Depersonalisation Disorder Flashcards
What is depersonalisation?
▪️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
What is derealisation?
Strange and disturbing sense of unfamiliarity or unreality in the environment
Clinically significant depersonalisation is commonly secondary to which neuropsychitric illnesses?
▪️Panic disorder
▪️PTSD
▪️Depression
▪️Temporal lobe epilepsy
What percent of the general population are estimated to experience clinically significant depersonalisation?
1-2% (surprisingly common!)
What are the five major domains of depersonalisation disorder syndrome?
- Depersonalisation
- Derealisation
- Desomatisation (alteration if bodily sensations, disembodiment etc)
- De-affectualisation (diminished emotional reactivity but may have considerable internal emotions)
- De-ideation (difficulty concentrating)
What perceptual anomalies may be present with derealisation?
▪️Colours not so bright
▪️Sounds appear far away
▪️Things look 2D
What might co-occur with desomatisation and how can this affect the experience?
Obsessional set-checking which may reinforce and perpetuate the experience
How did Dugas first describe depersonalisation in 1898?
A feeling or sensation of estrangement from own thoughts and actions, an alienation of personality
How did Jaspers describe derealisation?
“Alientation from the perceptual world”
What are the two main treatment approaches to depersonalisation disorder?
▪️Cognitive behavioural therapy
▪️Pharmacotherapy with lamotrogine either with or without SSRIs
How does depersonalisation typically evolve?
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)
What symptom is most commonly associated wirh depersonalisation episodes?
Migraine (unsure why)
What is the first step of clinical assessment of depersonalisation and what should it include?
History
▪️Nature of episodes
▪️Associated symptoms
▪️Symptom scales
▪️Consider differentials
What scales are most commonly used to assess DP symptoms?
▪️Cambridge Depersonalisation Scale (CDS) (preferred)
▪️Dissociative Experience Scale (DES)
What differential diagnoses should be considered when assessing for DPD?
▪️Temporal lobe epilepsy
▪️Anxiety/depression
▪️Psychosis
What might suggest a diagnosis of psychosis is more appropriate than DPD?
Absence of ‘as if’ quality - much more real and unaware it’s not real
What is the second step in the clinical assessment of DP?
Investigations
▪️CT/MRI, EEG
▪️Routine bloods
▪️Other investigations if suspicious of organic pathology
Why might you order an EEG to investigate DP?
If suspicious of temporal lobe epilepsy or other organic processes
Why is it important to order routine blood tests?
To check thyroid function - may be underactive
What is the Cambridge Depersonalisation Scale?
▪️29 item self-rated scale
▪️Scores experiences over last six months on frequency and duration (max score 10 for each)
What is the relationship between DP and anxiety?
▪️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?
What medications have been proposed for the pharmacological management of DPD?
▪️Lamotrigine (+/- SSRI)
▪️Clonazepam (benzo)
▪️Naltrexone
▪️Clomipramine (antidepressant)
▪️Psychostimulants (methylphenidate, modafinil)
Why might naltrexone be useful for the management of DPD but why is it not often used?
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
When might Clonazepam be useful for DPD?
When it is associated with anxiety
What is lamotrigine typically used for?
Epilepsy and mood stabilisation in bipolar
How does lamotrigine work?
▪️Reduces excitatory amino acid neurotransmission, predominantly glutamate
▪️By blocking Na-dependent channels and stabilising neuronal membrane
Lamotrigine has been found to block DP and DR induced by….
Ketamine
How can you increase the effectiveness of lamotrigine for improving DPD symptoms?
Prescribe in combination with an SSRI
What are the two main approaches to the non-pharmacological management of DPD?
▪️CBT
▪️Attentional training (e.g. mindfulness, fTMS)
What is the theory behind attentional training as a possible treatment for DPD?
DP is a result of abnormal attentional processing
Reduced attention to the external environment and increased attention to the internal environment? - need to rebalance!
What CBT strategies can be helpful for DPD?
▪️Diary keeping and analysis
▪️’Grounding’ strategies
▪️Dealing with unhelpful thoughts
▪️Focus on thinking processes
▪️Focus on behaviour
How can a diary be used for chronic DPD?
Record severity of DP/Dr every hour if possible
Will often notice it fluctuates more than they think
How can a diary keeping approach be used for infrequent episodes of DP/DR?
Record
