidality in childhood abuse survivors - the contribution of identification with the aggressor. J Affect Disord 2021; 295:804-810. [PMID: 34706450 DOI: 10.1016/j.jad.2021.08.138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 07/22/2021] [Accepted: 08/27/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Childhood abuse survivors are at risk for suicidal ideation and suicide attempts. Research has indicated that posttraumatic stress disorder (PTSD) symptoms and dissociation are related to elevated suicidal ideation and behavior (SIB) among this population. At the same time, although the theoretical and clinical literature in the trauma field have suggested that survivors' pathological attachment to their perpetrators, known as identification with the aggressor, might explain SIB, this supposition has not been investigated to date. METHOD Filling this gap, this study explored the associations between identification with the aggressor, PTSD symptoms, dissociation, and SIB among 589 adult survivors of childhood abuse. RESULTS Identification with the aggressor, PTSD symptoms, and dissociation were related to elevated levels in suicidal ideation and behavior. Furthermore, profile type (namely, having high versus medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation) was implicated in participants' SIB: Participants who adhered to a profile characterized by high levels of identification with the aggressor, PTSD symptoms, and dissociation had higher levels of suicide risk and suicidal ideation, as well as higher odds of reporting a history of suicide attempts, compared to participants who adhered to the other two profiles (i.e., characterized by medium or low levels of identification with the aggressor, PTSD symptoms, and dissociation). LIMITATIONS This study relied on convenience sampling and a cross-sectional design. CONCLUSIONS Identification with the aggressor might serve, alongside PTSD symptoms and dissociation, as a risk factor for suicidal ideation and behavior among childhood abuse survivors.
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Affiliation(s)
- Yael Lahav
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Israel.
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32
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Millman LSM, Hunter ECM, Orgs G, David AS, Terhune DB. Symptom variability in depersonalization-derealization disorder: A latent profile analysis. J Clin Psychol 2021; 78:637-655. [PMID: 34487354 DOI: 10.1002/jclp.23241] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 06/09/2021] [Accepted: 08/15/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Depersonalization-derealization disorder (DDD) is characterized by diverse symptomatology overlapping with anxiety and dissociative disorders, but the sources of this variability are poorly understood. This study aims to determine whether symptom heterogeneity is attributable to the presence of latent subgroups. METHOD We applied latent profile analysis to psychometric measures of anxiety, depersonalization-derealization, and dissociation in 303 DDD patients. RESULTS The analysis yielded evidence for five discrete subgroups: three of varying severity levels and two moderate-to-severe classes characterized by differential dissociative symptoms. The five classes reliably differed on several nondissociative symptoms, comorbidities, and factors precipitating their diagnosis but did not significantly differ in other symptoms including anxiety. CONCLUSION These results suggest the presence of three distinct DDD subtypes in the upper severity range that are distinguished by differential expression of detachment and compartmentalization symptoms. Further elucidation of these subtypes has potential implications for the etiology, mechanisms, and treatment of DDD.
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Affiliation(s)
| | | | - Guido Orgs
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, London, UK
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Rodrigues NB, McIntyre RS, Lipsitz O, Lee Y, Cha DS, Shekotikhina M, Vinberg M, Gill H, Subramaniapillai M, Kratiuk K, Lin K, Ho R, Mansur RB, Rosenblat JD. A simplified 6-Item clinician administered dissociative symptom scale (CADSS-6) for monitoring dissociative effects of sub-anesthetic ketamine infusions. J Affect Disord 2021; 282:160-164. [PMID: 33418362 DOI: 10.1016/j.jad.2020.12.119] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/23/2020] [Accepted: 12/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Dissociation is a treatment-emergent adverse event commonly associated with IV ketamine, often measured using the 23-item Clinician-Administered Dissociative States Scale (CADSS). The objective of this study was to develop a short form version of the CADSS for easier clinical use. METHODS Retrospective data of 260 patients with treatment-resistant depression (TRD) receiving IV ketamine were randomly divided into two datasets. The first dataset (n = 130) was leveraged to develop a brief 6-item version of the CADSS (CADSS-6) based on items most sensitive to ketamine-induced dissociation. The CADSS-6 questions were then applied to the second dataset (n = 130) and the Spearman's correlation between the full-length CADSS and the CADSS-6 were assessed. RESULTS The CADSS-6 was developed from questions 1, 2, 6, 7, 15, and 22 from the full length CADSS. There was a strong significant correlation between the CADSS-6 total score and the CADSS total score at infusions 1 (rs(106) = 0.92, p < 0.001), 2 (rs(100) = 0.91, p < 0.001), 3(rs(99) = 0.95, p < 0.001) and 4 (rs(102) = 0.94, p < 0.001). LIMITATIONS The CADSS-6 was developed using a retrospective data; therefore, the scale remains unvalidated in this population. CONCLUSIONS The CADSS-6 presented herein was sensitive to dissociation experienced by patients receiving IV ketamine. Overall, the CADSS-6 was strongly correlated at each infusion with the full-length CADSS. While future studies should look to validate the CADSS-6 in a TRD sample, this scale offers clinicians a brief assessment that can be used to characterize symptoms of dissociation.
