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Cognitive Neuropsychiatry May 2023Here we present a case of Depersonalisation-Derealisation Disorder which involves an unusual environmental trigger and profile of symptoms in a patient with an...
INTRODUCTION
Here we present a case of Depersonalisation-Derealisation Disorder which involves an unusual environmental trigger and profile of symptoms in a patient with an underlying left frontal encephalomalacia.
METHODS
The clinical information has been collected from multiple neurological, psychiatric, neuropsychological examinations and from the patient's medical records.
RESULTS
The neuropsychiatric assessment showed depersonalisation, derealisation, de-somatisation and de-affectualisation, along with a good response to SSRI + Lamotrigine; all typical features of DPD. The neuropsychological assessment showed language problems, and other mild cognitive difficulties that may provide a neuropsychological foundation contributing to the DPD episodes.
DISCUSSION AND CONCLUSION
Given Mr R's underlying neuropsychological deficit, hearing voices without speech-associated gestures might place excessive demands on his ability to process the information, exacerbating his feelings of threat. This sets up the pattern of suppressed insula activation, and possibly the suppression of the auditory cortex leading to the presented unusual DPD symptoms.
Topics: Humans; Depersonalization; Emotions; Neuropsychological Tests
PubMed: 37057376
DOI: 10.1080/13546805.2023.2197201 -
Journal of Trauma & Dissociation : the... 2017Depersonalization (DEP) and derealization (DER) were examined among college students with and without borderline personality disorder (BPD) and/or dissociative disorders...
Depersonalization (DEP) and derealization (DER) were examined among college students with and without borderline personality disorder (BPD) and/or dissociative disorders (DDs) by self-report and clinician assessment. The Steinberg Depersonalization Questionnaire (SDEPQ), the Steinberg Derealization Questionnaire (SDERQ), the Childhood Trauma Questionnaire, and the screening tool of the BPD section of the Structured Clinical Interview for DSM-IV (SCID-BPD) were administered to 1,301 students. Those with BPD (n = 80) according to the SCID-BPD and 111 non-BPD controls were evaluated using the Structured Clinical Interview for DSM-IV Dissociative Disorders by a psychiatrist blind to the diagnosis. Of the participants, 19.7% reported SDEPQ (17.8%) and/or SDERQ (11.0%) scores above cutoff levels and impairment from these experiences. Principal component analysis of 26 items of both scales yielded 4 factors: cognitive-emotional self-detachment, perceptual detachment, bodily self-detachment, and detachment from reality. Participants with concurrent DD and BPD had the highest scores for DEP and DER in the clinical interview and self-report. The total number of BPD criteria was associated with the severity of childhood trauma and dissociation. Both BPD and DD were associated with clinician-assessed and self-reported DER, self-reported DEP, and the cognitive-emotional self-detachment factor. Unlike BPD, DD was associated with clinician-assessed DEP, and BPD was related to the self-reported detachment from reality factor. Although the latter was correlated with the total childhood trauma score, possibly because of dissociative amnesia, clinician-assessed DER was not. Being the closest factor to BPD, the factor of detachment from reality warrants further study.
Topics: Adolescent; Adult; Adult Survivors of Child Abuse; Borderline Personality Disorder; Case-Control Studies; Comorbidity; Depersonalization; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Female; Humans; Interview, Psychological; Male; Self Report; Students; Surveys and Questionnaires; Turkey
PubMed: 27681414
DOI: 10.1080/15299732.2016.1240737 -
Zhurnal Nevrologii I Psikhiatrii Imeni... 2020To establish the psychopathological characteristics of depersonalization disorders in patients with depressive states of varying severity and nosological affiliation.
OBJECTIVE
To establish the psychopathological characteristics of depersonalization disorders in patients with depressive states of varying severity and nosological affiliation.
MATERIAL AND METHODS
Fifty-five patients (39 women, mean age 36.89±12.9 years and 16 men, mean age 37.11±13.7 years) were studied using a psychopathological method and psychometric scales.
