Depersonalization In Patients Research Articles

Impaired age self-consciousness in latent schizophrenia

IntroductionThe topic of research was phenomenon of impaired age self-consciousness in non-psychotic latent schizophrenia patients defined.ObjectivesTo explore features of impaired age self-identity and to determine syndromic affiliation of the syndrome in comparison with premorbid personality disorders traits.MethodsThe study sample comprised 141 patients with latent schizophrenia (pseudo neurotic (F21.3 - 64.5%, 91 patients), coenesthopathic (F20.8 - 25.5%, 36 patients) and pseudo psychopathic (F21.4, - 9.9%, 14 patients)) aged 16-31 (average 22.1 years old) in 2007-2019. A follow-up, experimental psychological and clinical study was conducted.ResultsThe onset of impaired age self-identity was dominated by a radical drop of the subjective age in self-conscious mind of the patients accompanied by a tormented feeling of loss of self-dependence, role autonomy, helplessness, inability of decision making and to be answerable. Patients described this sudden condition as a loss of ‘maturity feeling’ and return to the juvenile perception of self. In a delusive and unclear manner, phrases such as ‘I feel inferior to others as if a helpless child among adults’, ‘I feel as if my childhood is back’ were uttered. Excessive worrying and enlivening of childhood memories were also included. This correlates to occurrence of humble and sometimes dependent/avoidant behavior, feeling of helplessness and fear with respect to caring for one self, rising subordination and suggestibility.ConclusionsThis phenomenon of regress to earlier ontogenetic level of personal development reported as impaired age self-consciousness can thus be regarded as an obligate form of depersonalization in patients with latent schizophrenia.

Self-esteem of medical students and their attitudes towards the nurse profession

Abstract Introduction. The profession of a nurse is next to the medical profession, one of the pillars of medical care in Poland and in the world. In recent years, the need to see the importance of this profession and the responsibility associated with it, both by the public and the doctors, is increasingly underlined. Aim. The research carried out is an attempt to answer the question, what attitudes towards nurses are shaped by future doctors already during the studies and what influence on students’ self-esteem on these attitudes. Material and methods. The research was conducted among 89 students of the medical faculty, Medical University in Lublin in April 2018. A questionnaire of own authorship was used, constructed on the basis of descriptive research carried out by Maik M. et al and the Rosenberg Self-Assessment Questionnaire (SES). The obtained results were subjected to statistical analysis using the STATISTICA program, version 13.1. Result. The vast majority of medical students (80%) believe that the role of a nurse is underestimated both in society and in the medical community. Students think that this work requires sacrifice and constant vigilance. Students who have encountered nursing staff notice symptoms of burnout in some of them, such as depersonalization of patients (56%). However, most of them (60%) think that this is ungrateful work and often interferes with family life. Students do not agree that the nurse should always be smiling and optimistic (75%). She values her features such as patience, good organization of time (86%) and ability to cooperate with doctors (91%). Most of students think that a nurse is a partner of a doctor (73%), while almost half (49%) of them see imperfections in cooperation both professional groups, resulting from the lack of mutual respect (64%). Students notice the commitment and hard work performed by nurses (70%), and also, although to a lesser extent, they appreciate their knowledge (56%). Conclusion. Appreciation of the nurse’s role on the part of doctors seems to be particularly important due to the need for cooperation of medical staff. The quality of cooperation between the interdisciplinary team and, consequently, the quality of care and medical care depends to a large extent on the mutual respect, understanding and correct communication between these professional groups.

Relationship of Training in Acupuncture to Physician Burnout.

