Depersonalization Symptoms Research Articles

Depersonalization-derealization symptom complex in the clinic of manifest forms of schizophrenia

Background. The issues of early diagnostics and prevention of schizophrenia, despite more than a century of their study, remain relevant. In recent decades, there has been an increase in interest in the study of depersonalization-derealization symptom complex in the context of verification of the initial manifestations of the disease. Meanwhile, ICD-10 does not include symptoms of depersonalization and derealization in the rank of diagnostically important symptoms for this pathology, and they are traditionally considered as manifestations of schizotypal disorders. The existing contradictions suggest the need for further study of depersonalization and derealization in the clinic of manifest forms of schizophrenia.The aim of the study. To assess the prevalence and clinical manifestations of depersonalization-derealization in paroxysmal forms of schizophrenia.Materials and methods. The study included 40 patients with depersonalization-derealization symptoms in the clinical picture of manifest forms of schizophrenia. Typological groups were represented by paranoid schizophrenia with an attack-like or continuous course (18 people) and schizoaffective disorder (22 people). We used such research methods as clinical follow-up, clinical and anamnestic, clinical and psychopathological, and also the Cambridge Depersonalization Scale.Results. Manifestations of depersonalization-derealization at the pre-manifest stage of the disease were observed in 82.5 % of the study cohort. In most cases, mild and moderate severity was detected – in 37.5 and 42.5 %, respectively; severe form was found only in 20 % of patients. In 17.5 % of cases, manifestations of depersonalization and derealization were periodic, and in the majority (65 %) of patients they were persistent. Almost 1/3 of patients had total depersonalization, 22.5 % had only autopsychic and allopsychic depersonalization, and 17.5 % of cases had isolated somatopsychic depersonalization. An association was found between the severity of depersonalization-derealization and paranoid syndrome. During the disease, as negative disorders increase, the manifestations of depersonalization-derealization are reduced.Conclusion. The obtained data demonstrate the need for further studying depersonalization symptom complex in the clinic of manifest forms of schizophrenia in the aspect of prognosis of the clinical course of the disease.

Measuring Prevalence of Burnout among Nurses in Hospital Ward

Burnout is a phenomenon commonly found in nurses, arising from chronic work fatigue. It is a detrimental and impactful syndrome that affects not only the individual, but also the organization and the patients. This study aims to determine the prevalence of burnout syndrome in nurses working in hospital wards. The research design used is descriptive quantitative. The population in this study comprises 78 nurses who worked in the inpatient room of a private hospital in Malang Regency. The sampling technique used was total sampling. Data were collected using the MBI (Maslach Burnout Inventory) questionnaire which contains 22 items designed to assess burnout symptoms in health workers. The MBI measures three indicators of burnout: emotional exhaustion, depersonalization, and reduced personal accomplishment. The value ranges for low, medium, and high risk are 0–18, 19–26, and 26 for emotional exhaustion; 0–5, 6–9, 9 for depersonalization; and 0-33, 34–39, 39 for reduced personal accomplishment. Burnout is determined if emotional exhaustion and Depersonalization are both "high", or if emotional exhaustion is "high" and personal accomplishment is "low". The results of this study showed that 7.7% of nurses experienced burnout, 71.8% of nurses experienced symptoms of emotional exhaustion in the low category, all respondents experienced symptoms of depersonalization in the low category, and symptoms of self-achievement as many as 52.6% of nurses are in the low category. The conclusion of this research is that only a few respondents experienced burnout. However, the risk of burnout still exists, as indicated by the low personal accomplishment among respondents. Identifying factors that influence burnout can help to better understand this phenomenon nurses.

Depersonalization, Meditation, and the Experience of (No-)Self

This paper aims to contribute to an integrated understanding of what goes missing in adverse meditation experiences and in cases of depersonalization disorder. Depersonalization disorder is characterized by distressing alterations in, and sometimes the complete disappearance of, the 'I'-sense. This paper examines the nature of the 'I'-sense and what it means to lose it from a Buddhist perspective. We argue for a nihilist position that the loss of the sense of self arises from misidentifications of the psychophysical complex with non-self elements, such as memories, thoughts, or body movements. Drawing from meditation experiences and depersonalization symptoms, we propose that the sense of self is not a static entity given in experience but fluctuates between various senses of self (and no-self) depending on circumstances. This pluralistic understanding of the various senses of self offers a more nuanced understanding of symptoms in depersonalization disorder and adverse effects of meditation practices.

