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Genes May 2022Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness,... (Review)
Review
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
Topics: Dissociative Disorders; Emotions; Genome-Wide Association Study; Humans; Molecular Biology
PubMed: 35627228
DOI: 10.3390/genes13050843 -
Innovations in Clinical Neuroscience Jul 2014Depersonalization/derealization disorder is characterized by depersonalization often co-occurring with derealization in the absence of significant psychosis, memory, or...
Depersonalization/derealization disorder is characterized by depersonalization often co-occurring with derealization in the absence of significant psychosis, memory, or identity disturbance. Depersonalization/derealization is categorized as one of the dissociative disorders, which also includes dissociative amnesia, dissociative fugue, dissociative identity disorder, and forms of dissociative disorder not otherwise specified. Although these disorders may be under-diagnosed or misdiagnosed, many persons with psychiatric illness who have experienced trauma report symptoms consistent with dissociative disorders. There are limited scientific data on prevalence of depersonalization/derealization disorder specifically. This paper reviews clinical, phenomenological and epidemiological information regarding diagnosis and treatment of dissociative disorders in general, and illustrates common presenting histories of persons with derealization/depersonalization disorder utilizing composite cases. The clinical vignettes focus on recommended psychotherapy and pharmacotherapy interventions as part of a comprehensive multidisciplinary treatment plan for these individuals.
PubMed: 25337444
DOI: No ID Found -
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 -
Journal of Vestibular Research :... 2021Magnetic Resonance Imaging (MRI) scanning can induce psychological effects. No studies have investigated the role of magnetic vestibular stimulation (MVS) in 3TMRI...
BACKGROUND
Magnetic Resonance Imaging (MRI) scanning can induce psychological effects. No studies have investigated the role of magnetic vestibular stimulation (MVS) in 3TMRI scanner-induced psychological reactions.
OBJECTIVE
To assess depersonalization/derealization (DD), state anxiety and motion-perception in a 3TMRI scanner, acutely and long-term.
PARTICIPANTS
48 healthcare professionals and students were included, after preliminary rejection of claustrophobes and neuro-otology and psychiatry assessments.
PROCEDURES
Participants completed questionnaires on personal habits, dissociation, anxiety/depression and motion sickness susceptibility. Validated DD and state anxiety questionnaires were administered before and after magnetic exposure twice, entering the bore head and feet first in random order, one week apart. During the following week, dizziness/disorientation was reported daily. One month later, 11 subjects repeated the procedure to assess reproducibility.
RESULTS
Considerable individual susceptibility was observed, circa 40% of the subjects reported self-motion perception related to the exposure, with variable increase on DD symptoms. Multivariate analysis showed that DD scores after any exposure were influenced by entering the bore "feet first", motion-perception, and the mean sleep hours/week (MANCOVA, R = 0.58, p = 0.00001). There was no clear effect of scanner exposure on state anxiety, which was related to trait anxiey but not to DD scores. During repeated exposures, about half of all subjects re-entering the scan reported motion-perception, but DD or anxiety symptoms were not consistent.
CONCLUSION
Psychological effects during 3TMRI scanning result from multiple, interacting factors, including novelty of the procedure (first-exposure effect), motion-perception due to MVS, head/body orientation, sleeping habits and individual susceptibility. Forewarning subjects of these predisposing factors may increase tolerance to MRI scanning.
Topics: Adult; Anxiety; Depersonalization; Humans; Magnetic Resonance Imaging; Motion Perception; Reproducibility of Results
PubMed: 33325422
DOI: 10.3233/VES-201577 -
Psychiatrike = Psychiatriki 2018The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are...
