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Michal M, Wiltink J, Tibubos AN, Wild PS, Münzel T, Lackner K, Pfeiffer N, König J, Gieswinkel A, Beutel M, Kerahrodi JG. Impact of depersonalization on the course of depression: longitudinal observations from the gutenberg health study. BMC Psychiatry 2024; 24:196. [PMID: 38459472 PMCID: PMC10924423 DOI: 10.1186/s12888-024-05658-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 03/04/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Symptoms of depersonalization (DP) and derealization (DR) are a risk factor for more severe impairment, non-response to various treatments, and a chronic course. In this study, we investigated the effects of DP/DR symptoms in patients with clinically significant depressive symptoms on clinical characteristics and various outcomes in a representative population-based sample with a 5-year follow-up. METHODS The middle-aged sample comprised n = 10,422 persons at baseline, of whom n = 9,301 were free from depressive and DP/DR symptoms. N = 522 persons had clinically significant depression (PHQ-9 ≥ 10) and co-occurring DP/DR symptoms, and n = 599 persons had clinically significant depression (PHQ-9 ≥ 10) without DP/DR symptoms. RESULTS There were substantial health disparities between persons with and without depression. These disparities concerned a wide range of life domains, including lower quality of the recalled early life experiences with the parents, current socioeconomic status, social integration (partnership, loneliness), current social and interpersonal stressors (family, work), functional bodily complaints (e.g., tinnitus, migraine, chest pain), unhealthy lifestyle, and the prevalence of already developed physical diseases. These disparities persisted to the 5-year follow-up and were exceptionally severe for depressed persons with co-occurring DP/DR symptoms. Among the depressed persons, the co-occurrence of DP/DR symptoms more than doubled the risk for recurrence or persistence of depression. Only 6.9% of depressed persons with DP/DR symptoms achieved remission at the 5-year follow-up (PHQ-9 < 5). Depression with and without co-occurring DP/DR worsened self-rated physical health significantly. The impact of depression with co-occurring DP/DR on the worsening of the self-rated physical health status was stronger than those of age and major medical diseases (e.g., heart failure). However, only depression without DP/DR was associated with mortality in a hazard regression analysis adjusted for age, sex, and lifestyle. CONCLUSIONS The results demonstrated that DP/DR symptoms represent an important and easily assessable prognostic factor for the course of depression and health outcomes. Given the low remission rates for depression in general and depression with DP/DR in particular, efforts should be made to identify and better support this group, which is disadvantaged in many aspects of life.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany.
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany.
| | - Jörg Wiltink
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Ana N Tibubos
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Philipp S Wild
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- Center for Thrombosis and Hemostasis, University Medical Center Mainz, Johannes Gutenberg University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany
| | - Thomas Münzel
- Department of Cardiology I, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), University Medical Center Mainz, Partner site Rhine-Main, Mainz, Germany
| | - Karl Lackner
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
| | - Jochem König
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Alexander Gieswinkel
- Preventive Cardiology and Preventive Medicine, Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Manfred Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Jasmin Ghaemi Kerahrodi
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Salami A, Andreu-Perez J, Gillmeister H. Finding neural correlates of depersonalisation/derealisation disorder via explainable CNN-based analysis guided by clinical assessment scores. Artif Intell Med 2024; 149:102755. [PMID: 38462269 DOI: 10.1016/j.artmed.2023.102755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 03/12/2024]
Abstract
Mental health disorders are typically diagnosed based on subjective reports (e.g., through questionnaires) followed by clinical interviews to evaluate the self-reported symptoms. Therefore, considering the interconnected nature of psychiatric disorders, their accurate diagnosis is a real challenge without indicators of underlying physiological dysfunction. Depersonalisation/derealisation disorder (DPD) is an example of dissociative disorder affecting 1-2 % of the population. DPD is characterised mainly by persistent disembodiment, detachment from surroundings, and feelings of emotional numbness, which can significantly impact patients' quality of life. The underlying neural correlates of DPD have been investigated for years to understand and help with a more accurate and in-time diagnosis of the disorder. However, in terms of EEG studies, which hold great importance due to their convenient and inexpensive nature, the literature has often been based on hypotheses proposed by experts in the field, which require prior knowledge of the disorder. In addition, participants' labelling in research experiments is often derived from the outcome of the Cambridge Depersonalisation Scale (CDS), a subjective assessment to quantify the level of depersonalisation/derealisation, the threshold and reliability of which might be challenged. As a result, we aimed to propose a novel end-to-end EEG processing pipeline based on deep neural networks for DPD biomarker discovery, which requires no prior handcrafted labelled data. Alternatively, it can assimilate knowledge from clinical outcomes like CDS as well as data-driven patterns that differentiate individual brain responses. In addition, the structure of the proposed model targets the uncertainty in CDS scores by using them as prior information only to guide the unsupervised learning task in a multi-task learning scenario. A comprehensive evaluation has been done to confirm the significance of the proposed deep structure, including new ways of network visualisation to investigate spectral, spatial, and temporal information derived in the learning process. We argued that the proposed EEG analytics could also be applied to investigate other psychological and mental disorders currently indicated on the basis of clinical assessment scores. The code to reproduce the results presented in this paper is openly accessible at https://github.com/AbbasSalami/DPD_Analysis.
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Affiliation(s)
- Abbas Salami
- School of Computer Science and Electronic Engineering, University of Essex, Colchester CO4 3SQ, UK.
| | - Javier Andreu-Perez
- School of Computer Science and Electronic Engineering, University of Essex, Colchester CO4 3SQ, UK; Centre for Computational Intelligence, Smart Health Technologies Group, Institute of Public Health and Wellbeing, University of Essex, Colchester CO4 3SQ, UK; Simbad2, Department of Computer Science, University of Jaén, 23071 Jaen, Spain; Biomedical Research Institute of Malaga (IBIMA), 29590 Málaga, Spain.
| | - Helge Gillmeister
- Centre for Computational Intelligence, Smart Health Technologies Group, Institute of Public Health and Wellbeing, University of Essex, Colchester CO4 3SQ, UK; Department of Psychology, University of Essex, Colchester CO4 3SQ, UK.
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Watson O. Embodying the (Dis)embodiment: Narrating Depersonalization-Derealization Disorder. Qual Health Res 2022; 32:1858-1864. [PMID: 36045636 DOI: 10.1177/10497323221123763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Depersonalization-Derealization Disorder is an under-researched condition that is often left out of the larger discourse surrounding mental health and mental illness. This autoethnography examines the material and discursive tensions that are a product of my experience with Depersonalization-Derealization Disorder. In this critical self-exploration, I use communication privacy management theory, communication theory of resilience, and stigma management communication theory to unpack the communicative negotiations that accompany my disembodied experience, with the overarching goal of spreading awareness about Depersonalization-Derealization Disorder to help others make sense of their own diagnosis.
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Affiliation(s)
- Olivia Watson
- Department of Communication, 14716University of Missouri, Columbia, MO, USA
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Herkes J, Ellis LA, Churruca K, Braithwaite J. A cross-sectional study investigating the associations of person-organisation and person-group fit with staff outcomes in mental healthcare. BMJ Open 2019; 9:e030669. [PMID: 31551386 PMCID: PMC6773281 DOI: 10.1136/bmjopen-2019-030669] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Organisational and workplace cultures are fundamental determinants of health systems performance; through better understanding of the dimensions of culture there is the potential to influence them, and subsequently improve safety and quality of care, as well as the experiences of both patients and staff. One promising conceptual framework for studying culture in healthcare is person-environment (P-E) fit. Comprising person-organisational (P-O) and person-group (P-G) components, P-E fit is defined as the extent to which individuals are compatible with their work environment. The aim of this study was to examine the associations of P-O and P-G fit with staff outcomes in mental healthcare. SETTING AND PARTICIPANTS Participants (n=213) were staff and volunteers at 31 primary mental health facilities across six states of Australia. PRIMARY AND SECONDARY OUTCOME MEASURES Staff outcomes, comprising burnout (depersonalisation and emotional exhaustion), job satisfaction and work stress. DESIGN A multidimensional survey tool was used to measure P-O and P-G fit, and staff outcomes. Multiple regression analyses were used to test the associations between fit and outcome measures. RESULTS The regression analyses indicated that, based on a Bonferroni adjusted alpha value of α=00417, P-O fit accounted for 36.6% of the variability in satisfaction (F=8.951, p≤0.001); 27.7% in emotional exhaustion (F=6.766, p≤0.001); 32.8% in depersonalisation (F=8.646, p≤0.001); and 23.5% in work stress (F=5.439, p≤0.001). The P-G fit results were less conclusive, with P-G fit accounting for 15.8% of the variability in satisfaction (F=4.184, p≤0.001); 10.0% in emotional exhaustion (F=2.488, p=0.014); 28.6% in depersonalisation (F=8.945, p≤0.001); and 10.4% in work stress (F=2.590, p=0.032). There was no statistically significant increase in the variability accounted for when the interaction term of P-O and P-G fit was added to the regression. CONCLUSIONS The findings highlight that staff's perception of their workplace and organisational culture can have implications for staff well-being.