Major Depression as a Disorder of the Narrative Self: A Qualitative Study

Introduction: Abnormal self-experiences are a common feature of major depression despite their absence from current diagnostic manuals. Current diagnostic criteria leave us with an impoverished conception of depressive disorders, and they fail to exploit the diverse experiential alterations that might be useful for understanding and diagnosing patients, and last but not least for explaining the aetiology of these disorders. Although some phenomenological descriptions of abnormal self-experiences in major depression are available, further research is needed to validate these through detailed clinical interviews. Methods: To characterize these phenomena in more detail and to verify and consolidate previous accounts, we conducted a qualitative study using the Consensual Qualitative Research method. Results: Our findings identified three categories of abnormal self-experiences: (1) impossibility to project oneself forward, (2) not recognizing one’s self, and (3) losing control on one’s self. Conclusion: Before delving into these results, we briefly described how the self is conceptualized in phenomenological psychopathology and explored in the literature on the self-experience in major depression. After discussing our results in the light of recent and contemporary phenomenological literature, we suggest that the inability to recognize otherness as part of oneself – which is the core of depressive experiences – ends in specific symptoms of depersonalization that differ from schizophrenic ones. We conclude that the self-experience, and in particular narrative identity, is central to the development and maintenance of depression.

The connection between professional burnout of medical workers and the self-help methods during the COVID-19 pandemic

IntroductionMany medical workers suffered from severe professional burnout while working in the conditions of the COVID-19 pandemic, but few of them had the opportunity to find psychological help.ObjectivesThe aim of the research was to study the relationship between emotional burnout and self-help strategies in medical professionals during the pandemic.MethodsThe Maslach Burnout Inventory (MBI) was used to measure the level of professional burnout. It was filled out by medical workers from January 2021 to November 2022.The sample consisted of 314 medical workers (57 men and 255 women), whose average age was 36.97±11.93. According to the level of education, the sample included specialists with secondary general education (4.14%), with secondary special education (19.4%), with incomplete higher education (11.46%), with higher education (59.87%) and PhD (5.1%). 35 people (11%) of the surveyed medical workers worked in the red zone.ResultsWhen medical workers experience severe Emotional Exhaustion and Depersonalization, they often try to help themselves by drinking alcohol (r=0.156; p=0.005; r=0.184; p=0.001), eating (r=0.227; p=0.000; r=0.151; p=0.007), taking medications (r=0.204; p=0.000; r=0.212; p=0.005), solitude (r=0.204; p=0.000; r=0.133; p=0.019), watching TV series (r=0.173; p=0.002; r=0.146; p=0.01). With an increase in the Reduction of professional skills, medical workers also eat more (r=-0.148; p=0.009) and try to learn something new, engage in self-development (r=-0.137; p=0.015). It is important to note that the desire to seek psychological help is associated only with Emotional Exhaustion (r=0.121, p=0.032), that is, he/she may be aware at an early stage of professional burnout, when the symptoms of depersonalization and reduction of professional skills have not yet occurred.ConclusionsThus, all the considered self-help methods are already used with pronounced symptoms of professional burnout, but do not lead to its pronounced decrease. It is important to note that seeking psychological help is possible with awareness of emotional exhaustion, but not with depersonalization and reduction of professional skills.Disclosure: Research is supported by the Russian Science Foundation, project No. 21-18-00624.Disclosure of InterestNone Declared

The current situation and influencing factors of depersonalization in clinical nurses