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Affiliation(s)
- Nelson B Rodrigues
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Canada; University of Toronto, Toronto, ON, Canada.
| | - Orly Lipsitz
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Danielle S Cha
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada
| | | | - Maj Vinberg
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Hillerød and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Hartej Gill
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Mehala Subramaniapillai
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada
| | - Kevin Kratiuk
- Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Department of Physical Pharmacy, Poznan University of Medical Sciences, Poland
| | - Kangguang Lin
- Department of Affective Disorder, the Affiliated Brain Hospital of Guangzhou Medical University, (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China; Laboratory of Emotion and Cognition, the Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital), Guangzhou Medical University, Guangzhou, China
| | - Roger Ho
- Department of Psychological Medicine, National University of Singapore, Singapore
| | - Rodrigo B Mansur
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada
| | - Joshua D Rosenblat
- Mood Disorders Psychopharmacology Unit, University Health Network; University of Toronto, Toronto, ON, Canada; Canadian Rapid Treatment Center of Excellence, Mississauga, ON, Canada; Brain and Cognition Discovery Foundation, Canada; University of Toronto, Toronto, ON, Canada
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34
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Affiliation(s)
- Vinod Menon
- Department of Psychiatry and Behavioral Sciences and Department of Neurology and Neurological Sciences, Stanford Neurosciences Institute, Stanford University School of Medicine, Stanford, Calif
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Gainer DM, Crawford TN, Fischer KB, Wright MD. The relationship between dissociative symptoms and the medications used in the treatment of opioid use disorder. J Subst Abuse Treat 2020; 121:108195. [PMID: 33357605 DOI: 10.1016/j.jsat.2020.108195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/11/2020] [Accepted: 11/04/2020] [Indexed: 11/25/2022]
Abstract
Opioid use disorder has long been associated with psychiatric symptoms, including dissociative experiences. Medications used to treat opioid use disorder can potentially impact dissociative symptoms, but the existing literature has not explored this. We examined the relationship between dissociative symptoms and opioid use disorder using the Dissociative Experiences Scale (DES). We studied subjects who were taking prescribed methadone, buprenorphine, or naltrexone for opioid use disorder. We gave the DES, the Patient Health Questionairre-9 (PHQ-9), and the PTSD Checklist for DSM-5 (PCL-5) with Criterion A to subjects in three substance use treatment facilities in Ohio. We conducted Analysis of Variance (ANOVA) and Spearman's Rank Correlations to examine associations between the variables and outcomes. We developed three separate multiple linear regression models. We included 116 participants in our exploratory and naturalistic study. The majority of participants were female (51.7%), white (89.5%), ≤ 40 years of age (64.7%), and taking buprenorphine (55%). The average DES score was 16.1 (standard deviation = 14.9) and we considered 80.9% to have low dissociation (score < 30). Approximately 55% (n = 64) of participants were taking prescribed buprenorphine. Approximately 27% (n = 32) were taking prescribed methadone and approximately 18% (n = 21) were taking prescribed naltrexone (oral or extended release). There was a significant association between opioid medication type and log dissociative symptoms (p = .01). Participants taking prescribed buprenorphine had higher mean log dissociation symptom scores (2.7) compared to those taking prescribed methadone (2.2) and prescribed naltrexone (2.1). Log dissociation symptom scores were significantly associated with last use of any opiates (rs = -0.21; p = .02) and time on medication (rs = -0.228; p = .01). Compared to those taking buprenorphine, those taking both methadone (β = -0.26; p = .01) and naltrexone (β = -0.27; p = .006) had significantly lower dissociation scores, controlling for the other variables in the model. Dissociation scores were positively correlated with depression scores (r = 0.45; p < .0001) and with PCL-5 scores (r = 0.51; p < .0001). Our study highlights the importance of diagnosing and monitoring dissociative symptoms in individuals who are taking prescribed medications for opioid use disorder, especially since dissociative symptoms can interfere with substance use treatment.