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Affiliation(s)
- Jessica Herkes
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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Kolarik RC, O’Neal RL, Ewing JA. Resident Preferences for Program Director Role in Wellness Management. J Gen Intern Med 2018; 33:705-709. [PMID: 29508257 PMCID: PMC5910365 DOI: 10.1007/s11606-018-4367-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 11/17/2017] [Accepted: 02/01/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Burnout and depression are prevalent among resident physicians, though the supportive role of the program director (PD) is not well defined. OBJECTIVE To understand the residents' view of the residency program director's role in assessing and promoting resident wellness. METHODS A single institution survey of all house staff was conducted in 2017. Rates of burnout and depression were identified via the 2-item Maslach Burnout Inventory (MBI) and the Patient Health Questionaire-2 (PHQ-2), respectively. Residents then qualified their preferences for various assistance services and for the role of their program directors in assisting them. RESULTS One-hundred sixty-one of 202 (79.7%) residents completed the survey. The rate of depression was 28%. Rates of emotional exhaustion and depersonalization (2-item MBI) were 44 and 62%, respectively. Only 4% of respondents had used the Employee Assistance Program (EAP) in the prior 12 months. Eighty-two percent of residents were in favor of PDs inquiring about wellness regardless of their job performance and only 1% of residents stated the PD should not inquire about wellness at all. Thirty-three percent of residents reported that they would be likely to contact EAP on their own if they felt unwell. Significantly more residents (62%) reported being more likely to contact EAP if recommended by their PD (33 vs 62%, p < 0.001%). Important perceived barriers to seeking assistance were lack of time (65%), lack of knowledge of how to contact EAP (41%), and concerns about appearing weak (35%). CONCLUSIONS Despite a high prevalence of burnout and depression, residents are unlikely to seek help on their own. Program directors have an important role in assessing and promoting the wellness of their residents. The majority of residents wants their PD to inquire about wellness and may be more likely to seek and receive help if recommended and facilitated by their PD.
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Affiliation(s)
- Russ C. Kolarik
- University of South Carolina Greenville, Greenville, SC USA
- Combined Internal Medicine and Pediatrics Residency, Greenville Health System/USC SOM Greenville, Greenville, SC USA
| | | | - Joseph A. Ewing
- Quality Management Department, Greenville Health System, Greenville, SC USA
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Choi KR, Seng JS, Briggs EC, Munro-Kramer ML, Graham-Bermann SA, Lee RC, Ford JD. The Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) Among Adolescents: Co-Occurring PTSD, Depersonalization/Derealization, and Other Dissociation Symptoms. J Am Acad Child Adolesc Psychiatry 2017; 56:1062-1072. [PMID: 29173740 PMCID: PMC5726572 DOI: 10.1016/j.jaac.2017.09.425] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/08/2017] [Accepted: 09/26/2017] [Indexed: 01/09/2023]
Abstract
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.
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Yu C, Arcos-Burgos M, Licinio J, Wong ML. A latent genetic subtype of major depression identified by whole-exome genotyping data in a Mexican-American cohort. Transl Psychiatry 2017; 7:e1134. [PMID: 28509902 PMCID: PMC5534938 DOI: 10.1038/tp.2017.102] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Revised: 04/04/2017] [Accepted: 04/10/2017] [Indexed: 02/07/2023] Open
Abstract
Identifying data-driven subtypes of major depressive disorder (MDD) is an important topic of psychiatric research. Currently, MDD subtypes are based on clinically defined depression symptom patterns. Although a few data-driven attempts have been made to identify more homogenous subgroups within MDD, other studies have not focused on using human genetic data for MDD subtyping. Here we used a computational strategy to identify MDD subtypes based on single-nucleotide polymorphism genotyping data from MDD cases and controls using Hamming distance and cluster analysis. We examined a cohort of Mexican-American participants from Los Angeles, including MDD patients (n=203) and healthy controls (n=196). The results in cluster trees indicate that a significant latent subtype exists in the Mexican-American MDD group. The individuals in this hidden subtype have increased common genetic substrates related to major depression and they also have more anxiety and less middle insomnia, depersonalization and derealisation, and paranoid symptoms. Advances in this line of research to validate this strategy in other patient groups of different ethnicities will have the potential to eventually be translated to clinical practice, with the tantalising possibility that in the future it may be possible to refine MDD diagnosis based on genetic data.
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Affiliation(s)
- C Yu
- Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia
| | - M Arcos-Burgos
- Department of Genome Sciences, John Curtin School of Medical Research, Australian National University, Canberra, ACT, Australia
- University of Rosario International Institute of Translational Medicine, Bogota, Colombia
| | - J Licinio
- Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia
- South Ural State University Biomedical School, Chelyabinsk, Russia
| | - M-L Wong
- Mind and Brain Theme, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
- School of Medicine, Flinders University, Bedford Park, Adelaide, SA, Australia
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Affiliation(s)
| | | | - Anthony S David
- Institute of Psychiatry, Psychology and Neuroscience, London, UK
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Bodatsch M, Kuhn J. [Alienation: Differential Psychopathology of Ego-Disturbances]. Fortschr Neurol Psychiatr 2016; 84:699-708. [PMID: 27846655 DOI: 10.1055/s-0042-115180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Alienation, i. e. disorders of the inner experience of integrity, continuity, and agency, represents a feature of both psychotic and non-psychotic disorders. Thereby, ego disturbances are thought to be specific for schizophrenia. Depersonalisation, in contrast, has been reported in schizophrenia as well as a neurotic, probably distinct syndrome. The differentiation of psychotic vs. non-psychotic alienation is often all but trivial. The present paper provides an overview of the historical roots and the psychopathological conceptualizations of alienation. Clinically relevant features of psychotic alienation are highlighted. Experience of passivity, loss of authenticity and disturbances of striving and volition appear as psychotic characteristics.
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Affiliation(s)
- M Bodatsch
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Evangelisches und Johanniter Klinikum Niederrhein, Oberhausen
| | - J Kuhn
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Köln
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Villwock JA, Sobin LB, Koester LA, Harris TM. Impostor syndrome and burnout among American medical students: a pilot study. Int J Med Educ 2016; 7:364-369. [PMID: 27802178 PMCID: PMC5116369 DOI: 10.5116/ijme.5801.eac4] [Citation(s) in RCA: 171] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 10/15/2016] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To describe levels of burnout and impostor syndrome (IS) in medical students, and to recognize demographic differences in those experiencing burnout and IS. METHODS Anonymous survey administered online in 2014 that included demographic data, the Maslach Burnout Inventory and an IS screening questionnaire. Main outcome measures were level of burnout, and presence or absence of imposter syndrome. The presence of IS and burnout components were analyzed across age, gender, race, year of training, intention to pursue fellowship training, and greater than one year of work experience outside of medicine using chi-squared tests. The association between burnout and IS was also compared using chi-squared tests. RESULTS One hundred and thirty-eight students completed the questionnaire. Female gender was significantly associated with IS (χ2(3)=10.6, p=0.004) with more than double the percentage of females displaying IS than their male counterparts (49.4% of females versus 23.7% of males). IS was significantly associated with the burnout components of exhaustion (χ2 (2)=5.9, p=0.045), cynicism (χ2(2)=9.4, p=0.004), emotional exhaustion (χ2(2)=8.0, p=0.018), and depersonalization (χ2 (2)=10.3, p=0.006). The fourth year of medical school was significantly associated with IS (χ2(3)=10.5, p=0.015). CONCLUSIONS Almost a quarter of male medical students and nearly half of female students experience IS and IS was found to be significantly associated with burnout indices. Given the high psychological morbidity of these conditions, this association cannot be ignored. It behooves us to reconsider facets of medical education (i.e. shame-based learning and overall teaching style) and optimize the medical learning environment.
