Depersonalisation-Mod 3 Flashcards
What is depersonalisation?
‘alteration in the perception or experience of the self so that one feels detached from and as if one is an outside observer of one’s mental processes or body’ (DSM-IV).
-Disturbing sense of being ‘separate from oneself’, observing oneself as if from outside, feeling like a robot or automaton
-Strange and disturbing sense of unreality in one’s experience of oneself (DP) and one’s surroundings (DR).
What is the epidemiology of depersonalisation disorder?
-Epidemiological reviews (Bebbington et al, 1997; Hunter et al, 2004): conclude that clinically significant depersonalization may affect 1–2% of the general population, with a gender ratio of about 1:1.
What is derealisation?
Derealization Threatening sense of unfamiliarity or unreality in the environment, perceptual anomalies may be present, other people may feel like actors in a play
What is de-somatisation?
De-somatization: diminution, loss or alteration of bodily sensations, sense of disembodiment; there may be a raised pain threshold
What is de-affectualisation?
De-affectualisation: diminution or loss of emotional reactivity: emotions seem to lack spontaneity and subjective validity; this may affect intimate relationships
What is de-ideation?
Difficulty in concentrating, “cotton wool in head”.
What does the clinical assessment include for DPD?
Take a history;
-Nature of episodes: episodic/intermittent
-Any associated symptoms (e.g. migraine)
-Symptom scales e.g. CDS, DES
Consider differential :TLE, Anxiety/depression, psychosis – DPD has the “as if” quality.
What investigations can be done for DPD?
Investigations
-CT/MRI, EEG if suspicion of epilepsy or-other organic process
-Routine bloods incl. thyroid function
-Other investigations if history suggestive of organic pathology
What is the Cambridge Depersonalisation Scale (CDS)?
-29-item scale
-Self-rated
-Asks about experiences over last 6 months
-Scores for frequency and duration, maximum score 10 per item
-Example statements:
‘My favourite activities are no longer enjoyable’,
‘What I see looks ‘flat’ or ‘lifeless’, as if I were looking at picture.
What is the relationship between anxiety and DPD?
-Often history of anxiety and/or panic attacks
-Many patients have current co-morbid anxiety
-DP/DR seem to be normal response to threat
e.g. Mayer-Gross 1935 “Pre-formed response”
-Noyes and Kletti 1977- DP/DR in response to life-threatening danger
“Vicious circle” between anxiety and DP/DR: fuel each other
What are some pharmacological management options for DPD?
Pharmacological
-Lamotrigine +/- SSRI
-Clonazepam
-Naltrexone
-Clomipramine
-Psychostimulants (Methylphenidate, Modafinil)
What are the effects of lamotrigine?
-Lamotrigine reduces excitatory amino acid neurotransmission, predominantly glutamate, by blocking Na-dependent channels and stabilising the neuronal membrane.
-It has been found to block depersonalisation and derealization induced by the NMDA receptor antagonist ketamine (Anand et al 2000).
Is lamotrigine useful for DPD?
-In clinical settings, lamotrigine has been effective in reducing symptoms of DPD, particularly when given in combination with an SSRI (Sierra, Baker, Medford et al, 2006, Clinical Neuropharmacology 29: 253-258).
What are some non-pharmacological management options for DPD?
Non-pharmacological
-CBT approach
-Attentional training
-Mindfulness techniques?
-rTMS – some evidence for improvement with rTMS applied to right VLPFC
Describe the process of CBT: diary keeping
Diary keeping
-If chronic, then hourly (if possible)
What are you doing in that hour period with 0-10 rating of DPRD severity
-If infrequent, then when occurs,
recording the situation, severity
rating, duration, mood, thoughts,
behaviour
