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AIMS Neuroscience 2021The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a... (Review)
Review
Targeting temporal parietal junction for assessing and treating disembodiment phenomena: a systematic review of TMS effect on depersonalization and derealization disorders (DPD) and body illusions.
The temporal-parietal junction (TPJ) is a key structure for the embodiment, term referred to as the sense of being localized within one's physical body and is a fundamental aspect of the self. On the contrary, the sense of disembodiment, an alteration of one's sense of self or the sense of being localized out of one's physical body, is a prominent feature in specific dissociative disorders, namely depersonalization/derealization disorders (DPD). The aims of the study were to provide: 1) a qualitative synthesis of the effect of Transcranial Magnetic Stimulation (TMS), taking into account its use for therapeutic and experimental purposes; 2) a better understanding on whether the use of TMS could support the treatment of DPD and other clinical conditions in which depersonalization and derealization are displayed. To identify suitable publications, an online search of the PubMed, Cochrane Library, Web of science and Scopus databases was performed using relevant search terms. In addition, an in-depth search was performed by screening review articles and the references section of each included articles. Our search yielded a total of 108 records through multiple databases searching and one additional record was identified through other sources. After duplicates removal, title and abstract reading, we retained 16 records for the assessment of eligibility. According to our inclusion criteria, we retained 8 studies. The selected studies showed that TMS targeting the TPJ is a promising technique for treating disembodiment phenomena DPD and for inducing reversible disembodiment states in healthy subjects. These data represent the first step towards a greater understanding of possible treatments to be used in disembodiment disorders. The use of TMS over the TPJ appears to be promising for treating disembodiment phenomena.
PubMed: 33709023
DOI: 10.3934/Neuroscience.2021009 -
Frontiers in Neurology 2019The aim of this study was to investigate the relation between visual and vestibular hypersensitivity, and Depersonalization/Derealization symptoms in patients with...
The aim of this study was to investigate the relation between visual and vestibular hypersensitivity, and Depersonalization/Derealization symptoms in patients with chronic dizziness. 319 adult patients with chronic dizziness for more than 3 months (214 females and 105 males, mean age: 58 years, range: 13-90) were included in this prospective cross-sectional study. Patients underwent a complete audio-vestibular workup and 3 auto questionnaires: Hospital Anxiety and Depression (HAD), Depersonalization/Derealization Inventory (DDI), and an in-house questionnaire (Dizziness in Daily Activity, DDA) assessing 9 activities with a score ranging from 0 (no difficulty) to 10 (maximal discomfort) and 11 (avoidance) to detect patients with visual and vestibular hypersensitivity (VVH, a score > 41 corresponding to mean + 1 standard deviation). DDI scores were higher in case of VVH (6.9 ± 6.79, = 55 vs. 4.2 ± 4.81, = 256 without VVH, < 0.001, unpaired test), migraine (6.1 ± 6.40, = 110 vs. 4.0 ± 4.42, = 208no migraine, < 0.001, unpaired test), and motion sickness (6.8 ± 5.93, = 41 vs. 4.4 ± 5.11, = 277 no motion sickness, < 0.01, unpaired test). Women scored DDI higher than men (5.1 ± 5.42, = 213 vs. 3.9 ± 4.91, = 105, respectively, < 0.05, unpaired test). DDI scores were also related to depression and anxiety. DDI score was also higher during spells than during the basal state. During chronic dizziness, Depersonalization/Derealization symptoms seem to be related to anxiety and depression. Moreover, they were prominent in women, in those with visual and vestibular hypersensitivity, migraine, and motion sickness.
PubMed: 30814972
DOI: 10.3389/fneur.2019.00069 -
Annals of Clinical and Translational... Sep 2019Depersonalization refers to the sensation of being detached from one's body, often associated with feelings of loss of control over one's own body, actions, or thoughts....
OBJECTIVE
Depersonalization refers to the sensation of being detached from one's body, often associated with feelings of loss of control over one's own body, actions, or thoughts. Derealization refers to the altered perception of one's surroundings that is experienced as unreal. Although usually reported by psychiatric patients suffering from depression or anxiety, single case reports and small case series have described depersonalization- and derealization-like symptoms in the context of epilepsy.
METHODS
We investigated the brain mechanisms of ictal depersonalization- and derealization like symptoms by analyzing clinical and neuropsychological data as well as the epileptogenic zone based on a multimodal approach in a group of patients reporting depersonalization- (n = 9) and derealization-like symptoms (n = 7), from a single presurgical epilepsy center with focal epilepsy. We compared them with a group of control patients with experiential phenomena due to temporal lobe epilepsy (n = 28).
RESULTS
We show that all patients with ictal depersonalization-like symptoms report altered self-identification with their body and mostly suffer from frontal lobe epilepsy with the epileptogenic zone in the dorsal premotor cortex, while patients with derealization-like symptoms suffer from temporal lobe epilepsy. This finding is supported by post-ictal neuropsychological deficits, showing that depersonalization-like symptoms were significantly more often associated with frontal lobe dysfunction as compared to the control patients and patients with derealization-like symptoms.