RESULTS
There is a certain syntropy between the various variants of depressive and depersonalization disorders. Depersonalization of change, the mildest variant of the disorder of self-consciousness, is observed both in so-called endogenous affective disorders (phases of recurrent depressive disorder (DDR) and bipolar affective disorder (BAR)), and in predominantly psychogenic depressive disorders (impaired adaptation). Depersonalization of loss is characteristic of the more severe phases of DDR and BAR, as well as periods of exacerbation of dysthymia.
CONCLUSION
The synergism between depressive affect and depersonalization disorders determines the choice of therapeutic tactics.
Topics: Adult; Bipolar Disorder; Depersonalization; Depressive Disorder; Female; Humans; Male; Middle Aged; Mood Disorders; Psychopathology; Young Adult
PubMed: 33459539
DOI: 10.17116/jnevro202012012137 -
Scientific Reports Mar 2022Depersonalisation is a common dissociative experience characterised by distressing feelings of being detached or 'estranged' from one's self and body and/or the world....
Depersonalisation is a common dissociative experience characterised by distressing feelings of being detached or 'estranged' from one's self and body and/or the world. The COVID-19 pandemic forcing millions of people to socially distance themselves from others and to change their lifestyle habits. We have conducted an online study of 622 participants worldwide to investigate the relationship between digital media-based activities, distal social interactions and peoples' sense of self during the lockdown as contrasted with before the pandemic. We found that increased use of digital media-based activities and online social e-meetings correlated with higher feelings of depersonalisation. We also found that the participants reporting higher experiences of depersonalisation, also reported enhanced vividness of negative emotions (as opposed to positive emotions). Finally, participants who reported that lockdown influenced their life to a greater extent had higher occurrences of depersonalisation experiences. Our findings may help to address key questions regarding well-being during a lockdown, in the general population. Our study points to potential risks related to overly sedentary, and hyper-digitalised lifestyle habits that may induce feelings of living in one's 'head' (mind), disconnected from one's body, self and the world.
Topics: Adolescent; Adult; Aged; COVID-19; Depersonalization; Female; Humans; Life Style; Male; Middle Aged; Quarantine; Screen Time; Social Media; Young Adult
PubMed: 35273200
DOI: 10.1038/s41598-022-07657-8 -
Acta Clinica Croatica Jun 2017Healthy settings involve a holistic and multidisciplinary method that integrates actions towards risk factors. In hospital settings, a high level of stress can lead to... (Review)
Review
Healthy settings involve a holistic and multidisciplinary method that integrates actions towards risk factors. In hospital settings, a high level of stress can lead to depression, anxiety, decreased job satisfaction and lower loyalty to the organization. Burnout syndrome can be defined as physical, psychological and emotional exhaustion, depersonalization, and low sense of personal accomplishment. The aim of this literature review was to make systematic literature analysis to provide scientific evidence for the consequences of constant exposure to high levels of stress and for the methods to be used to prevent burnout syndrome among health care workers. The Medline database was searched to identify relevant studies and articles published during the last 15 years. The key words used in this survey were burnout syndrome, prevention, nurses, and healthy settings. The 6 eligible studies were included in literature review. Evidence showed nurses to be exposed to stress and to have symptoms of burnout syndrome. As a result of burnout syndrome, chronic fatigue and reduced working capacity occur, thus raising the risk of adverse events. In conclusion, the occurrence of burnout syndrome is a major problem for hospitals and healthcare system. Action plan for hospital burnout syndrome prevention would greatly reduce the incidence and improve the quality of health care.
Topics: Adult; Anxiety; Burnout, Professional; Depersonalization; Depression; Fatigue; Female; Hospitals; Humans; Job Satisfaction; Male; Middle Aged; Nurses; Occupational Health; Surveys and Questionnaires
PubMed: 29485797
DOI: 10.20471/acc.2017.56.02.13 -
Psychiatrike = Psychiatriki Dec 2021Depersonalization is a dissociative disorder associated to a profound disruption of self-awareness in the form of emotional numbing and feelings of disembodiment. The...