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Affiliation(s)
- Jennifer A. Villwock
- Department of Otolaryngology, University of Kansas Medical Center, Kansas City, USA
| | - Lindsay B. Sobin
- Department of Otolaryngology, Boston Children's Hospital, Boston, MA, USA
| | - Lindsey A. Koester
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Tucker M. Harris
- Arnot Medical Services, Arnot Ogden Medical Center, Elmira, NY, USA
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Madeira L, Bonoldi I, Rocchetti M, Brandizzi M, Samson C, Azis M, Queen B, Bossong M, Allen P, Perez J, Howes OD, McGuire P, Fusar-Poli P. Prevalence and implications of Truman symptoms in subjects at ultra high risk for psychosis. Psychiatry Res 2016; 238:270-276. [PMID: 27086244 DOI: 10.1016/j.psychres.2016.02.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 12/13/2015] [Accepted: 02/01/2016] [Indexed: 01/23/2023]
Abstract
Preliminary qualitative research has suggested that patients with early stages of psychosis and those at Ultra High Risk (UHR) may experience "Truman symptoms" (TS). This study is an exploratory investigation of TS in a sample of 26 UHR subjects and 14 matched controls (HC) recruited from three prodromal and early intervention clinics and its relation with clinical features, depersonalization and basic self-disturbances. The UHR were assessed with the Comprehensive Assessment of At-Risk Mental States (CAARMS), Social and Occupational Functioning Assessment Scale (SOFAS), the Positive and Negative Syndrome Scale (PANSS), the Cambridge Depersonalization Scale (CDS) and the Examination of Anomalous Self Experiences (EASE) checklist. In our sample, TS were specific (TS absent in HC) and highly prevalent (50%) in UHR subjects. We found a significant difference in EASE total scores across HC, UHR with TS and without TS but post-hoc analyses showed similar scores in the two latter groups. The presence of TS in our UHR sample was associated with significant higher PANSS general psychopathology but with non-significant difference in the CAARMS, CDS and SOFAS scores. This study of TS in UHR subjects suggested that they might be prevalent and specific of this population.
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Affiliation(s)
- Luis Madeira
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" Prodromal Clinic, SLaM NHS Foundation Trust, London, UK; Hospital Santa Maria, Psychiatry Department, Lisbon, Portugal
| | - Ilaria Bonoldi
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" Prodromal Clinic, SLaM NHS Foundation Trust, London, UK
| | - Matteo Rocchetti
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Martina Brandizzi
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" Prodromal Clinic, SLaM NHS Foundation Trust, London, UK; Department of Neurology and Psychiatry Sapienza, University of Rome UOD Psicoterapia, "Villa Tiburtina" via Casal de'Pazzi 16, 00156 Roma, Italy
| | - Carly Samson
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Beverly Queen
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Matthijs Bossong
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Paul Allen
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough NHS Foundation Trust, UK
| | - Oliver D Howes
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" Prodromal Clinic, SLaM NHS Foundation Trust, London, UK
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK; "OASIS" Prodromal Clinic, SLaM NHS Foundation Trust, London, UK.
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Hojat M, Vergare M, Isenberg G, Cohen M, Spandorfer J. Underlying construct of empathy, optimism, and burnout in medical students. Int J Med Educ 2015; 6:12-6. [PMID: 25633650 PMCID: PMC4332366 DOI: 10.5116/ijme.54c3.60cd] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 01/24/2015] [Indexed: 05/13/2023]
Abstract
OBJECTIVE This study was designed to explore the underlying construct of measures of empathy, optimism, and burnout in medical students. METHODS Three instruments for measuring empathy (Jefferson Scale of Empathy, JSE); Optimism (the Life Orientation Test-Revised, LOT-R); and burnout (the Maslach Burnout Inventory, MBI, which includes three scales of Emotional Exhaustion, Depersonalization, and Personal Accomplishment) were administered to 265 third-year students at Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University. Data were subjected to factor analysis to examine relationships among measures of empathy, optimism, and burnout in a multivariate statistical model. RESULTS Factor analysis (principal component with oblique rotation) resulted in two underlying constructs, each with an eigenvalue greater than one. The first factor involved "positive personality attributes" (factor coefficients greater than .58 for measures of empathy, optimism, and personal accomplishment). The second factor involved "negative personality attributes" (factor coefficients greater than .78 for measures of emotional exhaustion, and depersonalization). CONCLUSIONS Results confirmed that an association exists between empathy in the context of patient care and personality characteristics that are conducive to relationship building, and considered to be "positive personality attributes," as opposed to personality characteristics that are considered as "negative personality attributes" that are detrimental to interpersonal relationships. Implications for the professional development of physicians-in-training and in-practice are discussed.
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Affiliation(s)
- Mohammadreza Hojat
- Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Michael Vergare
- Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Gerald Isenberg
- Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University, Philadelphia, USA
| | - Mitchell Cohen
- Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University, Philadelphia, USA
| | - John Spandorfer
- Sidney Kimmel (formerly Jefferson) Medical College at Thomas Jefferson University, Philadelphia, USA
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Ogundipe OA, Olagunju AT, Lasebikan VO, Coker AO. Burnout among doctors in residency training in a tertiary hospital. Asian J Psychiatr 2014; 10:27-32. [PMID: 25042948 DOI: 10.1016/j.ajp.2014.02.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 02/21/2014] [Accepted: 02/22/2014] [Indexed: 11/18/2022]
Abstract
The mental health of doctors is an issue of growing concern all over the world as it frequently interplays with their professional trainings and responsibilities. This study was done to determine the pattern and correlates of burnout among 204 doctors undergoing residency training. Eligible participants were interviewed using designed questionnaire, General Health Questionnaire (GHQ-12) and Maslach Burnout Inventory (MBI). The mean age of participants was 33.44±4.50. Ninety-three (45.6%) respondents reported burnout in the dimension of emotional exhaustion (EE), 118 (57.8%) in the dimension of depersonalization (D), and 126 (61.8%) in the dimension of reduced personal accomplishment (RPA). Factors that were significantly associated with all the dimensions of burnout were perceived heavy workload and presence of emotional distress (based on GHQ score of ≥3). The perception of call duty as being not stressful was negatively predictive of burnout in the emotional exhaustion subscale (odds ratio [OR]=0.52; 95%confidence interval [CI]=0.29-0.97; p=0.03), while emotional distress was a positive predictor (OR=6.97; 95%CI=3.28-14.81; p<0.001]. Absence of doctor-to-doctor conflict negatively predicted burnout in the depersonalization subscale (OR=0.36; 95%CI=0.17-0.76); p<0.01), while older age (OR=0.66; 95%CI=0.47-0.95; p=0.03) and adequate support from the management (OR=0.45; 95%CI=0.22-0.90; p=0.02) constituted negative predictors of burnout in the reduced personal accomplishment subscale. Burnout is highly prevalent among resident doctors. Evolvement of comprehensive mental health services, training supports, conflict de-escalation/resolution mechanisms, and periodic assessment are indicated to mitigate work related distress with burn out among resident doctors, while improving their productivity.
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Affiliation(s)
- O A Ogundipe
- Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003 Lagos, Nigeria; Health Service Commission, Lagos Island, Lagos State, Nigeria
| | - A T Olagunju
- Department of Psychiatry, Lagos University Teaching Hospital, PMB 12003 Lagos, Nigeria; Department of Psychiatry, College of Medicine, University of Lagos, PMB 12003 Lagos, Nigeria.
| | - V O Lasebikan
- Department of Psychiatry, University College Hospital, Ibadan, Oyo State, Nigeria
| | - A O Coker
- Department of Behavioural Sciences, Lagos State College of Medicine, Ikeja, Lagos State, Nigeria
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14
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Maeda T, Mimura M. [Aberrant bodily self in schizophrenia]. Brain Nerve 2014; 66:363-366. [PMID: 24748083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Patients with schizophrenia often experience aberrant bodily self including depersonalization and cenesthopathy, especially in its prodromal and early stage. These symptoms are regarded as the beginning of self-disturbances (i.e. the core psychopathology of the illness). Thus, an understanding of schizophrenic bodily experiences could provide insight into the pathophysiology of schizophrenia. Recently, in the field of cognitive neuroscience, research on self-awareness during intentional actions has focused on examining sense of body ownership (SoO) and sense of agency (SoA). The most critical factor for the emergence of those higher-order senses of self is subject's intention for actions. Intentional signals could integrate multiple bodily sensory feedbacks during actions, and lead to develop a coherent sense of self. Empirical studies using behavioral and neuroimaging experiments have demonstrated that schizophrenic patients exhibit specific patterns of abnormal SoO and SoA. Thus, from a clinical standpoint, the detection of specific nature of schizophrenic bodily experiences could provide evidence for early diagnosis and intervention for schizophrenia.