Objective: To investigate the depersonalization status and to analyze the effect of workplace incivility perception, intrusive rumination and fear of negative evaluation on depersonalization in clinical nurses. Methods: In May 2019, 10 cities were selected as sampling cities by the method of grabbing random ball in Henan Province and Fujian Province. Using the stratified sampling, clinical nurses were selected as the research objects for a questionnaire survey in 22 tertiary hospitals and 23 secondary hospitals, included 1200 nurses. A total of 1200 questionnaires were issued and collected, and 1159 valid questionnaires were collected with effective recovery of 96.6%. Clinical nurses were investigated by Workplace Incivility Scale, Event Related Rumination Inventory, Fear of Negative Evaluation Scale, Maslach Burnout Inventory-General Survey. The demographic characteristics of nurses' depersonalization were compared and analyzed with t test and single factor analysis of variance. The influence mechanism of workplace incivility perception, intrusive rumination and fear of negative evaluation on depersonalization was analyzed with Bootstrap. Results: Depersonalization scores were (9.3±2.6) points, 467 of those had depersonalization symptoms in clinical nurses (40.3%). The scores of depersonalization of those with <3 years of service [ (10.5±2.9) points] was higher than those with 3-10 years [ (9.1±2.8) points] and 11-31 years [ (9.0±2.9) points]. The scores of depersonalization of those with monthly earning of <3000 yuan [ (10.1±2.8) points] was higher than those with 3000-7999 yuan [ (8.4±2.7) points] and 8000-12000 yuan [ (8.0±2.9) points]. The scores of depersonalization of clinical nurses in surgical departments [ (10.0±2.9) points] was higher than those in non-surgical departments [ (8.7±2.6) points]. The scores of depersonalization of clinical nurses in tertiary hospitals [ (10.0±2.7) points] was higher than those in secondary hospitals [ (8.6±2.8) points]. The differences were statistically significant (P<0.05). Workplace incivility perception affected depersonalization through the single mediating role of intrusive rumination, fear of negative evaluation and the chain mediating role of intrusive rumination and fear of negative evaluation (β=0.16, 0.17, 0.07, 95%CI: 0.15-0.20, 0.15-0.21, 0.03-0.09, P<0.05) . Conclusion: Workplace incivility perception directly or through the independent mediating effects of intrusive rumination or fear of negative evaluation, and the chain mediating effects of intrusive rumination and fear of negative evaluation influences the depersonalization of clinical nurses.

Dynamic symptom associations in posttraumatic stress disorder: a network approach

ABSTRACT Background and objective: The current study aimed to investigate the within-day symptom dynamics in PTSD patients, specifically focusing on symptoms that most predict changes in other symptoms. The study included a baseline diagnostic assessment, followed by an assessment using the experience sampling method (ESM) via a smartphone. Method: Participants answered questions related to their PTSD symptoms four times per day for 15 consecutive days (compliance rate 75%). The clinical sample consisted of 48 treatment-seeking individuals: 44 with PTSD as a primary diagnosis, and four patients with subsyndromal PTSD, all of whom had not yet begun trauma-focused treatment. The ESM assessment included the 20 items from the PTSD Checklist for DSM-5, five items from the International Trauma Questionnaire (ITQ) assessing disturbances in relationships and functional impairment, and two items from the Clinician-Administered PTSD Scale for DSM-5 assessing symptoms of depersonalization and derealization. Results: Temporal networks (prospective associations between symptoms) showed that changes in hypervigilance predicted changes in the greatest number of symptoms at the next time point. Furthermore, hypervigilance showed temporal connections with at least one additional symptom from each of the DSM-5 PTSD symptom clusters. Conclusions: Results show that the contemporaneous network (representing the relationship between given symptoms within the same assessment occasion) and the temporal network (representing prospective associations between symptoms) differ and that it is important to estimate both. Some findings from earlier research are replicated, but heterogeneity across studies remains. Future studies should include potential moderators.

Examining the association between depersonalisation traits and the bodily self in waking and dreaming

Depersonalisation (DP) is characterized by fundamental alterations to the sense of self that include feelings of detachment and estrangement from one’s body. We conducted an online study in healthy participants (n = 514) with DP traits to investigate and quantify the subjective experience of body and self during waking and dreaming, as the vast majority of previous studies focussed on waking experience only. Investigating dreams in people experiencing DP symptoms may help us understand whether the dream state is a ‘spared space’ where people can temporarily ‘retrieve’ their sense of self and sense of bodily presence. We found that higher DP traits—i.e. higher scores on the Cambridge Depersonalisation Scale (CDS)—were associated with more frequent dream experiences from an outside observer perspective (r = 0.28) and more frequent dream experiences of distinct bodily sensations (r = 0.23). We also found that people with higher CDS scores had more frequent dream experiences of altered bodily perception (r = 0.24), more frequent nightmares (r = 0.33) and higher dream recall (r = 0.17). CDS scores were negatively correlated with body boundary scores (r = − 0.31) in waking states and there was a negative association between CDS scores and the degree of trust in interoceptive signals (r = − 0.52). Our study elucidates the complex phenomenology of DP in relation to bodily selfhood during waking and dreaming and suggests avenues for potential therapeutic interventions in people with chronic depersonalisation (depersonalisation -derealisation disorder).

