Depersonalisation Disorder

Question 1

What is depersonalisation?

Answer 1

▪️Alteration in the perception or experience
▪️Feels detached from or as if one is an outside observer of one’s mental processes or body
▪️Strange sense of unreality

Question 2

What is derealisation?

Answer 2

Strange and disturbing sense of unfamiliarity or unreality in the environment

Question 3

Clinically significant depersonalisation is commonly secondary to which neuropsychitric illnesses?

Answer 3

▪️Panic disorder
▪️PTSD
▪️Depression
▪️Temporal lobe epilepsy

Question 4

What percent of the general population are estimated to experience clinically significant depersonalisation?

Answer 4

1-2% (surprisingly common!)

Question 5

What are the five major domains of depersonalisation disorder syndrome?

Answer 5

1. Depersonalisation
2. Derealisation
3. Desomatisation (alteration if bodily sensations, disembodiment etc)
4. De-affectualisation (diminished emotional reactivity but may have considerable internal emotions)
5. De-ideation (difficulty concentrating)

Question 6

What perceptual anomalies may be present with derealisation?

Answer 6

▪️Colours not so bright
▪️Sounds appear far away
▪️Things look 2D

Question 7

What might co-occur with desomatisation and how can this affect the experience?

Answer 7

Obsessional set-checking which may reinforce and perpetuate the experience

Question 8

How did Dugas first describe depersonalisation in 1898?

Answer 8

A feeling or sensation of estrangement from own thoughts and actions, an alienation of personality

Question 9

How did Jaspers describe derealisation?

Answer 9

“Alientation from the perceptual world”

Question 10

What are the two main treatment approaches to depersonalisation disorder?

Answer 10

▪️Cognitive behavioural therapy
▪️Pharmacotherapy with lamotrogine either with or without SSRIs

Question 11

How does depersonalisation typically evolve?

Answer 11

Begins transient and episodic but there’s episodes get longer and more intense until its most of the time

(people can often pinpoint exactly when it started)

Question 12

What symptom is most commonly associated wirh depersonalisation episodes?

Answer 12

Migraine (unsure why)

Question 13

What is the first step of clinical assessment of depersonalisation and what should it include?

Answer 13

History

▪️Nature of episodes
▪️Associated symptoms
▪️Symptom scales
▪️Consider differentials

Question 14

What scales are most commonly used to assess DP symptoms?

Answer 14

▪️Cambridge Depersonalisation Scale (CDS) (preferred)
▪️Dissociative Experience Scale (DES)

Question 15

What differential diagnoses should be considered when assessing for DPD?

Answer 15

▪️Temporal lobe epilepsy
▪️Anxiety/depression
▪️Psychosis

Question 16

What might suggest a diagnosis of psychosis is more appropriate than DPD?

Answer 16

Absence of ‘as if’ quality - much more real and unaware it’s not real

Question 17

What is the second step in the clinical assessment of DP?

Answer 17

Investigations

▪️CT/MRI, EEG
▪️Routine bloods
▪️Other investigations if suspicious of organic pathology

Question 18

Why might you order an EEG to investigate DP?

Answer 18

If suspicious of temporal lobe epilepsy or other organic processes

Question 19

Why is it important to order routine blood tests?

Answer 19

To check thyroid function - may be underactive

Question 20

What is the Cambridge Depersonalisation Scale?

Answer 20

▪️29 item self-rated scale
▪️Scores experiences over last six months on frequency and duration (max score 10 for each)

Question 21

What is the relationship between DP and anxiety?

Answer 21

▪️DP/Dr seems to be a normal response to threat
▪️Many often have a history of anxiety and/or panic attacks
▪️High degree of comorbidity
▪️Perpetuate eachother?

Question 22

What medications have been proposed for the pharmacological management of DPD?

Answer 22

▪️Lamotrigine (+/- SSRI)
▪️Clonazepam (benzo)
▪️Naltrexone
▪️Clomipramine (antidepressant)
▪️Psychostimulants (methylphenidate, modafinil)

Question 23

Why might naltrexone be useful for the management of DPD but why is it not often used?

Answer 23

It is an anti-opioid - opium can produce depersonalisation effects

BUT has side effects most can’t tolerate such as aches and pains as it blocks the opioid system

Question 24

When might Clonazepam be useful for DPD?

Answer 24

When it is associated with anxiety

Question 25

What is lamotrigine typically used for?

Answer 25

Epilepsy and mood stabilisation in bipolar

Question 26

How does lamotrigine work?

Answer 26

▪️Reduces excitatory amino acid neurotransmission, predominantly glutamate
▪️By blocking Na-dependent channels and stabilising neuronal membrane

Question 27

Lamotrigine has been found to block DP and DR induced by….

Answer 27

Ketamine

Question 28

How can you increase the effectiveness of lamotrigine for improving DPD symptoms?

Answer 28

Prescribe in combination with an SSRI

Question 29

What are the two main approaches to the non-pharmacological management of DPD?

Answer 29

▪️CBT
▪️Attentional training (e.g. mindfulness, fTMS)

Question 30

What is the theory behind attentional training as a possible treatment for DPD?

Answer 30

DP is a result of abnormal attentional processing

Reduced attention to the external environment and increased attention to the internal environment? - need to rebalance!

Question 31

What CBT strategies can be helpful for DPD?

Answer 31

▪️Diary keeping and analysis
▪️’Grounding’ strategies
▪️Dealing with unhelpful thoughts
▪️Focus on thinking processes
▪️Focus on behaviour

Question 32

How can a diary be used for chronic DPD?

Answer 32

Record severity of DP/Dr every hour if possible

Will often notice it fluctuates more than they think

Question 33

How can a diary keeping approach be used for infrequent episodes of DP/DR?

Answer 33

Record