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Affiliation(s)
- Takaki Maeda
- Department of Neuropsychiatry, Keio University School of Medicine
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Michal M, Reuchlein B, Adler J, Reiner I, Beutel ME, Vögele C, Schächinger H, Schulz A. Striking discrepancy of anomalous body experiences with normal interoceptive accuracy in depersonalization-derealization disorder. PLoS One 2014; 9:e89823. [PMID: 24587061 PMCID: PMC3937420 DOI: 10.1371/journal.pone.0089823] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 01/27/2014] [Indexed: 11/29/2022] Open
Abstract
Background Disembodiment is a core feature of depersonalization disorder (DPD). Given the narratives of DPD patients about their disembodiment and emotional numbing and neurobiological findings of an inhibition of insular activity, DPD may be considered as a mental disorder with specific impairments of interoceptive awareness and body perception. Methods We investigated cardioceptive accuracy (CA) of DPD patients (n = 24) as compared to healthy controls (n = 26) with two different heartbeat detection tasks (“Schandry heartbeat counting task” and “Whitehead heartbeat discrimination task”). Self-rated clearness of body perception was measured by questionnaire. Results Contrary to our hypothesis, DPD patients performed similarly to healthy controls on the two different heartbeat detection tasks, and they had equal scores regarding their self-rated clearness of body perception. There was no correlation of the severity of “anomalous body experiences” and depersonalization with measures of interoceptive accuracy. Only among healthy controls CA in the Schandry task was positively correlated with self-rated clearness of body perception. Depersonalization was unrelated to severity of depression or anxiety, while depression and anxiety were highly correlated. Anxiety and depression did not modify the associations of depersonalization with interoceptive accuracy. Conclusions Our main findings highlight a striking discrepancy of normal interoception with overwhelming experiences of disembodiment in DPD. This may reflect difficulties of DPD patients to integrate their visceral and bodily perceptions into a sense of their selves. This problem may be considered an important target for psychotherapeutic treatment approaches.
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Affiliation(s)
- Matthias Michal
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
- * E-mail:
| | - Bettina Reuchlein
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Julia Adler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Iris Reiner
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Claus Vögele
- Research Unit INSIDE, Research Group Self-Regulation and Health, University of Luxembourg, Walferdange, Luxembourg
| | - Hartmut Schächinger
- Department of Clinical Psychophysiology, Institute of Psychobiology, University of Trier, Trier, Germany
| | - André Schulz
- Research Unit INSIDE, Research Group Self-Regulation and Health, University of Luxembourg, Walferdange, Luxembourg
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16
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Vassos MV, Nankervis KL. Investigating the importance of various individual, interpersonal, organisational and demographic variables when predicting job burnout in disability support workers. Res Dev Disabil 2012; 33:1780-1791. [PMID: 22699251 DOI: 10.1016/j.ridd.2012.04.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 04/26/2012] [Accepted: 04/26/2012] [Indexed: 06/01/2023]
Abstract
Previous research has highlighted that factors such as large workload, role ambiguity, lack of support from colleagues, and challenging behaviour are associated with higher levels of burnout within the disability support worker (DSW) population. The aim of this research was to investigate which factors contribute the most to the prediction of the three facets of burnout--feeling exhausted and overextended by one's work (emotional exhaustion), detached and callous responses towards work (depersonalisation) and a lack of achievement and productivity within one's role (personal accomplishment). The factors chosen for analysis within this research were analysed within four categories linked to theories of burnout development (individual, interpersonal, organisational and demographic). A sample of 108 DSWs completed a questionnaire booklet that contained standardised measures of burnout and job stressors related to disability work. Results highlighted the importance of predictors such as challenging behaviour (interpersonal), workload (individual), supervisor support (individual), work-home conflict (individual), job feedback (individual), role ambiguity (organisational), low job status (organisational), role conflict (organisational), gender (demographic) and work hours (demographic) when predicting one or more of the facets of burnout. In conclusion, disability services and organisations may benefit from focusing on remodelling their staff-related organisational practices in order to prevent the development of burnout in their DSWs (e.g., increase supervision and support practices).
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Affiliation(s)
- Maria V Vassos
- Centre of Excellence for Behaviour Support, University of Queensland, Ipswich, Queensland, Australia.
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17
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Aliev NA, Aliev ZN. [Clinical characteristics and treatment of depersonalization disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2011; 111:97-101. [PMID: 21905344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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18
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Lubrańska A. [Organizational climate and burnout syndrome]. Med Pr 2011; 62:623-631. [PMID: 22312954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND The paper addresses the issue of organizational climate and burnout syndrome. It has been assumed that burnout syndrome is dependent on work climate (organizational climate), therefore, two concepts were analyzed: by D. Kolb (organizational climate) and by Ch. Maslach (burnout syndrome). MATERIALS AND METHODS The research involved 239 persons (122 woman, 117 men), aged 21-66. In the study Maslach Burnout Inventory (MBI) and Inventory of Organizational Climate were used. RESULTS The results of statistical methods (correlation analysis, one-variable analysis of variance and regression analysis) evidenced a strong relationship between organizational climate and burnout dimension. As depicted by the results, there are important differences in the level of burnout between the study participants who work in different types of organizational climate. CONCLUSIONS The results of the statistical analyses indicate that the organizational climate determines burnout syndrome. Therefore, creating supportive conditions at the workplace might reduce the risk of burnout.
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Lambert E, Hogan NL, Altheimer I, Jiang S, Stevenson MT. The relationship between burnout and support for punishment and treatment: a preliminary examination. Int J Offender Ther Comp Criminol 2010; 54:1004-1022. [PMID: 19793913 DOI: 10.1177/0306624x09348585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
According to the existing literature, support for punishment and support for treatment of inmates are the two major orientations held by correctional workers. There is a small but growing body of studies that has examined the predictors of these orientations. The literature suggests that personal characteristics account for little of the variance in correctional orientations whereas individual-level perceptions of work environment factors are related to correctional orientations; however, the effects of job burnout have not been explored. This study investigates the relationship between burnout and the two correctional orientations. Burnout has three dimensions: emotional exhaustion, depersonalization, and ineffectiveness. This study finds that depersonalization is positively related to support for punishment and negatively related to support for treatment. Ineffectiveness leads to a lower support for treatment whereas emotional exhaustion leads to a higher support for treatment.
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Affiliation(s)
- Eric Lambert
- Department of Criminal Justice, Wayne State University, Detroit, Michigan, USA.
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20
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Dudek B, Hauk M. [Brief Scale of Vocational Stress (BSVS)]. Med Pr 2010; 61:479-487. [PMID: 20865860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
Stress at work is one of the basic notions in applied psychology. There are many approaches to vocational stress presented in the scientific literature and in a number of articles. There is also a variety of methods dedicated to stress assessment. One of the interesting examples is "The Stress in General Scale" developed by Stanton and his coworkers. This questionnaire consists of two subscales named: Pressure and Threat. The operationalisation of the stress at work phenomenon proposed by the authors seems to be very interesting (it allows for quick and easy diagnosis of the problem). That is why, we have decided to prepare the Polish adaptation of this questionnaire. The paper presents individual stages of the adaptation study, which has resulted in the construction of a 26-item questionnaire of the five-factor structure (factor I--Pressure, factor II--Attractiveness, factor III--Risk, factor IV--Liking, factor V--Calm), and the preliminary psychometric properties seem to be satisfactory (e.g. Cronbach alpha = 0.86).
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21
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Affiliation(s)
- Clara Kean
- Department of Physiology and Pharmacology, University of Bristol, Bristol BS8 1TD, UK.