Depersonalization is a dissociative disorder associated to a profound disruption of self-awareness in the form of emotional numbing and feelings of disembodiment. The salient feature of depersonalization is a breakdown in the familiarity of one's psychological and somatic self (and surroundings when derealization is also present), in spite of being aware of the unreality of the change. At an early stage of research it was realized that people inclined to dissociation find it harder to tolerate discontinuity in perceptual environments, possibly due to a rigid perceptual attitude. Consequently, perceptual discontinuity experienced during momentary immersion into a VE would be expected to increase symptoms of dissociation among individuals prone to develop them. It has been put forward that a tendency toward immersion or absorption, linking to imaginative processes underlying the dissociative experience, significantly relates to the level of change in virtual reality-induced dissociative symptoms. Consequently, it has been implied that increased tolerability of perceptual discontinuities and a more flexible perceptual attitude in people suffering depersonalization/derealization disorder may be of help. We propose the use of adaptive immersive virtual environments to the treatment of depersonalization. In particular, we propose that implementation of biofeedback electrical stimulation to detect somato-sensory processing bias may contribute to selectively targeting deranged neurocognitive processing components, and as an indirect consequence promote, to some extent, the diagnostic process. Psychophysiological approaches may be of help in the treatment of depersonalization via additional series of afferent inputs - virtual reality (VR) stimuli - to alter the receptive fields of the affected proprioceptive systems and reorganize them. The aim of this paper is to stimulate future research towards the development of potential virtual rehabilitation programs based on biofeedback, electrical stimulation and concurrent measurement of galvanic skin response and EEG targeting selective somatosensory stimulation in patients with depersonalization. Our research hypotheses might constitute a starting point for the development of new treatment tools for depersonalization in particular and depersonalization/derealization disorder in general.
Topics: Awareness; Depersonalization; Dissociative Disorders; Emotions; Galvanic Skin Response; Humans
PubMed: 34390559
DOI: 10.22365/jpsych.2021.032 -
The American Journal of Psychiatry Sep 2022
Topics: Depersonalization; Dissociative Disorders; Humans; Stress Disorders, Post-Traumatic
PubMed: 36048492
DOI: 10.1176/appi.ajp.20220573 -
JBI Database of Systematic Reviews and... Jul 2017More than ever, the current increasing need for palliative care leads to health professionals providing this type of care which further leads to multiple challenges, and... (Review)
Review
BACKGROUND
More than ever, the current increasing need for palliative care leads to health professionals providing this type of care which further leads to multiple challenges, and stressful and demanding situations. The multiple challenges of working in palliative care put health professionals working in this context at the risk of burnout.
OBJECTIVES
To examine the evidence on the prevalence of burnout among health professionals working in palliative care.
INCLUSION CRITERIA TYPES OF PARTICIPANTS
The current review included studies that encompass qualified health professionals working in palliative care, caring for patients 18 years of age or older.
CONDITION
The current review considered studies reporting on the point prevalence of burnout, measured by a burnout scale, such as, but not limited to, the Maslach Burnout Inventory, Burnout Measure and Copenhagen Burnout Inventory.
CONTEXT
The current review considered studies conducted in the context of specialist palliative care, more specifically, palliative care units, specialized palliative home care or hospices.
TYPES OF STUDIES
The current review considered observational study designs, including prospective and retrospective cohort, case-control and cross-sectional studies.
SEARCH STRATEGY
An initial search of MEDLINE (via PubMed) and CINAHL was undertaken, followed by a second search for published and unpublished studies since 1975 in major healthcare-related electronic databases. Studies written in English, Spanish and Portuguese were included.
METHODOLOGICAL QUALITY
Two independent reviewers assessed the methodological quality of studies using the standardized critical appraisal instrument from the Joanna Briggs Institute. No studies were excluded from the review based on the methodological appraisal.
DATA EXTRACTION
Data were extracted using a data extraction table, taking into account the review questions.
