-
Psychological Trauma : Theory,... Jan 2024Dissociative symptoms are linked to experiences of trauma, often originating in childhood and adolescence. Dissociative disorders are associated with a high burden of...
OBJECTIVE
Dissociative symptoms are linked to experiences of trauma, often originating in childhood and adolescence. Dissociative disorders are associated with a high burden of illness and a poor quality of life. Despite evidence suggesting that early intervention can improve outcomes, little research exists on the treatment of dissociative disorders in childhood and adolescence. The current study aimed to systematically review the existing body of literature to identify current treatments applied within child and adolescent populations diagnosed with a dissociative disorder.
METHOD
This review was conducted in line with PRISMA guidelines. Databases were searched for relevant publications, resulting in 3,064 papers to be screened. Articles were included if they involved child or adolescent populations experiencing dissociation and undergoing treatment. Seven articles were included in the current review: two quantitative and five case studies.
RESULTS
Treatment duration varied greatly, ranging from 1 to 29 months. Treatments were mostly combinations of psychotherapy, dialectical behavior therapy, eye movement desensitization and reprocessing, as well as adjunctive therapies such as mindfulness and psychoeducation.
CONCLUSIONS
Our study demonstrated that the literature on current treatment for children and adolescents is clearly scarce, with only seven studies, five of which were case studies and two of which were over 20 years old. The treatments used for dissociation in children and adolescents experiencing dissociation were varied, but psychotherapy was the most used treatment method. This review has revealed that there is no clear framework that exists for the treatment of dissociation in child and adolescent patients, despite the need for one. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
PubMed: 38271004
DOI: 10.1037/tra0001615 -
Journal of Trauma & Dissociation : the... 2024Dissociative Identity Disorder (DID) is a highly disabling diagnosis, characterized by the presence of two or more personality states which impacts global functioning,... (Review)
Review
A Systematic Review and Narrative Analysis of the Evidence for Individual Psychodynamically Informed Psychotherapy in the Treatment of Dissociative Identity Disorder in Adults.
Dissociative Identity Disorder (DID) is a highly disabling diagnosis, characterized by the presence of two or more personality states which impacts global functioning, with a substantial risk of suicide. The International Society for the Study of Trauma and Dissociation (ISSTD) published guidelines for treating DID in 2011 that noted individual Psychodynamically Informed Psychotherapy (PDIP) was a cornerstone of treatment. This paper systematically reviews the evidence base for PDIP in the treatment of adults with DID according to the 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-five articles were located and reviewed: seven prospective longitudinal publications, 13 case series and 15 case studies. Results suggested that PDIP has been widely deployed in DID to reported good effect with a range of treatment protocols and using multiple theoretical models. Despite the positive findings observed, the evidence base remains at the level of observational-descriptive design. Creative approaches in recent years have been developed, which add empirical weight to the use of PDIP as an effective treatment. The elevation to observational-analytic designs in the Evidence-Based Medicine hierarchy has yet to take place. Bearing in mind the challenges of research in PDIP, suggestions are offered for how the evidence base might develop.
Topics: Adult; Humans; Dissociative Identity Disorder; Prospective Studies; Psychotherapy; Suicide; Treatment Outcome
PubMed: 38146918
DOI: 10.1080/15299732.2023.2293802 -
General Hospital Psychiatry 2024Functional neurological disorder (FND) involves the presence of neurological symptoms that cannot be explained by neurological disease. FND has long been linked to... (Review)
Review
OBJECTIVE
Functional neurological disorder (FND) involves the presence of neurological symptoms that cannot be explained by neurological disease. FND has long been linked to hypnosis and suggestion, both of which have been used as treatments. Given ongoing interest, this review examined evidence for the efficacy of hypnosis and suggestion as treatment interventions for FND.
METHOD
A systematic search of bibliographic databases was conducted to identify group studies published over the last hundred years. No restrictions were placed on study design, language, or clinical setting. Two reviewers independently assessed papers for inclusion, extracted data, and rated study quality.
RESULTS
The search identified 35 studies, including 5 randomised controlled trials, 2 non-randomised trials, and 28 pre-post studies. Of 1584 patients receiving either intervention, 1379 (87%) showed significant improvements, including many who demonstrated resolution of their symptoms in the short-term. Given the heterogeneity of interventions and limitations in study quality overall, more formal quantitative synthesis was not possible.
CONCLUSIONS
The findings highlight longstanding and ongoing interest in using hypnosis and suggestion as interventions for FND. While the findings appear promising, limitations in the evidence base, reflecting limitations in FND research more broadly, prevent definitive recommendations. Further research seems warranted given these supportive findings.