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Affiliation(s)
- Danielle M Gainer
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America.
| | - Timothy N Crawford
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| | - Karley B Fischer
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
| | - Mark D Wright
- Wright State University Boonshoft School of Medicine, 2555 University Blvd., Suite 100, Fairborn, OH 45324, United States of America
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36
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Ballard ED, Zarate CA. The role of dissociation in ketamine's antidepressant effects. Nat Commun 2020; 11:6431. [PMID: 33353946 PMCID: PMC7755908 DOI: 10.1038/s41467-020-20190-4] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Ketamine produces immediate antidepressant effects and has inspired research into next-generation treatments. Ketamine also has short term dissociative effects, in which individuals report altered consciousness and perceptions of themselves and their environment. However, whether ketamine's dissociative side effects are necessary for its antidepressant effects remains unclear. This perspective examines the relationship between dissociative effects and acute and longer-lasting antidepressant response to ketamine and other N-methyl-D-aspartate (NMDA) receptor antagonists. Presently, the literature does not support the conclusion that dissociation is necessary for antidepressant response to ketamine. However, further work is needed to explore the relationship between dissociation and antidepressant response at the molecular, biomarker, and psychological levels.
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Affiliation(s)
- Elizabeth D Ballard
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Carlos A Zarate
- Section on the Neurobiology and Treatment of Mood Disorders, Intramural Research Program, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, 20892, USA
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37
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Rabellino D, Frewen PA, McKinnon MC, Lanius RA. Peripersonal Space and Bodily Self-Consciousness: Implications for Psychological Trauma-Related Disorders. Front Neurosci 2020; 14:586605. [PMID: 33362457 PMCID: PMC7758430 DOI: 10.3389/fnins.2020.586605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 11/10/2020] [Indexed: 11/24/2022] Open
Abstract
Peripersonal space (PPS) is defined as the space surrounding the body where we can reach or be reached by external entities, including objects or other individuals. PPS is an essential component of bodily self-consciousness that allows us to perform actions in the world (e.g., grasping and manipulating objects) and protect our body while interacting with the surrounding environment. Multisensory processing plays a critical role in PPS representation, facilitating not only to situate ourselves in space but also assisting in the localization of external entities at a close distance from our bodies. Such abilities appear especially crucial when an external entity (a sound, an object, or a person) is approaching us, thereby allowing the assessment of the salience of a potential incoming threat. Accordingly, PPS represents a key aspect of social cognitive processes operational when we interact with other people (for example, in a dynamic dyad). The underpinnings of PPS have been investigated largely in human models and in animals and include the operation of dedicated multimodal neurons (neurons that respond specifically to co-occurring stimuli from different perceptive modalities, e.g., auditory and tactile stimuli) within brain regions involved in sensorimotor processing (ventral intraparietal sulcus, ventral premotor cortex), interoception (insula), and visual recognition (lateral occipital cortex). Although the defensive role of the PPS has been observed in psychopathology (e.g., in phobias) the relation between PPS and altered states of bodily consciousness remains largely unexplored. Specifically, PPS representation in trauma-related disorders, where altered states of consciousness can involve dissociation from the body and its surroundings, have not been investigated. Accordingly, we review here: (1) the behavioral and neurobiological literature surrounding trauma-related disorders and its relevance to PPS; and (2) outline future research directions aimed at examining altered states of bodily self-consciousness in trauma related-disorders.
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Affiliation(s)
- Daniela Rabellino
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
| | - Paul A. Frewen
- Department of Psychiatry, Western University, London, ON, Canada
- Department of Psychology, Western University, London, ON, Canada
| | - Margaret C. McKinnon
- Mood Disorders Program, St. Joseph’s Healthcare, Hamilton, ON, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Homewood Research Institute, Guelph, ON, Canada
| | - Ruth A. Lanius
- Department of Psychiatry, Western University, London, ON, Canada
- Imaging Division, Lawson Health Research Institute, London, ON, Canada
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Roydeva MI, Reinders AATS. Biomarkers of Pathological Dissociation: A Systematic Review. Neurosci Biobehav Rev 2020; 123:120-202. [PMID: 33271160 DOI: 10.1016/j.neubiorev.2020.11.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
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Affiliation(s)
- Monika I Roydeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
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Longden E, Branitsky A, Moskowitz A, Berry K, Bucci S, Varese F. The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis. Schizophr Bull 2020; 46:1104-1113. [PMID: 32251520 PMCID: PMC7505175 DOI: 10.1093/schbul/sbaa037] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 -.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 -.531), delusions (r = .418; 95%CI: .370 -.464), paranoia (r = .447; 95%CI: .393 -.499), and disorganization (r = .346; 95%CI: .249 -.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.
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Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Liu Y, Zhu X, Xie Y, Yan J, Guo Q. Respiratory roller coaster ride following ambulatory surgery in a young woman: A case report. Int J Surg Case Rep 2020; 75:104-107. [PMID: 32932037 PMCID: PMC7493036 DOI: 10.1016/j.ijscr.2020.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 11/28/2022] Open
Abstract
It is the first report about severely abnormal respiratory symptoms in a young patient following ambulatory surgery. The patients in Ambulatory Surgery Center are in good condition, it’s easy to neglect the importance of preoperative preparation. More extensive clinical and psychological examinations prior to surgery are necessary in young individuals in the Ambulatory Surgery Center.