Physician burnout is an ongoing problem that affects both physician wellbeing and patient care. Burnout is characterized by emotional exhaustion and depersonalization. Studies have explored ways to prevent and alleviate burnout. Receiving training in acupuncture may reduce physician burnout. The purpose of this study is to determine if acupuncture training is associated with less patient depersonalization and less emotional exhaustion among physicians. These self-reported data were collected from a cross-sectional survey of family physicians at the Uniformed Services Academy of Family Physicians 2017 conference. Physicians answered questions regarding their level of acupuncture training as well as questions about burnout (depersonalization and emotional exhaustion). The overall response rate was 66% (325/492). Of these, 233 cases provided complete datasets. In a model controlling for years' practice and clinical pace, acupuncture training was significantly associated with decreased depersonalization, F (1, 194) = 5.82, P < .05. Study data show an association between decreased physician depersonalization and acupuncture training, suggesting acupuncture training may be a helpful strategy to reduce family physicians' depersonalization of patients.

Brief Video-Module Administered Mindfulness Program for Physicians: A Pilot Study

The purpose of this study was to evaluate the feasibility of implementing a video-module-based mindfulness pilot program intended to reduce stress, improve well-being, and develop mindfulness skills in physicians in a community hospital setting. Preliminary findings are presented. Using a single-sample, pre-post study design, we administered an eight-week mindfulness training offered as part of a wellness initiative for medical staff in a suburban community hospital. Participants enrolled on a first-come, first-served basis. Participants engaged in three 90-min in-person trainings, weekly online video-module trainings, and weekly teleconference coaching calls. Video-module trainings were available at all times, to be accessed at the participants׳ convenience. Journals and a guided meditation audio library were also provided. Physician stress, well-being (emotional exhaustion, depersonalization of patients, and sense of personal accomplishment), and mindfulness skills (observing, describing, acting with awareness, and accepting without judgment) were evaluated at baseline, end-of-program, and eight weeks post-intervention using well-validated instruments. A total of 23 physicians enrolled and 19 completed the program. Compared to baseline, statistically significant decreases in stress, personal accomplishment, and emotional exhaustion were observed at end-of-program and eight weeks post-intervention (all P < .05). Significant increases in all mindfulness skills were observed at end-of-program; these increases persisted for describing, acting with awareness, and accepting without judgment at eight weeks post-intervention (all P < .05). This study provides preliminary evidence that a flexible, video-module-based mindfulness program can decrease stress, increase well-being, and develop lasting mindfulness skills in physicians.

Depersonalization in patients with persecutory delusions.

Delusions are, in part, attempts to explain confusing anomalous experience. Depersonalization, a key subset of anomalous experience, has been little studied in relation to persecutory delusions. The aims of this study were to assess the presence of depersonalization in patients with persecutory delusions and to examine associations with levels of paranoia and worry. Fifty patients with a current persecutory delusion completed measures of depersonalization, psychotic symptoms, and worry. Depersonalization experiences were common: 30 patients (60%) each reported at least 10 different depersonalization symptoms occurring often. A greater number of depersonalization experiences were associated with higher levels of paranoia and worry. The positive association of worry and paranoia became nonsignificant when controlling for depersonalization. Overall, depersonalization may be common in patients with persecutory delusions and is associated with the severity of paranoia. The results are consistent with the view that worry may cause depersonalization experiences that contribute to the occurrence of paranoid thoughts.

Relationship of metacognition, absorption, and depersonalization in patients with auditory hallucinations

The purpose of this work was to study the relationship of metacognition, absorption, and depersonalization in hallucinating patients. A within-subjects correlational design was employed. We formed four groups from a clinical population (schizophrenic patients with hallucinations, schizophrenic patients with no hallucinations but with delusions, schizophrenic patients recovered from positive symptoms, and patients with a non-psychotic psychiatric disorder) and a non-clinical control group. All participants were given the Metacognitions Questionnaire (MCQ-30, Wells & Cartwright-Hatton, 2004), the Tellegen Absorption Scale (TAS, Tellegen & Atkinson, 1974) and the Cambridge Depersonalization Scale (CDS, Sierra & Berrios, 2000). Schizophrenic subjects with hallucinations scored significantly higher on the depersonalization scale than any other group, and significantly higher on the absorption scale than any group except for the clinical patient controls. Schizophrenic patients with hallucinations also had significantly more dysfunctional metacognitive beliefs than subjects with no psychiatric pathology. It was further found that the metacognition variable correlated positively with the absorption and depersonalization variables, and that these variables in turn correlated positively with each other. Finally, it should be stressed that the variables that best predict hallucination severity are depersonalization and the MCQ-30 subscale `Need to control thoughts'. We discuss the role of metacognitive and dissociative variables in understanding hallucinations and suggest some approaches to their treatment.

