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The American Journal of Psychiatry May 2021Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based... (Review)
Review
Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based antidepressants in major depression, the majority of treated individuals fail to achieve full syndromal and functional recovery with the index and subsequent pharmacological treatments. Ketamine and esketamine represent pharmacologically novel treatment avenues for adults with treatment-resistant depression. In addition to providing hope to affected persons, these agents represent the first non-monoaminergic agents with proven rapid-onset efficacy in major depressive disorder. Nevertheless, concerns remain about the safety and tolerability of ketamine and esketamine in mood disorders. Moreover, there is uncertainty about the appropriate position of these agents in treatment algorithms, their comparative effectiveness, and the appropriate setting, infrastructure, and personnel required for their competent and safe implementation. In this article, an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice, with particular attention to practice parameters at point of care. Areas of consensus and future research vistas are discussed.
Topics: Antidepressive Agents; Delivery of Health Care; Depressive Disorder, Major; Depressive Disorder, Treatment-Resistant; Dissociative Disorders; Excitatory Amino Acid Antagonists; Humans; Hypertension; Implementation Science; Ketamine; Lower Urinary Tract Symptoms; Monitoring, Physiologic; Patient Selection; Personnel Staffing and Scheduling; Psychoses, Substance-Induced; Substance-Related Disorders; Suicidal Ideation
PubMed: 33726522
DOI: 10.1176/appi.ajp.2020.20081251 -
Dialogues in Clinical Neuroscience Sep 2018Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs... (Review)
Review
Controversy about dissociation and the dissociative disorders (DD) has existed since the beginning of modern psychiatry and psychology. Even among professionals, beliefs about dissociation/DD often are not based on the scientific literature. Multiple lines of evidence support a powerful relationship between dissociation/DD and psychological trauma, especially cumulative and/or early life trauma. Skeptics counter that dissociation produces fantasies of trauma, and that DD are artefactual conditions produced by iatrogenesis and/or socio-cultural factors. Almost no research or clinical data support this view. DD are common in general and clinical populations and represent a major underserved population with a substantial risk for suicidal and self-destructive behavior. Prospective treatment outcome studies of severely ill DD patients show significant improvement in symptoms including suicidal/self-destructive behaviors, with reductions in treatment cost. A major public health effort is needed to raise awareness about dissociation/DD, including educational efforts in all mental health training programs and increased funding for research.
Topics: Dissociative Disorders; History, 20th Century; History, 21st Century; Humans; Prospective Studies; Research; Stress Disorders, Post-Traumatic
PubMed: 30581293
DOI: 10.31887/DCNS.2018.20.3/rloewenstein -
Psychiatria Polska Feb 2023Dissociative identity disorder (DID) belongs to the complicated issues of psychiatry and psychology areas. The specificity of the disorder and its clinical picture imply... (Review)
Review
Dissociative identity disorder (DID) belongs to the complicated issues of psychiatry and psychology areas. The specificity of the disorder and its clinical picture imply numerous difficulties in the diagnosis and treatment process. The diagnosis of DID can also have significant legal consequences, especially in the context of criminal liability or the general ability to be a witness. Thus, DID is an interdisciplinary problem. In practice, DID is rarely diagnosed, although it is estimated that it occurs in about 1% of the general population. In many cases, the period from the first contact with the healthcare system to a correct diagnosis exceeds several years (on average, 6.7 to 8 years). The average misdiagnosis rate is 2.8 per patient. The lack of a quick and proper diagnosis makes it impossible to undertake adequate treatment, which extends the entire therapeutic process, affects its effectiveness and significantly increases costs. There is no doubt that in educating psychiatrists and clinical psychologists, greater emphasis should be placed on correctly detecting dissociative symptoms and the use of adequate diagnostic tools. The aim of this article is to present and identify the main problems that DID implies in the diagnostic and therapeutic (psychological and psychiatric) areas. The article discusses the existing diagnostic tools, the issues of comorbidity and the causes of incorrect diagnoses. The issues of false-positive diagnoses and difficulties in differentiating patients with DID from simulators were also discussed. The primary mistakes made during the therapy, such as the strategy of minimization or the actions leading to multiple therapist disorder, were analyzed. Legal aspects will be presented in a separate article.