Introduction Ambulatory surgery has the advantages of shortening the waiting time for hospitalization and reducing medical expenses. It has been more and more widely used in recent years in China. The patients admitted in Ambulatory Surgery Center are generally in good condition (ASA I-II), with clear diagnosis, short operation time, low operation risk and low incidence of postoperative complications. It is easy to paralyze the medical staff, neglecting the importance of preoperative preparation, and then causing physical and psychological damage to the patient. Presentation of case We describe the case of a 21-year-old woman, presented with erratic respiratory rate with a maximum of 40 breaths min−1 and a minimum of 7 breaths min−1 after undergoing arthroscopic meniscectomy. The arterial blood gas analysis revealed a disruption of the acid-base homeostasis with respiratory alkalosis and metabolic acidosis, while all other examinations were normal. Discussion Drug-related adverse reactions, emergence agitation or psychiatric factors may have caused the observed symptoms. Conclusion Our observations demonstrate that more extensive clinical and psychological examinations prior to surgery involving general anesthesia may help in avoiding anesthesia-related complications, even in young individuals from the Ambulatory Surgery Center.
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Affiliation(s)
- Yijun Liu
- Department of Anesthesiology, Xiangya Hospital of Central South University, Hunan, 410008, China.
| | - Xiaoyan Zhu
- Department of Anesthesiology, Xiangya Hospital of Central South University, Hunan, 410008, China.
| | - Yongqiu Xie
- Department of Anesthesiology, Xiangya Hospital of Central South University, Hunan, 410008, China.
| | - Jianqin Yan
- Department of Anesthesiology, Xiangya Hospital of Central South University, Hunan, 410008, China.
| | - Qulian Guo
- Department of Anesthesiology, Xiangya Hospital of Central South University, Hunan, 410008, China.
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Tuineag M, Therman S, Lindgren M, Rouanet M, Nahon S, Bertrand L, Saury S, Renaud S, Beaulieu S, Linnaranta O. Dissociative symptoms as measured by the Cambridge Depersonalization Scale in patients with a bipolar disorder. J Affect Disord 2020; 263:187-192. [PMID: 31818776 DOI: 10.1016/j.jad.2019.11.137] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/25/2019] [Accepted: 11/29/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Cambridge Depersonalization Scale (CDS) characterizes the quality, frequency, and duration of dissociative symptoms. While the psychometric properties of the CDS have been evaluated in primary dissociative disorder, this has been insufficiently addressed among other psychiatric patient groups such as patients with a bipolar disorder (BD). METHODS Outpatients with variable mood (n = 73) responded to a survey that assessed dissociative symptoms and other characteristics. We used factor analysis and McDonald's omega to evaluate psychometric properties of the CDS, and correlations with other characteristics. RESULTS Previously suggested multifactorial models of the CDS were not supported, but the single-dimensional model fit both dichotomized (p = 0.31, CFI = 0.99, RMSEA = 0.02, ECV 70%) and trichotomized CDS responses (p = 0.06, CFI = 0.96, RMSEA = 0.04, ECV 47%). The CDS showed high internal consistency (ω = 0.96). CDS factor scores correlated with symptom severity on the Quick Inventory for Depressive Symptoms (QIDS-SR-16) (ρ = 0.59), the Social Phobia Inventory (ρ = 0.52), the American Association of Psychiatry Severity measure for Panic Disorders (ρ = 0.46), the Childhood Trauma Questionnaire (ρ = 0.44), and the Trauma Screening Questionnaire (ρ = 0.53). Two abbreviated versions of the CDS, retaining the best 14 or 7 items were proposed. LIMITATIONS The sample size remained moderate. CONCLUSIONS The CDS is a psychometrically sound, unidimensional measure with clinical impact to detect and characterize dissociative symptoms in BD patients. Establishing the reliability and validity of the abbreviated scales for screening necessitates further study.