Evaluation of a Regional Acute Care Surgery Service by Residents in General Surgery

Acute care surgery (ACS) services dedicated to care of acute general surgery patients have been established in many tertiary centers across Canada. Little is known about the impact of this trend on postgraduate education. In this study we aimed to evaluate ACS through a cross-sectional survey of general surgery residents in Winnipeg, Manitoba. General surgery residents at the University of Manitoba were asked to complete an anonymous survey. Basic demographic data were obtained. The educational value of ACS was assessed using 10 statements derived from the CanMEDS framework for training physicians. Resident burnout was measured using the Maslach Burnout Inventory, on emotional exhaustion, depersonalization, and personal accomplishment. The response rate was 70% (14/20). ACS was evaluated positively based on the CanMEDS roles by the following proportions of responders: surgical skills (79%), clinical knowledge (100%), communicator (100%), collaborator (100%), manager (86%), health advocate (100%), scholar (64%), and professional (93%). Fifty percent of responders had a high score on emotional exhaustion, 43% on depersonalization, and 0% on low sense of personal accomplishment. The overall burnout was 64%. ACS provides a comprehensive clinical experience based on the CanMEDS competencies. Despite an increased sense of personal accomplishment, residents experienced a high incidence of burnout, as demonstrated by high scores on emotional exhaustion and depersonalization of patients.

Depersonalization and personality in panic disorder

Background Prevalence and clinical correlates of depersonalization symptoms have been associated with panic disorder. Personality traits might increase the likelihood of experiencing depersonalization symptoms or depersonalization disorder in panic patients. Aims The objectives of this study are to establish the prevalence of depersonalization symptoms during the panic attack and in depersonalization disorder and to examine the personality factors associated with the presence of depersonalization in patients with panic disorder. Methods The sample comprised 104 consecutive adult outpatients with panic disorder, diagnosed according to the Semistructured Clinical Interview for DSM-IV (Axis I/II disorders). Participants were assessed with the Cambridge Depersonalization Scales, the Temperament and Character Inventory, and the Panic and Agoraphobia Scale. Results Forty-eight percent of the sample had depersonalization symptoms during the panic attack, whereas 20% of patients had a depersonalization disorder. Women presented more depersonalization disorders than did men ( P = .036). Patients with panic disorder with depersonalization disorder had a more severe panic disorder ( P = .002). Logistic regression analysis showed that self-transcendence trait (odds ratio, 1.089; 95% confidence interval, 1.021-1.162; P = .010) and severity of panic (odds ratio, 1.056; 95% confidence interval, 1.005-1.110; P = .032) were independently associated with depersonalization disorder. Conclusions A high prevalence of depersonalization symptoms and depersonalization disorder was confirmed in patients with panic disorder, supporting a dosage effect model for understanding depersonalization pathology. Self-transcendence trait and severity of panic disorder were reported as risk factors for depersonalization disorder.