Topics: Humans; Dissociative Identity Disorder; Dissociative Disorders; Psychiatry; Comorbidity; Diagnostic Errors
PubMed: 37350721
DOI: 10.12740/PP/146969 -
International Review of Neurobiology 2020This chapter reviews the relationship between stress and brain function in patients with neuropsychiatric disorders, with an emphasis on disorders that have most clearly... (Review)
Review
This chapter reviews the relationship between stress and brain function in patients with neuropsychiatric disorders, with an emphasis on disorders that have most clearly been linked to traumatic stress exposure. These disorders, which have been described as trauma spectrum disorders, include posttraumatic stress disorder (PTSD), a subgroup of major depression, borderline personality disorder (BPD) and dissociative disorders; they share in common a neurobiological footprint, including smaller hippocampal volume, and are distinguished from other disorders that may share symptom similarities, like some of the anxiety disorders, but are not as clearly linked to stress. The relationship between environmental events such as stressors, especially in early childhood, and their effects on brain and neurobiology is important to understand in approaching these disorders as well as the development of therapeutic interventions. Addressing patients with stress-related disorders from multiple developmental (age at onset of trauma) as well as levels of analysis (cognitive, cultural, neurobiological) approaches will provide the most complete picture and result in the most successful treatment outcomes.
Topics: Animals; Borderline Personality Disorder; Brain; Dissociative Disorders; Humans; Mental Disorders; Stress Disorders, Post-Traumatic; Stress, Psychological; Wounds and Injuries
PubMed: 32450992
DOI: 10.1016/bs.irn.2020.01.004 -
Biological Psychiatry Feb 2022
Topics: Dissociative Disorders; Dissociative Identity Disorder; Humans; Interview, Psychological; Neurosciences; Psychiatric Status Rating Scales
PubMed: 34961597
DOI: 10.1016/j.biopsych.2021.11.004 -
Journal of the American Academy of... Dec 2017The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by...
OBJECTIVE
The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents by evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5 and then examining a broader set of dissociation symptoms.
METHOD
A sample of treatment-seeking, trauma-exposed adolescents 12 to 16 years old (N = 3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with 2 dissociation symptoms and the other with 10 dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology.
RESULTS
Model A, the depersonalization/derealization model, had 5 classes: dissociative subtype/high PTSD; high PTSD; anxious arousal; dysphoric arousal; and a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal.
CONCLUSION
These 2 models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone in adolescents, but assessing a wider range of dissociative symptoms is needed to fully characterize adolescent traumatic stress responses.
Topics: Adolescent; Child; Depersonalization; Dissociative Disorders; Female; Humans; Male; Models, Psychological; Models, Statistical; Psychiatric Status Rating Scales; Stress Disorders, Post-Traumatic
PubMed: 29173740
DOI: 10.1016/j.jaac.2017.09.425 -
Journal of Behavior Therapy and... Sep 2021We described a new treatment model for Posttraumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID), based on cognitive-behavioural principles. In this...
BACKGROUND AND OBJECTIVES
We described a new treatment model for Posttraumatic Stress Disorder (PTSD) and Dissociative Identity Disorder (DID), based on cognitive-behavioural principles. In this model, dissociation is seen as a maladaptive avoidant coping strategy. In addition, we stress that patients have dysfunctional beliefs about dissociation. Both elements, avoidance behaviour and dysfunctional beliefs, are challenged during the brief, intensive trauma-focused treatment. When the PTSD-symptoms decrease, the patient is offered a fare-well ritual to say goodbye to their identities in one or more additional sessions.
METHODS
We illustrate this treatment approach with a case report of a woman with PTSD as a result of sexual abuse in her childhood, and DID with four identities. Treatment outcome was measured at intake, at pre-treatment, at post-treatment and at 3 and 6 months follow-up.
RESULTS
After the short treatment of only 2 weeks, she no longer fulfilled the DSM-5 diagnostic criteria for PTSD nor DID. These results were maintained at the follow-ups.
LIMITATIONS
Although we included a baseline-controlled time phase, it was not a controlled study, and only one patient was treated.
CONCLUSIONS
This new treatment model for DID-patients is promising but results should be interpreted cautiously since we described only one patient.
Topics: Child; Cognition; Cognitive Behavioral Therapy; Dissociative Disorders; Dissociative Identity Disorder; Female; Humans; Stress Disorders, Post-Traumatic
PubMed: 33848810
DOI: 10.1016/j.jbtep.2021.101655 -
Nature Oct 2020Advanced imaging methods now allow cell-type-specific recording of neural activity across the mammalian brain, potentially enabling the exploration of how brain-wide...