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Affiliation(s)
- Maria Tuineag
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Mood disorders Psychopharmacology Unit, University of Toronto, 399 Bathurst Street, Toronto, ON M5T 2S8, Canada
| | - Sebastian Therman
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Maija Lindgren
- National Institute for Health and Welfare, PL 30, 00271 Helsinki, Finland
| | - Manon Rouanet
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sara Nahon
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; University of Oxford, Oxford OX3 7JX, United Kingdom
| | - Lia Bertrand
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada
| | - Sybille Saury
- Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Suzanne Renaud
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
| | - Outi Linnaranta
- Department of Psychiatry, McGill University, 1033 Pine Avenue West Montreal, QC, H3A 1A1, Canada; Bipolar disorders clinic, Douglas Mental Health University Institute, 6875 LaSalle Boulevard Montreal, Quebec H4H 1R3, Canada
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Golshani S, Ghanbari S, Firoozabadi A, Shakeri J, Hookari S, Rahami B, Sadeghi Bahmani D, Brand S. Dissociative Symptoms and Self-Reported Childhood and Current Trauma in Male Incarcerated People with Borderline Personality Disorder - Results from a Small Cross-Sectional Study in Iran. Neuropsychiatr Dis Treat 2020; 16:2407-2417. [PMID: 33116540 PMCID: PMC7586052 DOI: 10.2147/ndt.s266016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/28/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND There is evidence that incarcerated people show higher rates of symptoms of psychopathology. In the present study, we assessed male Iranian incarcerated people with borderline personality disorders (BPD) and investigated the occurrence of past and current trauma and their associations with dissociative experiences. METHODS A total of 69 male Iranian incarcerated people (mean age: 33.76 years) diagnosed with PBD completed questionnaires covering sociodemographic information, dissociative experiences, and past and current traumatic events. RESULTS Participants reporting the occurrence of childhood trauma also reported the occurrence of adulthood trauma. Dissociation and adulthood trauma were associated in a U-shaped, non-linear fashion: Low and high adulthood trauma were associated with higher dissociation. Younger age, the presence of childhood trauma, and being single or divorced predicted adulthood trauma. CONCLUSION The pattern of results suggests that both childhood and adulthood trauma are highly prevalent among male incarcerated people, while the association between adulthood trauma and dissociation appeared to be more complex. When treating male incarcerated people, a complex interplay between past and current traumas and dissociation should be considered.
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Affiliation(s)
- Sanobar Golshani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sahel Ghanbari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Firoozabadi
- Research Center for Psychiatry and Behavioral Sciences, Department of Psychiatry, Hafez Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jalal Shakeri
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sarah Hookari
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Bahareh Rahami
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Dena Sadeghi Bahmani
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective-, Stress- and Sleep Disorders (ZASS), Basel 4002, Switzerland
| | - Serge Brand
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.,Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.,University of Basel, Psychiatric Clinics (UPK), Center for Affective-, Stress- and Sleep Disorders (ZASS), Basel 4002, Switzerland.,Department of Sport, Exercise, and Health, Division of Sport Science and Psychosocial Health, University of Basel, Basel, Switzerland.,Department of Psychiatry, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Rehman Y, Sadeghirad B, Guyatt GH, McKinnon MC, McCabe RE, Lanius RA, Richardson DJ, Couban R, Sousa-Dias H, Busse JW. Management of post-traumatic stress disorder: A protocol for a multiple treatment comparison meta-analysis of randomized controlled trials. Medicine (Baltimore) 2019; 98:e17064. [PMID: 31574805 PMCID: PMC6775348 DOI: 10.1097/md.0000000000017064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Most systematic reviews have explored the efficacy of treatments on symptoms associated with post-traumatic stress disorder (PTSD), which is a chronic and often disabling condition. Previous network meta-analysis (NMA) had limitations such as focusing on pharmacological or psychotherapies. Our review is aims to explore the relative effectiveness of both pharmacological and psychotherapies and we will establish the differential efficacy of interventions for PTSD in consideration of both symptom reduction and functional recovery. METHODS We will conduct a network meta-analysis of randomized controlled trials evaluating treatment interventions for PTSD. We will systematically search Medline, PILOT, Embase, CINHAL, AMED, Psychinfo, Health Star, DARE and CENTRAL to identify trials that: (1) enroll adult patients with PTSD, and (2) randomize them to alternative interventions or an intervention and a placebo/sham arm. Independent reviewers will screen trials for eligibility, assess risk of bias using a modified Cochrane instrument, and extract data. Our outcomes of interest include PTSD symptom reduction, quality of life, functional recovery, social and occupational impairment, return to work and all-cause drop outs. RESULTS We will conduct frequentist random-effects network meta-analysis to assess relative effects of competing interventions. We will use a priori hypotheses to explore heterogeneity between studies, and assess the certainty of evidence using the GRADE approach. CONCLUSION This network meta-analysis will determine the comparative effectiveness of therapeutic options for PTSD on both symptom reduction and functional recovery. Our results will be helpful to clinicians and patients with PTSD, by providing a high-quality evidence synthesis to guide shared-care decision making.