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22
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Zikić O, Cirić S, Mitković M. Depressive phenomenology in regard to depersonalization level. Psychiatr Danub 2009; 21:320-326. [PMID: 19794348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND It has been found that in patients suffering from unipolar depression, associated depersonalization symptomatology is more intense compared to healthy controls, and also that there is a positive correlation between depression and depersonalization. According to data that may be found in the literature, there is a relatively high prevalence of depersonalization symptomatology in unipolar depressions. Our study was aimed at finding whether the presence of depersonalization was related to a specific phenomenological expression of depressive symptomatology in unipolar depression. SUBJECTS AND METHODS The study included 84 subjects suffering from unipolar depression without psychotic features. Based on the Cambridge Depersonalization Scale (CDS) score, the subjects were divided into two groups - a group with associated depersonalization (CDS>or=70) (40 subjects) and a group with subsyndromal depersonalization (CDS<70) (44 subjects), the later one being treated as a control group. The groups were compared in regard to the intensity of depressive symptomatology, depressive symptoms frequency and the depressive symptoms duration. The General Socio-Demographic Questionnaire, the Cambridge Depersonalization Scale and The Patient Health Questionnaire - 9 were used. RESULTS The depressive patients with depersonalization had predominantly severe episodes, almost all patients had feelings of sadness, insomnia, and decrease of energetic potentials. The biggest difference between the groups, in terms of greater number of manifest symptoms in the patients with depersonalization, was for psychomotor disturbances (agitation or retardation), insomnia, decrease of energetic potentials and concentration. At the same time, 75% of the subjects with associated depersonalization had anhedonia, sadness/dysphoria, insomnia and decrease of energetic potentials continuously present. Unlike this group, the control group subjects experienced sadness, appetite problems, concentration and motor behavior changes almost half as frequently. Particularly significant were the differences regarding suicidal thoughts. It was shown that in the group with depersonalization there was a higher percentage of patients with suicidal thoughts, mostly continuously present, which represent a significant suicidal risk factor. CONCLUSION Unipolar depression, associated with depersonalization is more severe in its intensity .It has a bigger number of manifest symptoms which have a tendency to continuous duration. A special focus is on the negative impact on the occurrence and lasting presence of suicidal thoughts.
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Affiliation(s)
- Olivera Zikić
- Clinic for Mental Health Protection, UCC Nis, 18000 Nis, Serbia.
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Waldman SV, Diez JCL, Arazi HC, Linetzky B, Guinjoan S, Grancelli H. Burnout, perceived stress, and depression among cardiology residents in Argentina. Acad Psychiatry 2009; 33:296-301. [PMID: 19690109 DOI: 10.1176/appi.ap.33.4.296] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE Because medical residency is a stressful time for training physicians, placing residents at increased risk for psychological distress, the authors studied the prevalence of burnout, perceived stress, and depression in cardiology residents in Argentina and examined the association between sociodemographic characteristics and these syndromes. METHODS The authors conducted a cross-sectional observational study of 106 cardiology residents in Argentina and a comparison group of 104 age- and gender-matched nonmedical professionals. The main outcome measures included the prevalence of burnout with the Maslach Burnout Inventory, distress with the Perceived Stress Scale, and depression with the Beck Depression Inventory. RESULTS One hundred six residents completed the survey. Of these, 31.3% were women, the mean age was 29.1 years old, and half were married. Respondents worked an average of 64 hours per week, and 60% of the residents needed a second job. High emotional exhaustion and depersonalization was found in the majority of respondents. Significant depressive symptoms were found in less than half of residents, and stress was on average 21.7 points on the Perceived Stress Scale. Residents who had a second job showed high levels of depersonalization. No other association was found with sociodemographic characteristics. There were no differences in sociodemographic characteristics of residents compared with nonmedical professionals, but nonmedical professionals worked less hours per week, had a lower percentage of second jobs, and higher salary. Burnout, depressive symptoms, and perceived stress were significantly lower in the reference group. CONCLUSION Cardiology residents in Argentina exhibit high levels of burnout, perceived stress, and depressive symptoms, which warrants greater attention to the psychological needs of residents.
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Affiliation(s)
- Silvina V Waldman
- Cardiology, Fundación para la Lucha contra las Enfermedades Neurológicas de la Infancia, Montañeses 2325, Buenos Aires, Argentina.
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Gallagher S, McGilloway S. Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms. Int J Emerg Ment Health 2009; 11:235-248. [PMID: 20524508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This two-stage study was undertaken to assess the extent and nature of Critical Incident Stress (CIS) amongst frontline staff in a large ambulance service in Ireland. In Stage One, 63% (112/180) of participants completed a Screening Questionnaire and the GHQ-12. In Stage Two, 27 participants, who had experienced a critical incident (CI) during the previous year completed several measures to assess PTSD symptomatology, burnout, health-related Quality of Life, and dispositional optimism. Eighty-one per cent (80/94) of the Stage One group reported that their health had been affected by a CI; 42% (44/106) were identified as 'cases' on the GHQ-12. Stage Two results indicated that 12 participants had PTSD symptoms while this entire group showed moderate levels of emotional exhaustion and depersonalization, despite experiencing high levels of personal accomplishment and optimism. The findings suggest a high prevalence of CIS among ambulance personnel in Ireland and a significant impact on overall health and wellbeing. This has important implications for the effective management of CIS and suggests an important role for occupational health and organizational psychologists in providing routine support to ambulance service staff andpossibly other emergency services personnel.
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Affiliation(s)
- Sharon Gallagher
- Department of Psychology, National University of Ireland, Maynooth, County Kildare, Ireland.
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Jáuregui-Renaud K, Sang FYP, Gresty MA, Green DA, Bronstein AM. Depersonalisation/derealisation symptoms and updating orientation in patients with vestibular disease. J Neurol Neurosurg Psychiatry 2008; 79:276-83. [PMID: 17578858 DOI: 10.1136/jnnp.2007.122119] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patients with vestibular disease have an increased rate of reporting symptoms of depersonalisation/derealisation (DD) and similar symptoms can be provoked in healthy subjects during caloric vestibular stimulation. OBJECTIVE To assess the relationship between DD symptoms in patients with peripheral vestibular disease and their ability to update orientation in the environment. METHODS Sixty healthy subjects and 50 patients with peripheral vestibular disease completed a DD questionnaire (Cox and Swinson, 2002) and a General Health Questionnaire (GHQ)-12 (Goldberg and Williams, 1988). This was followed by a test of updating spatial orientation in which subjects were exposed to 10 manually driven whole body rotations of 45 degrees, 90 degrees or 135 degrees in a square room, which contained distinctive features on the walls, in such a way that the features and corners subtended 45 degrees with respect to the subject. After each rotation subjects reported which wall or corner they were facing. Estimation error was calculated by subtracting the reported rotation from the actual rotation. RESULTS DD scores were significantly higher in vestibular patients than in healthy subjects (p<0.05, t test). In patients, the lowest symptom scores and the lowest estimation errors were found in those with a unilateral canal paresis without balance symptoms whereas the highest scores and largest estimation errors were found in those with bilateral vestibular loss (p<0.05, ANOVA). Across all patients, DD scores were related to estimation errors (adjusted r2 = 0.25, p<0.05, ANCOVA). CONCLUSIONS Patients with peripheral vestibular disease have a deficit in the ability to update orientation on the environment and a high prevalence of DD symptoms, which may imply a high order effect of the vestibular impairment. Derealisation symptoms in vestibular disease may be a consequence of a sensory mismatch between disordered vestibular input and other sensory signals of orientation.
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Affiliation(s)
- K Jáuregui-Renaud
- Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, México DF.
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Abstract
OBJECTIVE Studies of the neuroanatomical localization of schizophrenia have not given sufficient attention to the inferior parietal lobule (IPL). METHODS A search of the medical literature was carried out for links between schizophrenia and the IPL. RESULTS Structural differences in the IPL in schizophrenia were reported by 10 recent neuroimaging studies, although the studies did not all agree with each other. Functional differences in the IPL in schizophrenia have been prominently reported in four areas: sensory integration, body image, concept of self, and executive function. CONCLUSION The IPL appears to be an important, but relatively neglected, component of the frontal-limbic-temporal-parietal neural network involved in the schizophrenia disease process. To encourage histopathological research of this area, the Stanley Medical Research Institute is making available a new collection of sucrose-fixed IPL tissue from 25 individuals with schizophrenia and 25 matched controls. Additional imaging and functional studies are needed to better define the network and role of the IPL.