DATA SYNTHESIS
Significant differences were found between condition measures, thus we were unable to perform a meta-analysis.
RESULTS
Eight cross-sectional studies met the inclusion criteria, with a total of 1406 health professionals. The sample was limited to nurses, physicians and social workers. None of the included articles presented data about other health professionals. Seven of the included studies assessed the prevalence of burnout using the same instrument - the Maslach Burnout Inventory. Data revealed a prevalence of burnout of 17.3% among health professionals. Personal Accomplishment was the sub-scale from the Maslach Burnout Inventory that had the highest prevalence (19.5%). Nurses had higher levels of Emotional Exhaustion (19.5%) and Depersonalization (8.2%), and physicians had lower levels of Personal Accomplishment (41.2%). The prevalence of burnout was, however, higher in social workers (27%). The palliative care context with the highest prevalence of burnout was home care (19.6%).
CONCLUSION
The current systematic review contributes to a body of empirical knowledge that can facilitate the professional development of palliative care teams by highlighting the prevalence of burnout in health professionals, which staff category is the most affected (social workers), and which palliative care context has the highest prevalence (home care).
Topics: Burnout, Professional; Cross-Sectional Studies; Depersonalization; Health Personnel; Home Care Services; Hospices; Humans; Observational Studies as Topic; Palliative Care; Prevalence; Prospective Studies; Retrospective Studies; Social Workers; Stress, Psychological
PubMed: 28708752
DOI: 10.11124/JBISRIR-2016-003309 -
PloS One 2018Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Although burnout in paediatric nurses has been addressed in previous research, the heterogeneous nature of the results obtained and of the variables studied highlights the need for a detailed analysis of the literature.
OBJECTIVE
The aim of this study was to analyse the literature on burnout characteristics, reported prevalence, severity and risk factors, to achieve a better understanding of the risk of emotional exhaustion, depersonalisation and feelings of low personal accomplishment.
METHOD
For this purpose, we carried out a systematic review and meta-analysis of the literature. The databases consulted were CINAHL, LILACS, PubMed, the Proquest Platform (Proquest Health & Medical Complete), Scielo and Scopus. This study used the search equation "burnout AND "pediatric nurs*"", and was conducted in July 2017.
RESULTS
The search produced 34 studies targeting burnout in paediatric nurses, with no restrictions on the date of publication. Many of these studies detected moderate-high values for the three dimensions of burnout, and highlighted sociodemographic, psychological and job-related variables associated with this syndrome. The sample population for the meta-analysis was composed of 1600 paediatric nurses. The following prevalence values were obtained: (i) emotional exhaustion, 31% (95% CI: 25-37%); (ii) depersonalisation, 21% (95% CI: 11-33%); (iii) low personal accomplishment, 39% (95% CI: 28-50%).
CONCLUSIONS
A significant number of paediatric nurses were found to have moderate-high levels of emotional exhaustion and depersonalisation, and low levels of personal accomplishment. These nurses, therefore, were either experiencing burnout or at high risk of suffering it in the future. These results support the need for further study of the risk factors for burnout in paediatric nurses. They also highlight the importance of developing interventions or therapies to help prevent or attenuate the above symptoms, thus helping nurses cope with the workplace environment and with situations that may lead to burnout.
Topics: Burnout, Professional; Depersonalization; Female; Humans; Male; Nurses, Pediatric; Prevalence; Risk Factors; Workplace
PubMed: 29694375
DOI: 10.1371/journal.pone.0195039 -
Revista de Saude Publica 2018OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to...
OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013-2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences.
Topics: Adult; Burnout, Professional; Chronic Disease; Cross-Sectional Studies; Depersonalization; Female; Health Surveys; Hospitals, Public; Humans; Job Satisfaction; Male; Medical Staff, Hospital; Middle Aged; Nursing Staff, Hospital; Personnel, Hospital; Prevalence; Socioeconomic Factors; Spain; Time Factors
PubMed: 29723388
DOI: 10.11606/s1518-8787.2018052000242