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Affiliation(s)
- Yasir Rehman
- Department of Health Research Methods, Evidence, and Impact (HEI)
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
- Canadian Academy of Osteopathy (CAO)
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (HEI)
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
| | - Gordon H. Guyatt
- Department of Health Research Methods, Evidence, and Impact (HEI)
| | - Margaret C. McKinnon
- Department of Psychiatry and Behavioral Neurosciences, McMaster University
- Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton
- Homewood Research Institute, Guelph
| | - Randi E. McCabe
- Department of Psychiatry and Behavioral Neurosciences, McMaster University
- Anxiety Treatment & Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton
| | - Ruth A. Lanius
- Homewood Research Institute, Guelph
- Imaging Division, Lawson Health Research Institute
- Department of Psychiatry and Neurosciences Western University
| | - Donald J. Richardson
- MacDonald/Franklin OSI Research Centre, Western University
- Lawson Health Research Institute
- Parkwood Hospital Operational Stress Injury Clinic, St. Joseph's Health Care London
- Department of Psychiatry and Neurosciences Western University, London
| | - Rachel Couban
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
| | | | - Jason W. Busse
- Department of Health Research Methods, Evidence, and Impact (HEI)
- The Michael G. DeGroote Institute of Pain Research and Care, McMaster University
- Department of Anesthesia
- The Michael G. DeGroote Centre for Medicinal Cannabis Research, McMaster University, Hamilton, ON, Canada
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Caputo GB. Strange-face illusions during eye-to-eye gazing in dyads: specific effects on derealization, depersonalization and dissociative identity. J Trauma Dissociation 2019; 20:420-444. [PMID: 30938658 DOI: 10.1080/15299732.2019.1597807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Experimentally induced strange-face illusions can be perceived when two individuals look at each other in the eyes under low illumination for about 10 minutes. This task of subject-other eye-to-eye gazing produces the following perceptions by the subject: (i) mild to huge deformations and color/shape changes of face and facial features; (ii) lifeless, unmoving faces and immaterial presences akin to out-of-body experiences; (iii) pseudo-hallucinations, enlightened 'idealized' faces and personalities - rather than the other's actual face. Dissociative phenomena seem to be involved, whereas the effects of non-pathological dissociation on strange-face illusions have not yet been directly investigated. In the present study, dissociative perceptions and strange-face illusions were measured through self-report questionnaires on a large sample (N = 90) of healthy young individuals. Results of correlation and factor analyses suggest that strange-face illusions can involve, respectively: (i) strange-face illusions correlated to derealization; (ii) strange-face illusions correlated to depersonalization; and (iii) strange-face illusions of identity, which are supposedly correlated to identity dissociation. The findings support the separation between detachment and compartmentalization in dissociative processes. Effects of gender show that strange-face illusions are more frequent in men with respect to women if dyads are composed of individuals of different-gender. Furthermore, drawings of strange-faces, which were perceived by portrait artists in place the others' faces, allowed a direct illustration of examples of dissociative identities. Findings are discussed in relation to the three-level model of self-referential processing.
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El-Gabalawy R, Sommer JL, Pietrzak R, Edmondson D, Sareen J, Avidan MS, Jacobsohn E. Post-traumatic stress in the postoperative period: current status and future directions. Can J Anaesth 2019; 66:1385-1395. [DOI: 10.1007/s12630-019-01418-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
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Facco E, Mendozzi L, Bona A, Motta A, Garegnani M, Costantini I, Dipasquale O, Cecconi P, Menotti R, Coscioli E, Lipari S. Dissociative identity as a continuum from healthy mind to psychiatric disorders: Epistemological and neurophenomenological implications approached through hypnosis. Med Hypotheses 2019; 130:109274. [PMID: 31383343 DOI: 10.1016/j.mehy.2019.109274] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 06/05/2019] [Accepted: 06/10/2019] [Indexed: 12/19/2022]
Abstract
The topic of multiple personality, redefined as Dissociative Identity Disorders (DIDs) in the DSM-5, is an intriguing and still debated disorder with a long history and deep cultural and epistemological implications, extending up to the idea of possession. Hypnosis is an appealing and valuable model to manipulate subjective experience and get an insight on both the physiology and the pathophysiology of the mind-brain functioning; it and has been closely connected with DIDs and possession since its origin in 18th century and as recently proved the capacity to yield a loss of sense of agency, mimicking delusions of alien control and spirit possession. In this study we report on five very uncommon "hypnotic virtuosos" (HVs) free from any psychiatric disorder, spontaneously undergoing the emergence of multiple identities during neutral hypnosis; this allowed us to check the relationship between their experience and fMRI data. During hypnosis the subjects underwent spontaneous non-intrusive experiences of other selves which were not recalled after the end of the session, due to post-hypnotic amnesia. The fMRI showed a significant decrease of connectivity in the Default Mode Network (DMN) especially between the posterior cingulate cortex and the medial prefrontal cortex. Our results and their contrast with the available data on fMRI in DIDs allows to draw the hypothesis of a continuum between healthy mind - where multiple identities may coexist at unconscious level and may sometimes emerge to the consciousness - and DIDs, where multiple personalities emerge as dissociated, ostensibly autonomous components yielding impaired functioning, subject's loss of control and suffering. If this is the case, it seems more reasonable to refrain from seeking for a clear-cut limit between normality (anyway a conventional, statistical concept) and pathology, and accept a grey area in between, where ostensibly odd but non-pathological experiences may occur (including so-called non-ordinary mental expressions) without calling for treatment but, rather, for being properly understood.