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Affiliation(s)
- E Fuller Torrey
- Laboratory Research, The Stanley Medical Research Institute, 8401 Connecticut Avenue, Suite 200, Chevy Chase, MD 20815, USA.
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Abstract
BACKGROUND AND AIM The aim of this study was to investigate the theoretical dimensionality of burnout measurement (MBI). The objective of the study was to check the working hypothesis according to which the subscales of the Maslach Burnout Inventory (MBI) such as "emotional exhaustion" and "cynicism" (depersonalization) were not correlated with that of "personal achievement" (professional efficacy). To do so, we performed a meta-analysis [Maslach and Jackson, The Maslach Burnout Inventory, 1981, 1986]. METHODS The sample included 12,112 participants (sample size range from 100-3312 participants; estimated mean=448.59; standard deviation=648.51). Doctheses, Francis, Interscience, Kluweronline, Medline, PsycInfo, and ScienceDirect were searched to identify papers. Exploring references identified 83 publications (1998-2001). Two keywords were used: "Maslach Burnout Inventory" and "organizational stress". The criteria for this meta-analysis included: using the MBI "human services survey (HSS)" for professional care givers, "educators' survey (ES)" for professional educators, "general survey (GS)" for other workers). RESULTS About 58% of the population concerned professional caregivers, 13% professional educators, 11% social workers, and 18% correctional officers and other workers. In this meta-analysis, effect sizes should be reported with the number of studies and confidence intervals to test the consistency and reliability of the mean estimated (effect size). In this case, each correlation can be corrected. The meta-analysis can therefore be conducted on this corrected correlation. The aim will be to control any artefact and sampling error. Meta-analysis showed that the value of the corrected correlation is not always negative in the case of a relation between the dimension of "emotional exhaustion" and "personal achievement" (professional efficacy). In the case of the dimension "emotional exhaustion" and "cynicism" (depersonalization), we observed that the value of the corrected correlation studies and confidence intervals showed that this dimension was always correlated positively in the studies included. For the relationship between the value of corrected correlation studies and confidence intervals of the dimension of "cynicism" (depersonalization) and "personal achievement" (professional efficacy), the studies included showed that they were always correlated negatively. These results confirm the hypothesis studied. CONCLUSION The study revealed two points: (1) the homogeneity of the studies included concerning the fact that assessment of emotional exhaustion and cynicism (depersonalization) are always correlated positively; (2) the heterogeneity of the studies included concerning the fact that personal achievement is correlated with the other subscales of burnout (MBI). This study confirms the hypothesis.
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Affiliation(s)
- M Lourel
- Laboratoire de psychologie des régulations individuelles et sociales: clinique et société (PRIS), université de Rouen, rue Lavoisier, 76821 Mont-Saint-Aignan, France.
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Abstract
Depersonalization (DP), i.e., feelings of being detached from one's own mental processes or body, can be considered as a form of mental escape from the full experience of reality. This mental escape is thought to be etiologically linked with maltreatment during childhood. The detached state of consciousness in DP contrasts with certain aspects of mindfulness, a state of consciousness characterized by being in touch with the present moment. Against this background, the present article investigates potential connections between DP severity, mindfulness, and childhood trauma in a mixed sample of nonpatients and chronic nonmalignant pain patients. We found a strong inverse correlation between DP severity and mindfulness in both samples, which persisted after partialing out general psychological distress. In the nonpatient sample, we additionally found significant correlations between emotional maltreatment on the one hand and DP severity (positive) and mindfulness (negative) on the other. We conclude that the results first argue for an antithetical relationship between DP and certain aspects of mindfulness and thus encourage future studies on mindfulness-based interventions for DP and second throw light on potential developmental factors contributing to mindfulness.
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Affiliation(s)
- Matthias Michal
- Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Mainz, Germany.
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Abstract
Dissociative disorders are rarely considered in the diagnostic assessment of older women, despite the fact that the existence, appearance and characteristics of certain dissociative disorders in older populations has been known and described since the 1980s. This communication reviews the core phenomena of Dissociative Identity Disorder and related forms of Dissociative Disorder Not Otherwise Specified, the natural history of their phenomena from youth to old age, and describes common presentations of Dissociative Disorders in older women. It also reviews the treatment of complex chronic dissociative disorders and discusses alternative approaches to their psychotherapy in the older female patient. It is crucial to recognize and respect the importance of appreciating individual differences among older dissociative patients and to individualize their treatments accordingly.
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Mula M, Pini S, Cassano GB. [Rating scales for the assessment of depersonalization symptoms: a review]. Epidemiol Psichiatr Soc 2007; 16:265-270. [PMID: 18020201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Abstract
The relationship between dissociative tendencies, as measured with the Dissociative Experiences Scale and its amnesia, absorption/imaginative involvement, and depersonalization/derealization subscales, and HPA axis functioning was studied in 2 samples of undergraduate students (N = 58 and 67). Acute stress was induced by means of the Trier Social Stress Test. Subjective and physiological stress (i.e., cortisol) responses were measured. Individuals high on the depersonalization/derealization subscale of the Dissociative Experiences Scale exhibited more pronounced cortisol responses, while individuals high on the absorption subscale showed attenuated responses. Interestingly, subjective stress experiences, as indicated by the Tension-Anxiety subscale of the Profile of Mood States, were positively related to trait dissociation. The present findings illustrate how various types of dissociation (i.e., depersonalization/derealization, absorption) are differentially related to cortisol stress responses.
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Affiliation(s)
- Timo Giesbrecht
- Department of Experimental Psychology, Maastricht University, The Netherlands.
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Mula M, Pini S, Cassano GB. The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal. J Affect Disord 2007; 99:91-9. [PMID: 16997382 DOI: 10.1016/j.jad.2006.08.025] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2006] [Revised: 08/22/2006] [Accepted: 08/22/2006] [Indexed: 12/30/2022]
Abstract
Depersonalization and derealization occur on a continuum of situations, from healthy individuals to a severely debilitating disorder where the symptoms can persist chronically. Since 1960s, different neurobiological models have been hypothesized and they have been associated with the temporal lobes. Recent advances in the functioning of the limbic system and the application of Geschwind's concept of disconnection in the cortico-limbic networks, pointed the role of the amygdala and its connections with medial prefrontal cortex and anterior cingulate cortex, the same structures that are strictly interlinked with the neurobiology of emotions and affective disorders. In this paper, we hypothesize that depersonalization may represent a clinical index of disease severity, poorer response to treatment and high level of comorbidity, in mood and anxiety disorders, discussing the neurobiology of depersonalization and the available clinical evidence.
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Affiliation(s)
- Marco Mula
- Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Section of Psychiatry, University of Pisa, Via Roma, 67-56100 Pisa, Italy.
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Muscatello MRA, Bruno A, Carroccio C, Cedro C, La Torre D, Di Rosa AE, Zoccali R, Aragona M, La Torre F, Mattei A, Angelone AM, Di Orio F. Association between burnout and anger in oncology versus ophthalmology health care professionals. Psychol Rep 2007; 99:641-50. [PMID: 17153837 DOI: 10.2466/pr0.99.2.641-650] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The prevalence of burnout in oncology staff was compared with that of the ophthalmology staff, who normally present a low prevalence of burnout as described in this literature. The correlation of burnout with the emotion of anger was also investigated. Thirty-six subjects working in an oncology department and 32 working in an ophthalmology department were examined using the Maslach Burnout Inventory and the State-Trait Anger Expression Inventory. The oncology group showed higher mean scores on the MBI Emotive Exhaustion and Depersonalization scales with respect to ophthalmology staff. Correlation analysis showed that increasing burnout was associated with higher anger expressed towards the environment and loss of anger control. Anger, as a response to frustration, appears to be a feature constantly associated with the clinical expression of burnout and it should not be underestimated in theoretical and preventive contexts.