Topics: Humans; Conversion Disorder; Dissociative Disorders; Hypnosis; Nervous System Diseases
PubMed: 38154334
DOI: 10.1016/j.genhosppsych.2023.12.006 -
The International Journal of... Jul 2021Ketamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, its efficacy in bipolar depression is...
BACKGROUND
Ketamine appears to have a therapeutic role in certain mental disorders, most notably unipolar major depressive disorder. However, its efficacy in bipolar depression is less clear. This study aimed to assess the efficacy and tolerability of ketamine for bipolar depression.
METHODS
We conducted a systematic review of experimental studies using ketamine for the treatment of bipolar depression. We searched PubMed, MEDLINE, Embase, PsycINFO, and the Cochrane Central Register for relevant studies published since each database's inception. We synthesized evidence regarding efficacy (improvement in depression rating scores) and tolerability (adverse events, dissociation, dropouts) across studies.
RESULTS
We identified 6 studies, with 135 participants (53% female; 44.7 years; standard deviation, 11.7 years). All studies used 0.5 mg/kg of add-on intravenous racemic ketamine, with the number of doses ranging from 1 to 6; all participants continued a mood-stabilizing agent. The overall proportion achieving a response (defined as those having a reduction in their baseline depression severity of at least 50%) was 61% for those receiving ketamine and 5% for those receiving a placebo. The overall response rates varied from 52% to 80% across studies. Ketamine was reasonably well tolerated; however, 2 participants (1 receiving ketamine and 1 receiving placebo) developed manic symptoms. Some participants developed significant dissociative symptoms at the 40-minute mark following ketamine infusion in 2 trials.
CONCLUSIONS
There is some preliminary evidence supporting use of intravenous racemic ketamine to treat adults with bipolar depression. There is a need for additional studies exploring longer-term outcomes and alterative formulations of ketamine.
Topics: Bipolar Disorder; Excitatory Amino Acid Antagonists; Humans; Ketamine
PubMed: 33929489
DOI: 10.1093/ijnp/pyab023 -
European Journal of Clinical... May 2021Ketamine has rapid-onset antidepressant effects in patients with treatment-resistant depression. Common side effects include dissociation (a sense of detachment from...
PURPOSE
Ketamine has rapid-onset antidepressant effects in patients with treatment-resistant depression. Common side effects include dissociation (a sense of detachment from reality) and increases in systolic and diastolic blood pressure. The objective of this structured review was to examine the effect of ketamine formulation and route of administration on its pharmacokinetics, safety and tolerability, to identify formulation characteristics and routes of administration that might minimise side effects.
METHODS
This was a structured review of published ketamine pharmacokinetics, safety and tolerability data for any ketamine formulation. The ratio of ketamine:norketamine was calculated from reported C values, as a measure of first pass metabolism. The effect of formulation and route of administration on safety was evaluated by measuring mean changes in systolic blood pressure and tolerability by changes in dissociation ratings. Data were correlated using Spearman's method.
RESULTS
A total of 41 treatment arms were identified from 21 publications, and included formulation development studies in healthy volunteers, and studies in clinical populations (patients undergoing anaesthesia, or being treated for pain or depression). Ketamine:norketamine ratios were strongly positively correlated with change in dissociation ratings (r = 0.89) and change in blood pressure (r = 0.96), and strongly negatively correlated with ketamine T (r = - 0.87; p < 0.00001 for all). Ketamine T strongly positively correlated with a change in dissociation ratings (r = - 0.96) and change in blood pressure (r = - 0.99; p < 0.00001 for all).
CONCLUSION
Ketamine formulations that maximize first pass metabolism and delay T will be better tolerated and safer than formulations which lack those characteristics.
Topics: Antidepressive Agents; Dissociative Disorders; Drug Administration Routes; Drug Delivery Systems; Humans; Hypertension; Ketamine; Metabolic Clearance Rate
PubMed: 33210159
DOI: 10.1007/s00228-020-03047-z -
Epilepsy & Behavior : E&B Mar 2024The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and... (Review)
Review
INTRODUCTION
The term 'functional/dissociative seizures (FDS)' refers to a paroxysmal, transient clinical manifestation that may include motor, sensory, vegetative, psychological and cognitive signs, similar to the manifestations observed in epileptic seizures. In recent years, there has been an increase of literature in the field of brain imaging research on functional neurological disorders and, more specifically, on FDS. However, most of the studies have been carried out on limited samples. We propose an update of this review work by performing a systematic review of studies performed since 2017 in the field of neuroimaging in patients with FDS.