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Affiliation(s)
- Enrico Facco
- Studium Patavinum - Dept. of Neurosciences, University of Padua, Italy; Science of Consciousness Research Group, Dept. of General Psychology, University of Padua, Italy; Inst. F. Granone - Italian Center of Clinical and Experimental Hypnosis (CIICS), Turin, Italy.
| | - Laura Mendozzi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
| | - Angelo Bona
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, Milan, Italy
| | - Achille Motta
- Department of Clinical Neurosciences, Villa San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, via Roma 16, Como, Italy
| | - Massimo Garegnani
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
| | - Isa Costantini
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; INRIA, Sophia-Antipolis, France
| | - Ottavia Dipasquale
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy; Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King's College, London, United Kingdom
| | - Pietro Cecconi
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
| | - Roberta Menotti
- Department of Clinical Neurosciences, Villa San Benedetto Hospital, Hermanas Hospitalarias, Albese con Cassano, via Roma 16, Como, Italy
| | | | - Susanna Lipari
- IRCCS, Fondazione Don Carlo Gnocchi ONLUS, via Capecelatro 66, 20148 Milan, Italy
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Wieder L, Terhune DB. Trauma and anxious attachment influence the relationship between suggestibility and dissociation: a moderated-moderation analysis. Cogn Neuropsychiatry 2019; 24:191-207. [PMID: 30987544 DOI: 10.1080/13546805.2019.1606705] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Hypnotic suggestibility is elevated in the dissociative disorders but the relationship between dissociative tendencies and suggestibility in the general population seems to be constrained by additional factors. The diathesis-stress (DS) model stipulates that suggestibility interacts with trauma exposure to augment the propensity for dissociative states whereas the dual pathway to suggestibility (DPS) model proposes two developmental routes involving either dissociation preceded by trauma, or a healthy cognitive profile characterised by superior imagination. METHODS This study sought to discriminate between these partially competing accounts and further considered the moderating role of anxious attachment. 209 participants completed psychometric measures of dissociative tendencies, trauma, and attachment, and a behavioural measure of suggestibility. RESULTS In support of the DS model, trauma moderated the relationship between suggestibility and dissociation and, as predicted by the DPS model, dissociation moderated the relationship between trauma and suggestibility. Anxious attachment additionally moderated both effects. Model comparisons indicated that the DS model consistently provided a superior fit to the data. Further analyses showed that secure attachment independently predicted suggestibility, thereby supporting the non-dissociative pathway in the DPS model. CONCLUSIONS These results suggest that high suggestibility confers vulnerability to dissociative states in individuals exposed to trauma and displaying an anxious attachment style.
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Affiliation(s)
- Lillian Wieder
- a Department of Psychology , Goldsmiths, University of London , London , UK
| | - Devin B Terhune
- a Department of Psychology , Goldsmiths, University of London , London , UK
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Yanakieva S, Polychroni N, Family N, Williams LTJ, Luke DP, Terhune DB. The effects of microdose LSD on time perception: a randomised, double-blind, placebo-controlled trial. Psychopharmacology (Berl) 2019; 236:1159-1170. [PMID: 30478716 PMCID: PMC6591199 DOI: 10.1007/s00213-018-5119-x] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/09/2018] [Indexed: 12/11/2022]
Abstract
RATIONALE Previous research demonstrating that lysergic acid diethylamide (LSD) produces alterations in time perception has implications for its impact on conscious states and a range of psychological functions that necessitate precise interval timing. However, interpretation of this research is hindered by methodological limitations and an inability to dissociate direct neurochemical effects on interval timing from indirect effects attributable to altered states of consciousness. METHODS We conducted a randomised, double-blind, placebo-controlled study contrasting oral administration of placebo with three microdoses of LSD (5, 10, and 20 μg) in older adults. Subjective drug effects were regularly recorded and interval timing was assessed using a temporal reproduction task spanning subsecond and suprasecond intervals. RESULTS LSD conditions were not associated with any robust changes in self-report indices of perception, mentation, or concentration. LSD reliably produced over-reproduction of temporal intervals of 2000 ms and longer with these effects most pronounced in the 10 μg dose condition. Hierarchical regression analyses indicated that LSD-mediated over-reproduction was independent of marginal differences in self-reported drug effects across conditions. CONCLUSIONS These results suggest that microdose LSD produces temporal dilation of suprasecond intervals in the absence of subjective alterations of consciousness.