The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally The Delusional Misidentification Syndromes (DMSs) are characterized by defective integration of the normally fused functions of perception and recognition. The classical sub-types are: the syndromes of Capgras, Fregoli,Intermetamorphosis (mentioned in 3) and Subjective doubles. These syndromes occur in a clear sensorium and shouldbe differentiated from the banal transient misidentifications occurring in confusional states and in mania and from thenon-delusional misidentifications (e.g. prosopagnosia). Joseph Capgras, who described the best-known sub-type, was indecisive on its pathogenesis. In his original report he defined the syndrome as "agnosia of identification" produced by a conflict between affective accompaniments ofsensory and mnemonic images. In his subsequent two publications, he considered the syndrome as a restitution delusionand as a psychopathological mechanism to hide incestuous desires. For more details see the chapter by J.P. Luaute in avolume on DMS. Psychodynamic approaches are, essentially, variants of the formulation that DMSs result from ambivalent feelings resolvedby directing hate feelings onto an imagined double in order to retain the original intact (and thus avoid guilt).These views have been voiced by David Enoch [relevant chapter in (3)] and with variations by many other investigatorsreviewed by Oyebode. Regression to archaic modes of thought (like thinking in terms of doubles and dualisms) due to personality disintegrationproduced by psychotic illness is a fascinating hypothesis by John Todd [mentioned in (1)]. However, if this was thecase, DMS should be much more frequent. Mayer-Gross and Ackner (mentioned in 9) had observed that when there is a delusional development, depersonalization-derealization experiences tend to be included within the delusional system. Such experiences usually precede orcoincide with the onset of DMS. In view of this, Christodoulou suggested that DMSs may represent delusional evolutions of depersonalization-derealization experiences. Similar mechanisms were proposed for false memories of familiarity,reduplicative paramnesia and autoscopy. Cerebral "dysrhythmia" has also been noted in patients with DMS. In view of clinical and prognostic similarities of DMSpatients with patients suffering from psychotic states occurring in an epileptic setting, many of these patients have beenconsidered as suffering from broadly speaking "epileptic" psychoses. Joseph [mentioned in (6)] suggested that organiccauses produce disconnection between right and left cortical areas that decode afferent sensory information. This resultsin the creation of a separate image in each hemisphere leading to an awareness of two, physically identical images. Ellis and Young [mentioned in (1) and (6)] have maintained that DMS may result from defects at different stages of aninformation processing chain. More specifically, the Capgras Syndrome appears when the route for unconscious recognitionis damaged. Similar mechanisms have been proposed for the rest of the subtypes. Margariti and Kontaxakis8 have considered that in DMS there is disruption of the ability to recognize identities ratherthan superficial appearance. Others have maintained that DMSs are multimodal neuropathologies and cannot be linkedto a single cognitive defect. Lastly, in view of the marked organic abnormalities detected in all DMS subtypes, DMSs have been linked with a greatnumber of organic conditions [reviewed in detail by Oyebode (5)]. According to Greek mythology, Procrustes was a bandit who stretched or amputated the limbs of his guests to fit hisiron bed. The DMSs do not deserve such treatment. Submitting them to the procrustean bed of uniformity should be avoided. People develop DMS for a variety of reasons. Most subjects have right hemisphere dysfunction but not exclusively.Their condition is associated not with one but with diverse phenomena (depersonalization - derealization, prosopagnosia,false memories of familiarity, autoscopy, reduplicative paramnesia etc.) similarities with psychotic phenomena associatedwith epilepsy have been suggested but this refers to some patients only. Additionally, the charged emotionalrelationship of the patient with the misidentified person(s) is neither necessary nor sufficient. Diagnostically speaking, many roads lead to DMS, ranging from the monosymptomatic and monothematic one (consideredas par excellence DMS) to that associated with disorders mainly of the schizophrenic or organic spectrum. DMScan also be reached by a more "superficial" road, the one of depression, in which the delusion is secondary and often dependenton the self-depreciation ideation. Speculating on these syndromes is a fascinating journey in psychopathologybut, although in most cases an organic contributor is present, yet the great diversity of conditions in the setting of whichDMSs occur renders the possibility of a unifying hypothesis unlikely.
Topics: Cognition Disorders; Delusions; Humans; Neuropsychological Tests; Psychotherapy, Psychodynamic; Schizophrenia, Paranoid
PubMed: 29754115
DOI: 10.22365/jpsych.2018.291.15 -
Psycho-oncology May 2018To determine the prevalence of high levels of emotional exhaustion and depersonalization and low personal accomplishment in nursing professionals in oncology services. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To determine the prevalence of high levels of emotional exhaustion and depersonalization and low personal accomplishment in nursing professionals in oncology services.
METHODS
A meta-analytical study was performed. The search was carried out in March 2017 in Pubmed, CINAHL, Scopus, Scielo, Proquest, CUIDEN, and LILACS databases. Studies using Maslach Burnout Inventory for the assessment of burnout were included.