When you avoid your feelings, you may feel even worse: how depersonalization puts you at risk of depression.

The clinical form of depersonalization affects approximately 1%-2% of the adult population. This study aimed to describe the symptoms of depersonalization in a non-clinical sample and to operationalize depersonalization as a regulatory mechanism. This article introduces the Depersonalization Mechanism Scale, 41-item measure developed to assess one's tendency for depersonalization in response to overstimulation. The aim of the study is to explore how depersonalization mechanism is associated with cognitive and behavioral emotion regulation strategies, depression, and anxiety. The study included a sample of 300 Polish adults (149 men) from the general population, ranging in age from 18 to 60. Participants were administered the following questionnaires: Depersonalization Mechanism Scale (DMS), Behavioral Emotion Regulation Questionnaire (BERQ), Cognitive Emotion Regulation Questionnaire (CERQ), Occupational Depression Inventory (ODI), Patient Health Questionnaire (PHQ), and Trait Anxiety Scale (SL-C). An exploratory factor analysis revealed a two-factor structure of Depersonalization Mechanism Scale, with very high reliability coefficients for both subscales and full scale. A regression analysis revealed that depersonalization mechanism is a significant predictor of depressive symptoms. Depersonalization mechanism is strongly correlated with maladaptive regulation strategies such as withdrawal, ignoring, rumination, catastrophizing, self-blame, and blaming others. Weaker but significant connections were identified with certain adaptive strategies: acceptance, positive refocusing, putting into perspective, and seeking social support. Women were more prone to depersonalization than men. Further research on depersonalization in non-clinical samples may improve understanding of this mechanism in the general population. This knowledge, combined with greater education about non-clinical forms of depersonalization, may support preventive programs against depression and professional assistance for people facing acute or chronic stressful life events.

Sintomas de burnout entre médicos e enfermeiros antes, durante e depois do cuidado de pacientes com COVID-19

Objective: this study evaluated burnout symptoms among physicians and nurses before, during and after COVID-19 care. Method: a cross-sectional comparative study in the Pulmonary Care unit of a tertiary-level public hospital. The Maslach Burnout Inventory was used. Results: 280 surveys were distributed across three periods: before (n=80), during (n=105) and after (n=95) COVID-19 care; 172 surveys were returned. The response rates were 57.5%, 64.8% and 61.1%, respectively. The prevalence of severe burnout was 30.4%, 63.2% and 34.5% before, during and after COVID-19 care (p&lt;0.001). Emotional exhaustion (p&lt;0.001) and depersonalization (p=0.002) symptoms were more prevalent among nurses than among physicians. Severe burnout was more prevalent in women, nurses and night shift staff. Conclusion: the high prevalence of burnout doubled in the first peak of hospital admissions and returned to pre-pandemic levels one month after COVID-19 care ended. Burnout varied by gender, shift and occupation, with nurses among the most vulnerable groups. Focus on early assessment and mitigation strategies are required to support nurses not only during crisis but permanently.

Peer Relationship and Mental Health Damage from Academic-Stress and Depersonalization in High School

An examination of how student stress impacts their mental health and peer relationships used an explanatory sequential mixed methods design with a quantitative survey of 136 students from an independent school student body and follow-up qualitative interviews of 8 students. A positive correlation between academic stress and depersonalization was identified in all 4 grades with both indicators increasing with grade level before plateauing in grade 12. The main stressors identified were to achieve high grades and accomplish schoolwork to satisfy their own and parental expectations. High academic stress is attributed to depersonalization symptoms when students cut social interactions during "crunch time" to focus on studying by entering a "trance state". However, some students instead became more social as a distraction or to study more efficiently in study groups. Overall, this study showed similarities in academic stress and depersonalization between university/professional and high school samples while analyzing the rationale behind reported scores.