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Sierra M, Senior C, Phillips ML, David AS. Autonomic response in the perception of disgust and happiness in depersonalization disorder. Psychiatry Res 2006; 145:225-31. [PMID: 17074399 DOI: 10.1016/j.psychres.2005.05.022] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 04/07/2005] [Accepted: 05/28/2005] [Indexed: 10/24/2022]
Abstract
Patients with depersonalization disorder have shown attenuated responses to emotional unpleasant stimuli, hence supporting the view that depersonalization is characterised by a selective inhibition on the processing of unpleasant emotions. It was the purpose of this study to establish if autonomic responses to facial emotional expressions also show the same blunting effect. The skin conductance responses (SCRs) of 16 patients with chronic DSM-IV depersonalization disorder, 15 normal controls and 15 clinical controls with DSM-IV anxiety disorders were recorded in response to facial expressions of happiness and disgust. Patients with anxiety disorders were found to have greater autonomic responses than patients with depersonalization, in spite of the fact that both groups had similarly high levels of subjective anxiety as measured by anxiety scales. SCR to happy faces did not vary across groups. The findings of this study provide further support to the idea that patients with depersonalization have a selective impairment in the processing of threatening or unpleasant emotional stimuli.
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Medford N, Brierley B, Brammer M, Bullmore ET, David AS, Phillips ML. Emotional memory in depersonalization disorder: a functional MRI study. Psychiatry Res 2006; 148:93-102. [PMID: 17085021 DOI: 10.1016/j.pscychresns.2006.05.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2005] [Revised: 05/04/2006] [Accepted: 05/14/2006] [Indexed: 10/23/2022]
Abstract
This study examines emotional memory effects in primary depersonalization disorder (DPD). A core complaint of DPD sufferers is the dulling of emotional responses, and previous work has shown that, in response to aversive stimuli, DPD patients do not show activation of brain regions involved in normal emotional processing. We hypothesized that DPD sufferers would not show the normal emotional enhancement of memory, and that they would not show activation of brain regions concerned with emotional processing during encoding and recognition of emotional verbal material. Using fMRI, 10 DPD patients were compared with an age-matched healthy control group while performing a test of emotional verbal memory, comprising one encoding and two recognition memory tasks. DPD patients showed significantly enhanced recognition for overtly emotive words, but did not show enhancement of memory for neutral words encoded in an emotive context. In addition, patients did not show activation of emotional processing areas during encoding, and exhibited no substantial difference in their neural responses to emotional and neutral material in the encoding and emotional word recognition tasks. This study provides further evidence that patients with DPD do not process emotionally salient material in the same way as healthy controls, in accordance with their subjective descriptions of reduced or absent emotional responses.
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Affiliation(s)
- Nicholas Medford
- Division of Psychological Medicine, P.O. Box 68, Institute of Psychiatry, DeCrespigny Park, London SE5 8AF, UK.
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Roca V, Hart J, Kimbrell T, Freeman T. Cognitive function and dissociative disorder status among veteran subjects with chronic posttraumatic stress disorder: a preliminary study. J Neuropsychiatry Clin Neurosci 2006; 18:226-30. [PMID: 16720800 DOI: 10.1176/jnp.2006.18.2.226] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Twenty-seven veteran subjects with chronic posttraumatic stress disorder (PTSD) were evaluated for dissociative disorders. Ten subjects met criteria for one or more dissociative disorders, and 17 subjects did not meet dissociative disorder criteria. Neurocognitive profiles of the two groups differed in several areas, with veterans meeting diagnostic criteria for both PTSD and a dissociative disorder and demonstrating considerably greater deficits in attention, autobiographical memory, and verbal memory than PTSD subjects without comorbid dissociative disorder diagnosis.
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Affiliation(s)
- V Roca
- Mental Health Service, Central Arkansas Veterans Healthcare System, Little Rock, 72205-5484, USA
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Krause R, Kirsch A. Über das Verhältnis von Traumatisierungen, Amnesie und Symptombelastung - eine empirische Pilotstudie/ On the relationship between traumatization, amnesia and symptom stress – an empirical pilot study. Zeitschrift für Psychosomatische Medizin und Psychotherapie 2006; 52:392-405. [PMID: 17156607 DOI: 10.13109/zptm.2006.52.4.392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the present study we examined facial affective behavior in acutely traumatized patients undergoing EMDR therapy. Furthermore, we analyzed whether a decrease in emotional numbing was due to a reduction of symptoms. Amnestic tendencies were used as a moderator variable. METHODS The facial affective behaviour was coded using the Emotional Facial Acting Coding System, an instrument for the registration of facial movements with emotional relevance. The facial affective behavior of the patient's first and last EMDR session was compared. RESULTS A significant increase in facial affective behavior as well as an increase in mental complaints were found. Furthermore, the reduction in amnestic tendencies did not result in a reduction of symptoms. CONCLUSIONS Under the influence of the treatment it is possible to improve access to episodic affective memory. Nevertheless, a positive influence cannot be denoted at the end of the treatment.
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Affiliation(s)
- Rainer Krause
- Lehrstuhl für Klinische Psychologie and Psychotherapie der Universität des Saarlandes, Saarbrücken
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Abstract
There is evidence suggesting that the prevalence of depersonalization in psychiatric patients can vary across cultures. To explore the possible influence of culture on the prevalence of depersonalization, we compared psychiatric inpatient samples from the United Kingdom (N = 31), Spain (N = 68), and Colombia (N = 41) on standardized and validated self-rating measures of dissociation and depersonalization: the Cambridge Depersonalization Scale and the Dissociative Experiences Scale (DES). Colombian patients were found to have lower global scores on the Cambridge Depersonalization Scale and the DES and all its subscales, with the exception of DES-Absorption. No differences were found for measures of depression or anxiety. These findings seem to support the view that depersonalization is susceptible to cultural influences. Attention is drawn to the potential relevance of the sociological dimension "individualism-collectivism" on the experience of the self, and it is proposed that cultures characterized by high individualism may confer vulnerability to depersonalization experiences.
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Affiliation(s)
- Mauricio Sierra
- Depersonalization Research Unit, Institute of Psychiatry, King's College, London, UK.
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Molina Castillo JJ, Martínez de la Iglesia J, Albert Colomer C, Berrios G, Sierra M, Luque Luque R. [Cross-cultural adaptation and validation of the Cambridge Depersonalisation Scale]. Actas Esp Psiquiatr 2006; 34:185-92. [PMID: 16736392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
INTRODUCTION The Cambridge Depersonalisation Scale (CDS) is a self-rating questionnaire constructed to capture the frequency and duration of depersonalization symptoms over the last six months. The instrument has proved to be valid and reliable and can be useful in both clinical and neurobiological research. METHODS This paper presents the Spanish adaptation and validation of the CDS. The study was carried out in two stages. First, we developed the Spanish version of the CDS by means of a cross-cultural adaptation methodology. Second, the CDS was tried on a sample of 130 subjects: 77 patients meeting DSM-IV-TR criteria for schizophrenia, 35 with depression disorders and 18 with anxiety disorders. Scores were compared against clinical diagnoses (gold standard). Furthermore, all the subjects of the study were administered the following: Dissociation Experiences Scale (DES), Positive and Negative Syndrome Scale (PANSS), Beck's Depression Inventory (BDI), and the Hamilton Anxiety Rating Scale (HARS). RESULTS 38 patients (29.2 %) had depersonalization symptoms. The scale showed high internal consistency (Cronbach's alpha > 0.9 and split-half reliability > 0.8) and a test-retest reliability of 0.391. Convergent validity was 0.65 (p < 0.001) and discriminant validity was 0.308 (p < 0.05). The area under the ROC curve was 0.94. A cut-off of 71 appears to be most useful (sensitivity and specificity were 76.3 % and 89.1 %, respectively). CONCLUSION The Spanish version of the CDS has good reliability and validity, similar to the original instrument.
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Abstract
Disturbances of visual perception like micropsia, macropsia, teleopsia, pelopsia, metamorphopsia or loss of stereoscopic depth perception are usually considered in ophthalmology as symptoms of retinopathy, especially maculopathy or disorders of binocularity. Differential diagnostic considerations include disorders like migraine and epilepsy but not the visual disturbance pertaining to the depersonalization-de-realization syndrome, although the above-mentioned symptoms are more prevalent in this psychogenic disorder. This article gives a review of depersonalization-de-realization in order to enable the ophthalmologist to include this syndrome into his diagnostic considerations.
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Affiliation(s)
- M Michal
- Klinik für Psychosomatische Medizin und Psychotherapie der Universität Frankfurt am Main.