RESULTS
The total sample of oncology nurses was n = 9959. The total number of included studies was n = 17, with n = 21 samples for the meta-analysis of emotional exhaustion and n = 18 for depersonalization and low personal accomplishment. The prevalence of emotional exhaustion and of depersonalization was 30% (95% CI = 26%-33%) and 15% (95% CI = 9%-23%), respectively, and that of low personal performance was 35% (95% CI = 27%-43%).
CONCLUSIONS
The are many oncology nurses with emotional exhaustion and low levels of personal accomplishment. The presence and the risk of burnout among these staff members are considerable.
Topics: Achievement; Adult; Burnout, Professional; Burnout, Psychological; Depersonalization; Emotions; Female; Humans; Job Satisfaction; Male; Nursing Staff, Hospital; Oncology Nursing; Prevalence; Stress, Psychological
PubMed: 29314432
DOI: 10.1002/pon.4632 -
Frontiers in Psychology 2023This paper presents a critical comparison between two phenomenological accounts of schizophrenic experience: on the one side, Blankenburg's seminal work on the basal... (Review)
Review
This paper presents a critical comparison between two phenomenological accounts of schizophrenic experience: on the one side, Blankenburg's seminal work on the basal disturbance () of schizophrenia as loss of natural self-evidence (); on the other side, Tatossian's insight, briefly elaborated in a lecture presented in Heidelberg in 1994 and largely forgotten by the relevant literature. Whereas the former mainly develops an reading of schizophrenia, the latter suggests an understanding. Indeed, for Blankenburg, schizophrenic experience can be broadly characterized as a progressive impoverishment of our rootedness in the social world, leading to derealization and depersonalization. In this respect, Tatossian takes schizophrenic autism not as the effect of a loss of originary sociality but as the result of a deeper disproportion. For Tatossian, schizophrenia is characterized, ultimately, by a basic self-disorder or alteration that consists in the breakdown of the twofold dimension of transcendental subjectivity, encompassing both constituting consciousness and phenomenologizing onlooker. In this sense, his interpretation of schizophrenic disorders is closer to the ipseity-disturbance model. I show that while Blankenburg and Tatossian share a dialectical understanding of schizophrenia by pointing to basic modifications of the "transcendental organization" of experience, their divergence originates from a different reading of the phenomenological epoché. Except for the clinical perspective, the point of contention between Blankenburg and Tatossian seems to concern their use of internal resources of the Husserlian phenomenology. By presenting the philosophical presuppositions of their analyses, I discuss two key figures of phenomenological psychopathology by showing how their debate on the meaning of schizophrenic experience can be reframed by looking at the relationship between transcendental subjectivity and intersubjectivity in Husserl's phenomenology.
PubMed: 37484111
DOI: 10.3389/fpsyg.2023.1214474 -
Psychiatry Research Oct 2020The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is...
The dissociative subtype of posttraumatic stress disorder (D-PTSD) is estimated to occur in approximately 14% of those with posttraumatic stress disorder (PTSD), and is characterized by clinically significant dissociative symptoms in addition to typical PTSD symptoms. Prior research has found childhood maltreatment contributes to dissociation and D-PTSD susceptibility, but more nuanced questions about the nature of childhood maltreatment remain unexplored. We investigated how childhood maltreatment type and severity are associated with the dissociative symptoms of D-PTSD among women with PTSD (N = 106) receiving psychiatric care at a program specializing in trauma-related disorders. Participants completed self-report surveys of psychiatric symptoms and prior trauma exposure including the PTSD Checklist for DSM-5, the Dissociative Subtype of PTSD Scale, and the Childhood Trauma Questionnaire. We used multivariate linear regression to model the association of childhood maltreatment types and dissociation. In our final model childhood emotional abuse and physical abuse significantly predicted the dissociative symptoms of D-PTSD. This suggests childhood maltreatment type and severity, in particular of emotional and physical abuse, are associated with the dissociative symptoms of D-PTSD. This work points toward potential etiological contributions to D-PTSD.
Topics: Adolescent; Adult; Adult Survivors of Child Abuse; Child Abuse; Cross-Sectional Studies; Depersonalization; Diagnostic and Statistical Manual of Mental Disorders; Dissociative Disorders; Female; Humans; Male; Middle Aged; Physical Abuse; Predictive Value of Tests; Stress Disorders, Post-Traumatic; Surveys and Questionnaires; Young Adult
PubMed: 32736266
DOI: 10.1016/j.psychres.2020.113301 -
Frontiers in Psychiatry 2020Depersonalization (DP) and derealization (DR) are symptoms of a disruption of perceptual integration leading to an altered quality of subjective experiences such as...