Clinical, Cognitive, and Neurobiological Correlates of Impaired Timing Abilities Associate to Cannabis Use: a Systematic Review

AbstractTime perception received growing interest in psychiatry for its psychopathological implications. Cannabis use can cause a subjective experience of temporal perception alteration and increases the risk of emergence of mental illnesses such as psychotic and mood disorders. In this framework, we systematically reviewed the findings regarding the clinical, cognitive, and neurobiological correlates of time alterations due to cannabis consumption. According to preclinical results, cannabis exerts a dose-dependent time overestimation, associated with motor inhibition and circadian alterations. Clinical results reported that cannabis impair time estimation and time reproduction abilities, causing subjective temporal fragmentation and depersonalization symptoms. The alteration of timing mediated by cannabis use might depend on a dopaminergic indirect action and on structural, functional, and metabolic alterations of the cerebello-thalamo-cortical circuit. Despite the potential interest, however, only few studies explored the link between cannabis-induced alterations of time processing and psychiatric symptoms.

Occupational burnout in nurses employed in cardiology and noncardiology departments

Abstract Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Uniwersytet Jagiellonian Collegium Medicum, Krakow Prevalence of occupational burnout in nurses employed in cardiology and non-cardiology departments in hospitals in the Małopolska region Introduction An increase in the incidence of burnout symptoms was observed in nurses employed in hospitals. Objective An assessment of the frequency of burnout symptoms among nurses working in hospital cardiology and non-cardiology departments. Metody: A cross-sectional, descriptive study was conducted between 2020 and 2022. It was carried out in a group of 155 nurses working in cardiology departments and 202 nurses working in non-cardiology departments. The nurses were randomly selected from the register of hospital employed nurses of Malopolska Regional Chamber of Nurses and Midwives. The incidence and intensity of burnout syndrom were determined based on Maslach Burnout Inventory (MBI). The study described the burnout syndrome the level of occupational burnout using the dimensions of emotional exhaustion, depersonalization, and personal accomplishment. Results Among the surveyed nurses, a high level of emotional exhaustion was the most common, 52.9% in cardiology nurses and 45% in other nurses. The average level of depersonalization was most common (37.4% vs 33.2%). Personal accomplishment was dominated by a low degree in both groups (48.4% and 48.0%). No significant differences were found between the types of departments. There were a significant relationship between the occurrence of depersonalization symptoms and age (p&amp;lt;0.007) and work experience of nurses (p&amp;lt;0.009). Nurses with a high degree of depersonalization were significantly younger or had shorter work experience. Conclusions The study found that nurses worked in hospital departments in Małopolska region were very high level of burnout. The incidents of exposure was no depend on the departments where they work.

Neurobiological and genetic correlates of the dissociative subtype of posttraumatic stress disorder.

Approximately 10%-30% of individuals with posttraumatic stress disorder (PTSD) exhibit a dissociative subtype of the condition defined by symptoms of depersonalization and derealization. This study examined the psychometric evidence for the dissociative subtype of PTSD in a sample of young, primarily male post-9/11-era Veterans (n = 374 at baseline and n = 163 at follow-up) and evaluated its biological correlates with respect to resting state functional connectivity (default mode network [DMN]; n = 275), brain morphology (hippocampal subfield volume and cortical thickness; n = 280), neurocognitive functioning (n = 337), and genetic variation (n = 193). Multivariate analyses of PTSD and dissociation items suggested a class structure was superior to dimensional and hybrid ones, with 7.5% of the sample comprising the dissociative class; this group showed stability over 1.5 years. Covarying for age, sex, and PTSD severity, linear regression models revealed that derealization/depersonalization severity was associated with: decreased DMN connectivity between bilateral posterior cingulate cortex and right isthmus (p = .015; adjusted-p [padj] = .097); increased bilateral whole hippocampal, hippocampal head, and molecular layer head volume (p = .010-.034; padj = .032-.053); worse self-monitoring (p = .018; padj = .079); and a candidate genetic variant (rs263232) in the adenylyl cyclase 8 gene (p = .026), previously associated with dissociation. Results converged on biological structures and systems implicated in sensory integration, the neural representation of spatial awareness, and stress-related spatial learning and memory, suggesting possible mechanisms underlying the dissociative subtype of PTSD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Influence of Shift Work on The Health of Nursing Professionals.