METHODS
We conducted a systematic review of the literature using the PRISMA methodology and reproduced most of the methodological elements of the latest systematic literature review.
RESULTS
Our work over the last five years has identified 14 articles. It is still difficult to isolate a distinct structure or network specifically involved in the mechanism of FDS. However, certain structures are recurrently involved in imaging studies, notably the amygdala, the orbitofrontal cortex, and the anterior cingulate cortex.
CONCLUSION
The contribution of neuroimaging may allow a more precise explanation of the disorder for patients, avoiding the stigma frequently associated with this diagnosis. as with other 'conversion' phenomena which have traditionally been considered only as 'medically unexplained'. In the longer term and beyond a better understanding of the physiopathology of the disorder, the challenge of this neuroimaging work would be to identify specific imaging biomarkers for a diagnosis of FDS.
Topics: Humans; Psychogenic Nonepileptic Seizures; Conversion Disorder; Dissociative Disorders; Seizures; Epilepsy
PubMed: 38281393
DOI: 10.1016/j.yebeh.2024.109654 -
PloS One 2021Dissociative experiences occur across a range of mental health disorders. However, the term 'dissociation' has long been argued to lack conceptual clarity and may...
BACKGROUND
Dissociative experiences occur across a range of mental health disorders. However, the term 'dissociation' has long been argued to lack conceptual clarity and may describe several distinct phenomena. We therefore aimed to conceptualise and empirically establish a discrete subset of dissociative experiences and develop a corresponding assessment measure.
METHODS
First, a systematic review of existing measures was carried out to identify themes across dissociative experiences. A theme of 'Felt Sense of Anomaly' (FSA) emerged. Second, assessment items were generated based on this construct and a measure developed using exploratory (EFA) and confirmatory (CFA) factor analyses of 8861 responses to an online self-report survey. Finally, the resulting measure was validated via CFA with data from 1031 patients with psychosis.
RESULTS
'Felt sense of anomaly' (FSA) was identified as common to many dissociative experiences, affecting several domains (e.g. body) and taking different forms ('types'; e.g. unfamiliarity). Items for a novel measure were therefore systematically generated using a conceptual framework whereby each item represented a type-by-domain interaction (e.g. 'my body feels unfamiliar'). Factor analysis of online responses found that FSA-dissociation manifested in seven ways: anomalous experiences of the self, body, and emotion, and altered senses of familiarity, connection, agency, and reality (Χ2 (553) = 4989.435, p<0.001, CFI = 0.929, TLI = 0.924, RMSEA = 0.052, SRMR = 0.047). Additionally, a single-factor 'global FSA' scale was produced (Χ2 (9) = 312.350, p<0.001, CFI = 0.970, TLI = 0.950, RMSEA = 0.107, SRMR = 0.021). Model fit was adequate in the clinical (psychosis) group (Χ2 (553) = 1623.641, p<0.001, CFI = 0.927, TLI = 0.921, RMSEA = 0.043, SRMR = 0.043). The scale had good convergent validity with a widely used dissociation scale (DES-II) (non-clinical: r = 0.802), excellent internal reliability (non-clinical: Cronbach's alpha = 0.98; clinical: Cronbach's alpha = 0.97), and excellent test-retest reliability (non-clinical: ICC = 0.92). Further, in non-clinical respondents scoring highly on a PTSD measure, CFA confirmed adequate model fit (Χ2 (553) = 4758.673, CFI = 0.913, TLI = 0.906, RMSEA = 0.052, SRMR = 0.054).
CONCLUSIONS
The Černis Felt Sense of Anomaly (ČEFSA) scale is a novel measure of a subset of dissociative experiences that share a core feature of FSA. It is psychometrically robust in both non-clinical and psychosis groups.
Topics: Dissociative Disorders; Factor Analysis, Statistical; Humans; Psychometrics; Self Report
PubMed: 33626089
DOI: 10.1371/journal.pone.0247037 -
Frontiers in Psychiatry 2023Dissociative amnesia is an emblematic psychiatric condition in which patients experience massive memory loss ranging from focal to global amnesia. This condition remains... (Review)
Review
AIM
Dissociative amnesia is an emblematic psychiatric condition in which patients experience massive memory loss ranging from focal to global amnesia. This condition remains poorly understood and this review aims to investigate the neuroanatomical feature of this disease.