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Affiliation(s)
- Steliana Yanakieva
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London, SE14 6NW, UK
| | - Naya Polychroni
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London, SE14 6NW, UK
| | | | - Luke T J Williams
- Eleusis Pharmaceuticals Ltd, London, UK
- Centre for Psychiatry, Division of Brain Sciences, Imperial College London, London, UK
| | - David P Luke
- Department of Psychology, Social Work, & Counselling, University of Greenwich, London, UK
| | - Devin B Terhune
- Department of Psychology, Goldsmiths, University of London, 8 Lewisham Way, New Cross, London, SE14 6NW, UK.
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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49
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Gidzgier P, Grundmann J, Lotzin A, Hiller P, Schneider B, Driessen M, Schaefer M, Scherbaum N, Hillemacher T, Schäfer I. The dissociative subtype of PTSD in women with substance use disorders: Exploring symptom and exposure profiles. J Subst Abuse Treat 2019; 99:73-79. [PMID: 30797397 DOI: 10.1016/j.jsat.2019.01.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 12/23/2018] [Accepted: 01/03/2019] [Indexed: 12/15/2022]
Abstract
The dissociative subtype of posttraumatic stress disorder (PTSD) was officially introduced in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In accordance with this new classification, prior studies using Latent Class Analysis (LCA) empirically identified a subgroup of patients that were characterized by a high severity of dissociative symptoms. Despite the high prevalence of PTSD in patients with substance use disorders (SUD), however, no LCA studies on the dissociative subtype of PTSD exist in this population so far. Therefore, the current study aimed to identify subgroups of patients with different symptom and exposure profiles in patients with SUD and PTSD. It was assumed that one symptom and exposure profile could be identified that would be characterized by higher dissociative symptoms, higher additional psychopathology and a higher burden of childhood trauma, as compared to other subgroups. In N = 258 female patients with SUD and PTSD, clinical characteristics of dissociative symptoms, PTSD severity, borderline personality disorder (BPD), depression, childhood trauma and substance abuse were assessed. To identify symptom and exposure profiles, Latent Class Analysis was applied. A three-class solution indicated the best model fit to our data. One class was characterized by a high probability of dissociative symptoms (D-PTSD class), whereas the other two classes were characterized by lower probabilities of dissociative symptoms. The D-PTSD class encompassed 18.7% of the patients. In accordance with our hypothesis, the D-PTSD class showed higher probabilities of PTSD severity, borderline personality disorder symptoms, depressive symptoms, childhood emotional and sexual abuse, childhood emotional neglect, and drug abuse. Our results indicate that the dissociative subtype of PTSD could also be identified in a sample of female patients with SUD. Patients with SUD and PTSD characterized by the dissociative subtype showed more severe psychopathological symptoms than the remaining patients, indicating enhanced clinical needs for this vulnerable group.
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Affiliation(s)
- Piotr Gidzgier
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Johanna Grundmann
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Annett Lotzin
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Philipp Hiller
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - Barbara Schneider
- Department of Addictive Disorders and Psychiatry, LVR-Klinik Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany.
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy Bethel, Ev. Krankenhaus Bielefeld, Burgsteig 13, 33617 Bielefeld, Germany.
| | - Martin Schaefer
- Department of Psychiatry, Psychotherapy, Psychosomatic and Addiction Medicine, Kliniken Essen-Mitte, Henricistrasse 92, 45136 Essen, Germany.
| | - Norbert Scherbaum
- LVR-Hospital Essen, Department of Addictive Behaviour and Addiction Medicine, Medical Faculty, University of Duisburg-Essen, Virchowstrasse 174, 45147 Essen, Germany.
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1D, 30625 Hannover, Germany; Department of Psychiatry and Psychotherapy, Paracelsus Medical University Nuremberg, Prof.-Ernst-Nathan-Str. 1, 90419 Nuremberg, Germany.
| | - Ingo Schäfer
- Center for Interdisciplinary Addiction Research, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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50
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Brand BL, Loewenstein RJ, Schielke HJ, van der Hart O, Nijenhuis ERS, Schlumpf YR, Vissia EM, Jepsen EKK, Reinders AATS. Cautions and concerns about Huntjens et al.'s Schema Therapy for Dissociative Identity Disorder. Eur J Psychotraumatol 2019; 10:1631698. [PMID: 31489130 PMCID: PMC6713106 DOI: 10.1080/20008198.2019.1631698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Bethany L Brand
- Towson University, Towson, MD, USA.,King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Richard J Loewenstein
- Sheppard Pratt Health System & University of Maryland School of Medicine, Baltimore, MD, USA
| | | | | | | | - Yolanda R Schlumpf
- Clienia Littenheid, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland.,University of Zurich, Division of Neuropsychology, Zurich, Switzerland
| | - Eline M Vissia
- GGZ centraal, Top Referent Trauma Centrum, Ermelo, the Netherlands
| | | | - Antje A T S Reinders
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
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