Depersonalization in Patients with Schizophrenia Spectrum Disorders, First-Degree Relatives and Normal Controls

Background: Depersonalization occurs in healthy individuals and across a broad range of psychiatric patients. Data on depersonalization in persons linked to patients through genetics, environment or education are scarce. Due to their higher risk of developing psychosis, first-degree healthy relatives might show differences with the general population. This study examines depersonalization in patients with schizophrenia or schizophrenia spectrum disorders, their first-degree healthy relatives and normal controls. Methods: The Cambridge Depersonalization Scale was used to measure depersonalization in a sample of 147 clinically stable patients with schizophrenia or schizophrenia spectrum disorders, 73 first-degree relatives with no psychiatric history and 172 healthy controls. Mixed effect models were used to account for both the familial structure of the data and the effect of sociodemographic characteristics. Results: Patients obtained higher scores than relatives and controls for frequency and duration of depersonalization experiences, number of items responded positively and total depersonalization, while first-degree relatives obtained lower scores than patients and controls for all these characteristics. Conclusions: First-degree relatives of patients reported fewer episodes of depersonalization, which were less intense and of shorter duration, than healthy controls. This finding might be related to a protection mechanism that keeps first-degree relatives away from near-psychotic experiences. The nature of such a mechanism remains to be discovered.

PW01-49 - Depersonalization in patients with panic disorder: role of personality

IntroductionDepersonalization (DP) is a common and complex clinical phenomenon in neurology and psychiatry. It is defined as an experience in which the individual feels a sense of unreality and detachment from him/herself. Prevalence and clinical correlates of dissociative symptoms in general, and DP in particular have been associated to panic disorder (Hunter et al., 2004). Moreover, DP has been associated with certain personality traits, specifically “harm-avoidant” temperament dimension, immature defenses, and overconnection and disconnection cognitive schemata (Simeon et al., 2002).ObjectivesTo investigate the prevalence of DP syndrome in panic disorder and its relationship with personality.MethodsOne-hundred-four consecutive adult patients with panic disorder were assessed with the Semi- Structured Clinical Interview for DSM-IV-Axis I and II. All participants were evaluated with the Cambridge Depersonalization Scale (Sierra and Berrios, 2000) and the Cloninger Temperament and Character Inventory. The severity of panic disorder was measured with the Panic and Agoraphobia Scale.ResultsSeventeen patients (16.3%) had a DP syndrome. There were not socio-demographic differences between both groups with and without DP syndrome. Patients with DP syndrome showed a higher score in “self-transcendence” character dimension (p&lt; .001), higher prevalence of personality disorders (p=.007) and greater severity of panic disorder (p=.007). A logistic regression analysis showed that severity of panic disorder (p=.031) and higher “self-transcendence” personality dimension (p=.019) predicts DP syndrome in panic disorder patients. The Hosmer-Lemeshow test showed the goodness-of-fit of the model.ConclusionsThe study confirms the association of DP syndrome with panic disorder and their relationship with “self-transcendence” personality dimension.

Our Present Complaint: American Medicine Then and Now

The suffering associated with disease has always been the province of medicine, and disease has always been invested with social meanings that transcend medicine. Western interpretations of disease and its role in human life underwent a major shift with the advent of scientific medicine in the early nineteenth century; that shift has brought immeasurable gains in medicine's efficacy and lasting dissatisfaction with the interpretive consequences of the reductionism that made those gains possible. Such are the roots of Our Present Complaint, Charles Rosenberg's most recent collection of essays. Pre-modern conceptions of disease focused on the balance of forces in the individual sufferer, a balance susceptible to disruption from social and behavioral as well as straightforwardly physiological causes. Risk for disease was, as Rosenberg puts it, configured in idiosyncratic, multi-causal, and contingent terms. Physicians took cognizance not only of physiology but of lifestyle, environment, constitutional proclivities, and social circumstances in diagnosing symptoms and in prescribing. The roots of our present complaint go back to the early nineteenth-century developments in basic science that began the intellectual transformation of medicine into its present shape. The development of basic science, especially pathological anatomy, led to an acceptance of the notion of diseases as specific entities existing apart from the individual people in whom they manifested themselves by causing pathological lesions. Such lesions were produced according to pathophysiological mechanisms that science could elucidate and, perhaps, interrupt. The notion of disease as specific entity was strengthened later in the nineteenth century by the advent and triumph of the germ theory. As medical schools began to integrate basic science into their curricula in the 1880s and 1890s, the new outlook began to affect clinical practice, leading to complaints about scientific medicine's depersonalization of patients, complaints that have continued to the present.