Advanced imaging methods now allow cell-type-specific recording of neural activity across the mammalian brain, potentially enabling the exploration of how brain-wide dynamical patterns give rise to complex behavioural states. Dissociation is an altered behavioural state in which the integrity of experience is disrupted, resulting in reproducible cognitive phenomena including the dissociation of stimulus detection from stimulus-related affective responses. Dissociation can occur as a result of trauma, epilepsy or dissociative drug use, but despite its substantial basic and clinical importance, the underlying neurophysiology of this state is unknown. Here we establish such a dissociation-like state in mice, induced by precisely-dosed administration of ketamine or phencyclidine. Large-scale imaging of neural activity revealed that these dissociative agents elicited a 1-3-Hz rhythm in layer 5 neurons of the retrosplenial cortex. Electrophysiological recording with four simultaneously deployed high-density probes revealed rhythmic coupling of the retrosplenial cortex with anatomically connected components of thalamus circuitry, but uncoupling from most other brain regions was observed-including a notable inverse correlation with frontally projecting thalamic nuclei. In testing for causal significance, we found that rhythmic optogenetic activation of retrosplenial cortex layer 5 neurons recapitulated dissociation-like behavioural effects. Local retrosplenial hyperpolarization-activated cyclic-nucleotide-gated potassium channel 1 (HCN1) pacemakers were required for systemic ketamine to induce this rhythm and to elicit dissociation-like behavioural effects. In a patient with focal epilepsy, simultaneous intracranial stereoencephalography recordings from across the brain revealed a similarly localized rhythm in the homologous deep posteromedial cortex that was temporally correlated with pre-seizure self-reported dissociation, and local brief electrical stimulation of this region elicited dissociative experiences. These results identify the molecular, cellular and physiological properties of a conserved deep posteromedial cortical rhythm that underlies states of dissociation.
Topics: Action Potentials; Animals; Behavior; Brain Waves; Cerebral Cortex; Dissociative Disorders; Electrophysiology; Female; Humans; Hyperpolarization-Activated Cyclic Nucleotide-Gated Channels; Ketamine; Male; Mice; Mice, Inbred C57BL; Neurons; Optogenetics; Self Report; Thalamus
PubMed: 32939091
DOI: 10.1038/s41586-020-2731-9 -
Psychiatria Danubina Oct 2023The Dissociative Identity Disorder has undergone significant transformations over the years. Once regarded as a rare condition, it gained popularity in the 1980s in the...
The Dissociative Identity Disorder has undergone significant transformations over the years. Once regarded as a rare condition, it gained popularity in the 1980s in the United States following the publication of a book on the subject, only to subsequently wane due to extensive controversies. Presently, we are witnessing a resurgence of adolescents who believe they may be afflicted by this disorder. This article delves into the changes that have occurred since the initial surge in 1980, with a particular focus on the role of social media in the dissemination of Dissociative Identity Disorder. The concepts of Mass Social Media-Induced Illness and Munchausen's by Internet are explored to elucidate this phenomenon. Additionally, we examine the criteria essential for distinguishing imitative Dissociative Identity Disorder from genuine cases, with the aim of aiding accurate diagnosis by psychiatrists. Mental health professionals may encounter new challenges when assessing young adults whose presentations are influenced by social media, necessitating awareness of the impact of social media on the dissemination of certain disorders.
Topics: Adolescent; Humans; Dissociative Identity Disorder; Psychiatry; Dissociative Disorders
PubMed: 37800227
DOI: No ID Found -
Brain : a Journal of Neurology Dec 2010Although generally considered as mutually exclusive, violence and sleep can coexist. Violence related to the sleep period is probably more frequent than generally... (Review)
Review
Although generally considered as mutually exclusive, violence and sleep can coexist. Violence related to the sleep period is probably more frequent than generally assumed and can be observed in various conditions including parasomnias (such as arousal disorders and rapid eye movement sleep behaviour disorder), epilepsy (in particular nocturnal frontal lobe epilepsy) and psychiatric diseases (including delirium and dissociative states). Important advances in the fields of genetics, neuroimaging and behavioural neurology have expanded the understanding of the mechanisms underlying violence and its particular relation to sleep. The present review outlines the different sleep disorders associated with violence and aims at providing information on diagnosis, therapy and forensic issues. It also discusses current pathophysiological models, establishing a link between sleep-related violence and violence observed in other settings.
Topics: Dissociative Disorders; Epilepsy; Forensic Medicine; Humans; Parasomnias; Polysomnography; Sleep Arousal Disorders; Sleep Wake Disorders; Sleep, REM; Violence
PubMed: 21126993
DOI: 10.1093/brain/awq296