METHODS
We conducted a systematic review of the scientific literature available on PubMed, up to December 1, 2022, using a combination of keywords referring to dissociative amnesia. We included every scientific report involving patients undergoing a functional imaging procedure.
RESULTS
Twenty-two studies met our inclusion criteria (gathering 49 patients). Only one was a controlled study with a large sample. The other 21 were case reports and case series. In resting state, neuroimaging studies mostly showed a hypo-activated right inferolateral prefrontal cortex, associated with limbic hypoactivity and lesser activation of the hippocampal and para-hippocampal structures. The patients also presented abnormal patterns of cerebral activation when performing memory tasks. When testing recognition of memories from the amnestic period, patients showed increased activation across temporal areas (hippocampal and para-hippocampal gyri) and the limbic network. When trying to recollect memories from an amnestic period compared to a non-amnestic period, patients failed to activate these structures efficiently. Most of these patterns tended to return to normal when symptoms resolved.
CONCLUSION
This review identified a paucity of controlled studies in the field of dissociative amnesia neuroimaging, which restricts the extrapolation of results. Patients with dissociative amnesia present a broad prefronto-temporo-limbic network dysfunction. Some of the brain areas implicated in this network might represent potential targets for innovative treatments.
PubMed: 36778638
DOI: 10.3389/fpsyt.2023.1092826 -
Psychological Medicine Feb 2022Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions,... (Meta-Analysis)
Meta-Analysis Review
Adverse life events precede the onset of functional neurological disorder (FND, also known as conversion disorder) more commonly than other neuropsychiatric conditions, but their aetiological role is unclear. We conducted a systematic review and quantitative analysis of the type, timing and number of life events preceding the onset of FND in adults, and a meta-analysis of the proportions of types of events in controlled studies. Fifty-one studies of different designs, covering 4247 patients, were eligible for inclusion. There was no clear majority of any type of preceding event. Family problems were the most common category of events, followed by relationship problems. Females were more likely to experience preceding family/relationship problems than males, who reported more work problems. Family problems were the commonest type of preceding event in studies in developing countries, whereas family and health problems were equally common in developed countries. Abuse was associated with early symptom onset, while patients with later onset were more likely to report family problems. The median number of events was one, and the events occurred closer to onset than in controls. Meta-analysis found that family, relationship and work events were all relatively more common in patients than pathological controls, as were events where symptoms might provide a solution to the stressor. In conclusion, although a range of events precede the onset of FND, they do not appear to do so uniformly. This may support a different aetiological role for stressors than in other disorders, although the support is indirect and the quality generally low.
Topics: Adult; Conversion Disorder; Dissociative Disorders; Female; Humans; Male
PubMed: 34819179
DOI: 10.1017/S0033291721004669 -
Journal of Psychosomatic Research May 2023Patients with functional neurological disorders (FND) present with weakness, sensory or movement disorder without corresponding brain pathology. The current... (Review)
Review
INTRODUCTION
Patients with functional neurological disorders (FND) present with weakness, sensory or movement disorder without corresponding brain pathology. The current classificatory systems suggest an inclusionary approach to diagnose FND. Hence, there is a need to systematically evaluate the diagnostic accuracy of clinical signs and electrophysiological investigations in view of the lack of gold standard tests to diagnose FND.
METHODS
PubMed and SCOPUS databases were searched for studies published from Jan 1950 to Jan 2022 which reported the diagnostic accuracy of clinical signs and electrophysiological investigations in patients with FND. The Newcastle Ottawa scale was used to assess the quality of the studies.
RESULTS
Twenty-one studies (727 cases and 932 controls), of which 16 reported clinical signs and, five reported electrophysiological investigations, were included in the review. Two studies were of good quality, 17 of moderate quality, and two of poor quality. We identified 46 clinical signs (24 in weakness, 3 in sensory, and 19 in movement disorders) and 17 investigations (all in movement disorders). Specificity values for signs and investigations were comparatively high compared to the wide variance in sensitivity values.
CONCLUSION
Electrophysiological investigations appear to have a promising role in diagnosing FND, particularly functional movement disorders. The combined use of individual clinical signs and electrophysiological investigations may support and improve diagnostic certainty of FND. Future research can focus on improving the methodology and validating the existing clinical signs and electrophysiological investigations to enhance the validity of the composite diagnostic criterias for FND diagnosis.
Topics: Humans; Nervous System Diseases; Movement Disorders; Conversion Disorder
PubMed: 36868109
DOI: 10.1016/j.jpsychores.2023.111196