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Johnson JG, Cohen P, Kasen S, Brook JS. Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity. J Psychiatr Res 2006; 40:131-40. [PMID: 16337235 DOI: 10.1016/j.jpsychires.2005.03.003] [Citation(s) in RCA: 112] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2004] [Revised: 02/18/2005] [Accepted: 03/02/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the association of dissociative disorder (DD) with impaired functioning and co-occurring Axis I and personality disorders among adults in the community. METHOD Psychiatric interviews were administered to a sample of 658 adult participants in the Children in the Community Study, a community-based longitudinal study. RESULTS Depersonalization disorder (prevalence: 0.8%), dissociative amnesia (prevalence: 1.8%), dissociative identity disorder (prevalence: 1.5%), and dissociative disorder not otherwise specified (prevalence: 4.4%), evident within the past year, were each associated with impaired functioning, as assessed by the clinician-administered Global Assessment of Functioning Scale. These associations remained significant after controlling for age, sex, and co-occurring disorders. Individuals with anxiety, mood, and personality disorders were significantly more likely than individuals without these disorders were to have DD, after the covariates were controlled. Individuals with Cluster A (DD prevalence: 58%), B (DD prevalence: 68%), and C (DD prevalence: 37%) personality disorders were substantially more likely than those without personality disorders were to have DD. CONCLUSIONS DD is associated with clinically significant impairment among adults in the community. DD may be particularly prevalent among individuals with personality disorders.
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Affiliation(s)
- Jeffrey G Johnson
- Columbia University and the New York State Psychiatric Institute, Box 47, 1051 Riverside Drive, New York, NY 10032, USA.
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Abstract
The aim of this study was to evaluate a questionnaire for the assessment of immediate functions of self-injurious behavior (SIB). SIB is defined as deliberate injuries of the skin such as burning, cutting or beating. Suicidal attempts as well as self-injuries for aesthetic reasons were excluded. Immediate functions were collected from the literature as well as from statements of SIB sufferers. Finally, 154 questions with the response options 'right', 'wrong' and 'unknown' -- for phenomena people did not know -- were given to 120 persons with SIB aged 13-54 years. They were recruited from SIB-related homepages as well as from psychologists and psychiatrists in hospitals in Austria and Germany. Twelve factors were extracted via factor analysis (varimax rotation): 'self-punishment', 'coping with emotions', 'extreme rage', 'vitality', 'dissociation', 'changed perception', 'control over body', 'uniqueness', 'interaction', 'addiction', 'coping with sexuality' and 'expression of sexuality'. All items of each factor were analyzed and unsatisfactory ones excluded to devise a questionnaire as short as possible but with high expressiveness and good reliability. The remaining 107 items have a reliability of r = 0.9118 (Cronbach's alpha). Evaluation of this questionnaire is in progress.
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Affiliation(s)
- Barbara Haas
- Institut für Psychologie, Universität Salzburg, Salzburg, Austria.
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Braam AW, Visser S, Cath DC, Hoogendijk WJG. Investigation of the syndrome of apotemnophilia and course of a cognitive-behavioural therapy. Psychopathology 2006; 39:32-7. [PMID: 16282717 DOI: 10.1159/000089661] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2004] [Accepted: 03/01/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The syndrome of apotemnophilia, body integrity or amputee identity disorder, is defined as the desire for amputation of a healthy limb, and may be accompanied by behaviour of pretending to be an amputee and sometimes, but not necessarily, by sexual arousal. SAMPLING AND METHODS A case history is presented of a 35-year-old man who was referred because of his desire for amputation of his left leg, without sexual connotations. The course of a combined cognitive behavioural psychotherapy with SSRI treatment is described. RESULTS Symptoms showed considerable similarity with obsessive-compulsive disorder, and some similarity with body dysmorphic disorder according to DSM-IV, but the core symptom seemed to be strongly connected with a sense of identity. Treatment with a selective serotonin re-uptake inhibitor decreased levels of distress only. The effects of cognitive restructuring of the psychotherapy were limited, whereas the behavioural elements substantially reduced the behaviour of pretending to be an amputee. CONCLUSIONS The rare syndrome of apotemnophilia raises unresolved questions of classification. Psychotic disorders should be ruled out carefully. The model designed in the current cognitive behavioural approach may serve as a starting point for further development of intervention protocols for this rare disorder.
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Affiliation(s)
- Arjan W Braam
- Institute of Extramural Medicine (EMGO), Amsterdam, The Netherlands.
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Abstract
The term "dissociation" has been used to describe a wide range of psychological and psychiatric phenomena. The popular conception of dissociation describes it as a unitary phenomenon, with only quantitative differences in severity between the various dissociative conditions. More recently, it has been argued that the available evidence is more consistent with a model that identifies at least two distinct categories of dissociative phenomena-"detachment" and "compartmentalization"- that have different definitions, mechanisms and treatment implications (Holmes, Brown, Mansell, Fearon, Hunter, Frasquilho & Oakley 2005). This paper presents evidence for this bipartite model of dissociation, followed by definitions and descriptions of detachment and compartmentalization. Possible psychological mechanisms underlying these phenomena are then discussed, with particular emphasis on the nature of compartmentalization in conversion disorder, hypnosis, dissociative amnesia and dissociative identity disorder.
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Affiliation(s)
- Richard J Brown
- Academic Division of Clinical Psychology, University of Manchester, Manchester Royal Infirmary, Manchester, UK.
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Affiliation(s)
- Ralf Kozian
- Landesklinik Brandenburg, Anton-Saefkow-Allee 2, 14772 Brandenburg
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48
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Abstract
There are problems with dissociative and conversion disorders with respect to classification, diagnosis, and therapeutic strategies which can only be understood in the historic context of hysteria. Even current diagnostic systems such as the DSM-IV and ICD-10 differ in the classification of such disorders. High prevalence rates ranging from 3% in the general population to 30% in clinical samples underscore their clinical relevance, and traumatic experiences play a major role in the pathogenesis. High rates of comorbid psychiatric disorders, the tendency to chronicity, and concepts of somatization (particularly in patients with conversion disorders) complicate psychotherapeutic approaches. Depending on the treatment goals, both psychodynamic and cognitive-behavioral methods can be applied, supplemented by specific techniques from trauma therapy, e.g. EMDR.
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Affiliation(s)
- H J Freyberger
- Klinik und Poliklinik für Psychiatrie und Psychotherapie der Universität Greifswald am Hanse-Klinikum Stralsund, Deutschland
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Abstract
BACKGROUND Depersonalization has long been considered a syndrome but there is poor agreement on its constituent symptoms. METHOD In order to establish whether different symptoms of depersonalization represent the expression of a single or several underlying dimensions, an exploratory factor analysis on the Cambridge Depersonalization Scale (CDS) was carried out on 138 consecutive patients diagnosed with depersonalization disorder. RESULTS Four well determined factors accounting for 73.3% of the variance were extracted. These were labelled 'Anomalous Body Experience'; 'Emotional Numbing'; 'Anomalous Subjective Recall' and 'Alienation from Surroundings'. CONCLUSIONS Symptoms of depersonalization belong to distinct but related psychopathological domains.
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Affiliation(s)
- Mauricio Sierra
- Depersonalization Research Unit, Psychological Medicine, Institute of Psychiatry, Denmark Hill, London.
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50
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Brandt C, Brechtelsbauer D, Bien CG, Reiners K. „Out-of-body experience“ als mögliches Anfallssymptom bei einem Patienten mit rechtsparietaler Läsion. Nervenarzt 2005; 76:1259, 1261-2. [PMID: 15830175 DOI: 10.1007/s00115-005-1904-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Out-of-body experiences are reported in a variety of diseases and physiologic conditions. We report a 44-year-old patient with epigastric auras, psychomotor and grand mal seizures, and paroxysmal experiences during which he believed to have left his body and seen himself from the outside. Electroencephalography showed a right temporal and right parietal seizure pattern on several occasions, and a lesion in the right parietal lobe was detected by cranial magnetic resonance imaging. Histological examination showed a pleomorphic xanthoastrocytoma. Following extirpation of the lesion, the patient has been seizure-free for 5 years.
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Affiliation(s)
- C Brandt
- Epilepsiezentrum Bethel, Klinik Mara I, Bielefeld.
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