Trapped in a Glass Bell Jar: Neural Correlates of Depersonalization and Derealization in Subjects at Clinical High-Risk of Psychosis and Depersonalization-Derealization Disorder.
BACKGROUND
Depersonalization (DP) and derealization (DR) are symptoms of a disruption of perceptual integration leading to an altered quality of subjective experiences such as feelings of unreality and detachment from the self (DP) or the surroundings (DR). Both DP and DR often occur in concert with other symptoms, for example in subjects at clinical high-risk (CHR) for psychosis, but also appear isolated in the form of DP/DR disorder. Despite evidence that DP/DR causes immense distress, little is known about their neurobiological underpinnings. Therefore, we investigated the neural correlates of DP/DR using pseudo-continuous arterial spin labeling MRI.
METHODS
We evaluated the frequency of DP/DR symptoms in a clinical sample (N = 217) of help-seeking individuals from the Early Detection and Intervention Centre for Mental Crisis (CHR, n = 97; clinical controls (CC), n = 91; and first-episode psychosis (FEP), n = 29). Further, in a subsample of those CHR subjects who underwent MRI, we investigated the resting-state regional cerebral blood flow (rCBF). Here, individuals with (n = 21) and without (n = 23) DP/DR were contrasted. Finally, rCBF was measured in a small independent second sample of patients with DP/DR disorder (n = 6) and healthy controls (HC, n = 6).
RESULTS
In the complete clinical sample, significantly higher frequency of DP/DR was found in CHR compared to CC (50.5 16.5%; χ = 24.218, p ≤ 0.001, Cramer's V = 0.359) as well as in FEP compared to CC (37.9 16.5%; χ = 5.960, = 0.015, Cramer's V = 0.223). In MRI, significantly lower rCBF was detected in the left orbitofrontal cortex in CHR with without DP/DR (x/y/z = -16/42/-22, p < 0.05, FWE corrected). In patients with DP/DR disorder, significantly higher rCBF was detected in the left caudate nucleus (x/y/z = -18/-32/18, p < 0.05) compared to HC.
CONCLUSIONS
This study shows that DP/DR symptoms are frequently found in CHR subjects. Investigating two separate DP/DR populations with an identical neuroimaging technique, our study also indicates that there may be divergent pathophysiological mechanisms-decreased neuronal activity in the orbitofrontal cortex, but increased activity within the caudate nucleus-leading to a final common pathway with similar psychopathological symptoms. This suggests that both top-down (orbitofrontal cortex) and bottom-up (caudate nucleus) mechanisms could contribute to the emergence of DP/DR.
PubMed: 33024435
DOI: 10.3389/fpsyt.2020.535652 -
Annals of Physical and Rehabilitation... Jun 2017This review article summarizes neuropsychological descriptions of abnormal body representations in brain-damaged patients and recent neuroscientific investigations of... (Review)
Review
This review article summarizes neuropsychological descriptions of abnormal body representations in brain-damaged patients and recent neuroscientific investigations of their sensorimotor underpinnings in healthy participants. The first part of the article describes unilateral disorders of the bodily self, such as asomatognosia, feelings of amputation, supernumerary phantom limbs and somatoparaphrenia, as well as descriptions of non-lateralized disorders of the bodily self, including Alice in Wonderland syndrome and autoscopic hallucinations. Because the sensorimotor mechanisms of these disorders are unclear, we focus on clinical descriptions and insist on the importance of reporting clinical cases to better understand the full range of bodily disorders encountered in neurological diseases. The second part of the article presents the advantages of merging neuroscientific approaches of the bodily self with immersive virtual reality, robotics and neuroprosthetics to foster the understanding of the multisensory, motor and neural mechanisms of bodily representations.
Topics: Agnosia; Alice in Wonderland Syndrome; Body Image; Brain Injuries; Delusions; Depersonalization; Hallucinations; Humans; Phantom Limb; Robotics; Virtual Reality
PubMed: 27318928
DOI: 10.1016/j.rehab.2016.04.007