CONCLUSION
We argue that depersonalization of epileptic origin constitutes a distinct disorder due to frontal lobe epilepsy. We discuss these findings with respect to earlier accounts of depersonalization and the recent concept of bodily self-consciousness.
Topics: Adult; Brain; Brain Mapping; Depersonalization; Electroencephalography; Epilepsy; Female; Humans; Magnetic Resonance Imaging; Male; Neuropsychological Tests; Retrospective Studies
PubMed: 31437864
DOI: 10.1002/acn3.50870 -
Innovations in Clinical Neuroscience 2023Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding...
Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding environment, respectively. The phenomena co-occur on a continuum of severity, ranging from a transient experience as a normal reaction to a traumatic event to a highly debilitating condition with persistent symptoms, formally described as depersonalization/derealization disorder (DPDR). Lack of awareness of DPDR is partly due to a limited neurobiological framework, and there remains a significant risk of misdiagnosis in clinical practice. Earlier literature has focused on several brain regions involved in the experience of depersonalization and derealization, including adaptive responses to stress via defense cascades comprising autonomic functioning, the hypothalamic-pituitary-adrenal (HPA) axis, and various other neurocircuits. Recent evidence has also demonstrated the role of more complex mechanisms that are bolstered by dissociative features, such as emotional dysregulation and disintegration of the body schema. This review intends to abridge the prevailing knowledge regarding structural and functional brain alterations associated with DPDR with that of its heterogenic manifestations. DPDR is not merely the disruption of various sensory integrations, but also of several large-scale brain networks. Although a comprehensive antidote is not available for DPDR, a holistic route to the neurobiological context in DPDR may improve general understanding of the disorder and help afflicted individuals re-establish their sense of personal identity. Such information may also be useful in the development of novel pharmacological agents and targeted psychological interventions.
PubMed: 37122581
DOI: No ID Found -
Journal of Trauma & Dissociation : the... 2020Borderline personality disorder (BPD) is a serious psychiatric illness, and it is often associated with dissociative symptoms. The purpose of this study was to assess...
Borderline personality disorder (BPD) is a serious psychiatric illness, and it is often associated with dissociative symptoms. The purpose of this study was to assess the course of depersonalization and derealization symptoms in recovered and non-recovered borderline patients over 20 years of prospective follow-up. The Dysphoric Affect Scale (DAS) - a 50-item self-report measure was administered to 290 borderline inpatients at baseline, and the remaining participants (85%) at 10 follow-up interviews conducted over 20 years. The level of depersonalization and derealization experienced by borderline patients was assessed using three items (feeling unreal, feeling completely numb, and feeling like people and things aren't real) from the DAS. The patients who recovered from BPD reported significantly lower scores in all three inner states (62 - 63%) at baseline compared to those patients who did not recover. Furthermore, scores of recovered and non-recovered groups decreased significantly in all three inner states studied over 20 years of prospective follow-up. Overall, these results suggest that the severity of depersonalization and derealization symptoms decreased significantly over 20 years of prospective follow-up and had a strong association with BPD recovery status.
Topics: Adolescent; Adult; Borderline Personality Disorder; Depersonalization; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Prospective Studies; Psychiatric Status Rating Scales; Severity of Illness Index
PubMed: 32000616
DOI: 10.1080/15299732.2020.1719259 -
The American Journal of Psychiatry Sep 2022Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation...
OBJECTIVE
Dissociation, a disruption or discontinuity in psychological functioning, is often linked with worse psychiatric symptoms; however, the prognostic value of dissociation after trauma is inconsistent. Determining whether trauma-related dissociation is uniquely predictive of later outcomes would enable early identification of at-risk trauma populations. The authors conducted the largest prospective longitudinal biomarker study of persistent dissociation to date to determine its predictive capacity for adverse psychiatric outcomes following acute trauma.
METHODS
All data were part of the Freeze 2 data release from the Advancing Understanding of Recovery After Trauma (AURORA) study. Study participants provided self-report data about persistent derealization (N=1,464), a severe type of dissociation, and completed a functional MRI emotion reactivity task and resting-state scan 2 weeks posttrauma (N=145). Three-month follow-up reports were collected of posttraumatic stress, depression, pain, anxiety symptoms, and functional impairment.
RESULTS
Derealization was associated with increased ventromedial prefrontal cortex (vmPFC) activation in the emotion reactivity task and decreased resting-state vmPFC connectivity with the cerebellum and orbitofrontal cortex. In separate analyses, brain-based and self-report measures of persistent derealization at 2 weeks predicted worse 3-month posttraumatic stress symptoms, distinct from the effects of childhood maltreatment history and current posttraumatic stress symptoms.
CONCLUSIONS
The findings suggest that persistent derealization is both an early psychological and biological marker of worse later psychiatric outcomes. The neural correlates of trauma-related dissociation may serve as potential targets for treatment engagement to prevent posttraumatic stress disorder. These results underscore dissociation assessment as crucial following trauma exposure to identify at-risk individuals, and they highlight an unmet clinical need for tailored early interventions.