The Spectrum of Organic Depersonalization: A Review Plus Four New Cases

Depersonalization and derealization are commonly reported in the general population as a response to stress. The symptoms have also been described in patients with a primary psychiatric or organic diagnosis, where their secondary status precludes a DSM-IV diagnosis of depersonalization disorder. The authors present 4 new cases of depersonalization in patients with an underlying organic condition, along with 47 cases from the literature in which the available information permits diagnosis of organic depersonalization. Information from case series documenting depersonalization in the context of medical illnesses is also presented and the underlying etiology discussed. Epilepsy and migraine appear to be the disorders most commonly associated with depersonalization. Left-sided temporal lobe dysfunction and anxiety are suggested as factors in the development of depersonalization; however, further studies are needed to determine the relationship. The introduction to the DSM-IV of an organic subtype of depersonalization disorder would facilitate research in this area.

Caregivers' Predispositions and Perceived Organizational Expectations for the Provision of Social Support to Nursing Home Residents

This article presents the results of an investigation of caregivers' provision of supportive communication to nursing home residents. Five primary conclusions are drawn from the data: (a) Caregivers value providing affective over instrumental support; (b) caregivers believe they place more importance on supportive communication than their organizations; (c) role conflict is emotionally exhausting, but does not affect caregivers' self-evaluations or perceptions of residents; (d) caregivers' depersonalization of patients is related to their desire to communicate instrumental support; and (e) caregivers feel more accomplished when they believe their organization values supportive communication with patients. The implications of these findings for social support, caregivers' burnout, and nursing homes are discussed.

The Depersonalization of Patients: A Profile Gleaned from Narratives

Occupational therapists who would better understand and advocate against depersonalization in health care can find specific references in narratives to the attitudes and behaviors that seem problematic. Patients argue that helpers fail to recognize that illness and disability are events charged with personal meaning. Instead of communicating with patients, helpers establish a distance that diminishes them. They withhold information in a manner that precludes hope, they use brusque manners, and they misuse their powers. Each of these behaviors seems unreasonable and impersonal, and each discourages patients. Together these narratives might inspire therapists to value interactive reasoning as central to practice, to recommit to their consideration of persons, and to enact a climate of caring.

She won't be Dancing Much Anyway: A Study of Surgeons, Surgical Nurses, and Elderly Patients

This research examined how the interpersonal dynamics between surgeons and surgical nurses in the operating room and their attitudes toward elderly patients affected the quality of care delivered. Qualitative data were gathered through in-depth interviews with surgeons and surgical nurses and from 5 months of participant observation in an operating room. The findings indicate that surgeons strongly influence how surgical personnel treat patients during surgery. The surgeon's ultimate control and unquestioned authority in surgery, when combined with depersonalization of patients, created situations in which the quality of care was compromised. The recommendations discussed include establishing the surgeon as a positive role model, specialized training for those working with elderly patients, and shared governance of the operating room.

Nursing in Transition

The perspective of this paper is that of a social scientist whose professional involvement with nurses, doctors, and patients has spanned more than a decade. The very selection and nature of my research and teaching, namely the psychosocial and cultural aspects of illness and patient care, and the time spent as participant-observer in medical settings imply a special interest and value perspective. Additionally, my long association with nursing education in the United States has led inevitably to identification with and concern about the problems I have chosen to discuss here in the context of current world conditions and what they seem to portend. Paramount among these problems and encompassing them all, I believe, is the danger of progressive depersonalization of patients, and, concomitantly, of nurses as well . This statement in no way minimizes the achievements of nursing to date in widening its focus from concern with the body of the