Depersonalisation, derealisation and dissociation

Question 1

What is the definition of depersonalisation?

Answer 1

Unpleasant state of disturbed perception, in which people, or the self, or parts of the body are experienced as being changed (e.g. as if made of cotton wool), becoming unreal, remote, or automatised (e.g. being replaced by robots. There is insight into its subjective nature and so is not psychosis, but patient may think they are going mad.
May be primary or part of another neurosis

Question 2

Pathophysiology of depersonalisation?

Answer 2

Imaging of the CNS has indicated that function of the sensory cortex is abnormal in the areas that integrate auditory, visual and somatosensory data

Question 3

What is meant by derealisation?

Answer 3

Psychosensory feelings of detachment or estrangement from our surroundings. Objects appear altered, but patients understand the unreality of these ideas but are made uneasy by them.

Question 4

What are the types of dissociation experienced?

Answer 4

• Amnesia  the COMMONEST type
• Depersonalisation  feeling of being detached from one’s body or ideas, as if one was an outside and observing themselves. (unrelated to drugs and alcohol)
• Dissociative identity disorder (DID)  patient has multiple personalities which interact in complex ways
• Fugue  inability to recall one’s past +- loss of identity or formation of a new identity, associated with unexpected, purposeful travel (lasts hours to months and for which there is no ‘me’ i.e. the person is no longer themselves

Question 5

After follow-up of 6 years, what percentage of presentations were due to an organic cause such as a tumour?

Answer 5

5%

Question 6

What is the management?

Answer 6

Explore stressors

Be ready to recognise components of physical illness and get psychiatric help