Topics: Brain; Dissociative Disorders; Emotions; Humans; Prospective Studies; Stress Disorders, Post-Traumatic
PubMed: 35730162
DOI: 10.1176/appi.ajp.21090911 -
International Journal of Scientific... Apr 2019'Burnout' among emergency healthcare workers needs focus as they make crucial life changing decisions every day and thus, their state of physical and mental wellbeing is...
OBJECTIVE
'Burnout' among emergency healthcare workers needs focus as they make crucial life changing decisions every day and thus, their state of physical and mental wellbeing is an absolute necessity. We aimed to find the level and factors contributing to burnout among the healthcare workers in the busiest Emergency Department of Northeast India. This is the first study done in this department to assess burnout.
METHOD
This cross-sectional, questionnaire-based study assessed burnout of the doctors, nurses, and paramedics working in an emergency department of a busy tertiary care teaching institute. Association of demographic variables and factors influencing burnout was explored. Results were analyzed by descriptive and inferential statistics.
RESULTS
Low level in emotional exhaustion, moderate level in depersonalization, and moderate level in the lack of personal accomplishment was reported by participants. Children and partner were found to be protective factors. Working hours, duration and status (permanent/contractual) of service influenced burnout.
CONCLUSION
Knowing the level of burnout and their determinants can help in formulating measures of improving the work environment. A healthy workforce ensures high quality of healthcare and patient satisfaction.
PubMed: 31069180
DOI: 10.15373/22778179 -
International Journal of Environmental... Sep 2022(1) Background: Various investigations have confirmed that burnout prevails in intensive and demanding contemporary working environments. Most of these studies have...
(1) Background: Various investigations have confirmed that burnout prevails in intensive and demanding contemporary working environments. Most of these studies have analyzed the associations between emotional exhaustion and various work factors. We studied the gap in the literature by simultaneously considering the three commonly recognized dimensions of burnout (emotional exhaustion, depersonalization, and reduced personal accomplishment) using a representative sample of telecommunication sales managers. (2) Methods: 849 survey respondents completed an anonymous questionnaire that included items representing psychosocial factors at work, lifestyle characteristics, and the Maslach Burnout inventory. The hierarchical regression analysis revealed the predictors of emotional exhaustion, depersonalization, and reduced personal accomplishment. (3) Results: job demands and witnessing bullying at the workplace were the most powerful predictors of emotional exhaustion, followed by self-rated health, night work, education, and physical inactivity. Witnessing bullying at the workplace, job control, self-rated health, and physical inactivity were the strongest predictors of depersonalization. Finally, direct experiences of negative acts at the workplace, job control, social support at work, bullying exposure duration, family crises, physical inactivity, smoking and alcohol, and body mass index were the most important predictors of reduced personal accomplishments. (4) Conclusions: the present study fills a gap in the research surrounding the three dimensions of burnout. The findings not only confirm that high job demands, low job control, and low social support at work contribute to burnout but also contribute to the novel understanding that workplace bullying plays an integral role.
Topics: Burnout, Professional; Burnout, Psychological; Humans; Job Satisfaction; Surveys and Questionnaires; Telecommunications; Workplace
PubMed: 36141531
DOI: 10.3390/ijerph191811249 -
Frontiers in Neurology 2020
PubMed: 32153485
DOI: 10.3389/fneur.2020.00022 -
Mindfulness 2022Although depersonalization has been described as the antithesis of mindfulness, few studies have empirically examined this relationship, and none have considered how it...
OBJECTIVES
Although depersonalization has been described as the antithesis of mindfulness, few studies have empirically examined this relationship, and none have considered how it may differ across various facets of mindfulness, either alone or in interaction. The present study examined the relationship between symptoms of depersonalization and facets of dispositional mindfulness in a general population sample.
METHODS
A total of 296 adult participants (139 male, 155 female, 2 other) were recruited online via Qualtrics and completed the Cambridge Depersonalisation Scale; Depression, Anxiety, and Stress Scale; and Five Facet Mindfulness Questionnaire.
RESULTS
Controlling for general distress, depersonalization symptoms were positively associated with Observe, Describe, and Nonreactivity facets and negatively associated with Acting with Awareness and Nonjudgment facets. After controlling for intercorrelations among the facets, depersonalization symptoms remained significantly associated with higher Nonreactivity and lower Acting with Awareness. The overall positive relationship between depersonalization symptoms and the Observe facet was moderated by both Nonjudgment and Nonreactivity. Specifically, higher Observing was related to increased depersonalization symptoms at low levels of Nonjudgment and to decreased symptoms at low levels of Nonreactivity.
CONCLUSIONS
The current study provides novel insight into the relationship between depersonalization symptoms and various aspects of mindfulness. Experiences of depersonalization demonstrated divergent relationships with mindfulness facets, alone and in interaction. The results may inform theoretical models of depersonalization and mindfulness-based interventions for depersonalization.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s12671-022-01890-y.
PubMed: 35492870
DOI: 10.1007/s12671-022-01890-y