Shift work is increasingly common in health services, subjecting healthcare professionals to work schedules that can alter circadian rhythms and eating habits with consequent repercussions for the intestinal homeostasis. The objective of this study was to describe the relationship of rotating work shifts with the intestinal health, sleep quality, and emotional dimension of nursing professionals. In March and May 2019, an observational and comparative study was conducted among 380 nursing professionals from different Spanish cities and divided into fixed shift (n = 159) and rotating shift (n = 221). To carry out the present work, the variables measured were gastrointestinal symptoms, stool consistency and shape, anxiety, depression, sleep, as well as stress and work environment. Nurses with rotating shifts reported more abdominal pain and symptoms of depersonalization, as well as worse sleep efficiency and worse nursing practice environment. In addition, overall scores of the Gastrointestinal Symptom Rating Scale and Hospital Anxiety and Depression Scale were found to be significantly worse in nurses with these shifts. Rotating shift work by nursing staff may be associated with the occurrence of gastrointestinal and anxiety-related symptoms. These findings, together with the presence of negative and insensitive attitudes towards patients by nurses on rotating shifts, should be considered to maintain the quality of healthcare.

Mental health trajectories of Brazilian health workers during two waves of the COVID-19 pandemic (2020-2021).

This study aimed to: (a) monitor the progression of symptoms of mental health burden among frontline workers caring for COVID-19 patients in Brazil during the two waves of the pandemic, considering the number of new cases and deaths, and; (b) to verify the different mental health outcomes and potential associations with current burnout symptoms. A non-probabilistic sample of health professionals was assessed as the pandemic progressed in Brazil (May/2020 August/2021). Standardized instruments focusing on anxiety, depression, insomnia, post-traumatic stress, and burnout symptoms were applied online. The results indicate a decrease in anxiety levels, what was related to when the number of new cases declined (end 1th-wave); symptoms returned to higher levels later. Emotional exhaustion increased when there was a higher incidence of cases, returning to the baseline levels at the end of the second wave. Depersonalization symptoms increased in this phase, characterized by a further decrease in new cases, while professional accomplishment decreased during the follow-up. The highest number of new cases was associated with a higher frequency of anxiety (OR = 1.467;95%CI = 1.109-1.941; p = 0.007) and professional accomplishment (OR = 1.490;95%CI = 1.098-2.023; p = 0.011). The subjects with trajectory of resilience against anxiety presented the lowest level of emotional exhaustion and depersonalization (p < 0.05). The conclusion is that the pressure experienced by healthcare professionals throughout the pandemic caused different impacts on their mental health, emphasizing the dynamic nature of this condition and the need for constant monitoring and care. This finding directly affects mental health prevention and intervention measures, which remain a priority and require continuous reinforcement, especially among the most vulnerable groups.

Electroconvulsive therapy vs Esketamine among patients with Major Depressive Episode

IntroductionMajor depressive disorder is one of the most common and disabling mental disorders. More than 30% of individuals do not achieve remission after several trials of antidepressants and treatment-resistant depression (TRD) is associated with premature mortality. Electroconvulsive therapy (ECT) is considered the gold-standard for TRD treatment,unfortunately it´s underused due to health care barriers and association with adverse cognitive impairment. So, scientists have sought to identify alternative treatments that approach ECT-equivalent efficacy. Trials with Ketamine and more recently with its S-enantiomer (Esketamine) has been made, revealing a rapid and robust antidepressant effect, emerging as an option for TRD treatment.ObjectivesWe we aim to conduct a qualitative review, comparing clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment.MethodsWe conduct a non-systematic review of recent evidence between the use of Esketamine and ECT as a TRD treatment, using PubMed/Medline database.ResultsTo compare clinical efficacy, tolerability and acceptability between the use of Esketamine and ECT as a TRD treatment we analyzed outcomes of interest. First,ECT was superior to Esketamine improving depressive symptoms. Comparing suicidal ideation and suicide attempts, most results were not statistically different. About cognition impairment, Esketamine performed better than ECT, particularizing attention, verbal memory, and executive functions; no differences were found for immediate memory or visual memory.About adverse effects Esketamine has less risk of headache and muscle pain, but higher reports of transient, dissociative or depersonalization symptoms, blurred vision, diplopia and nystagmus. An important consideration for clinicians is the comparative tolerability and safety of Esketamine vs ECT; as ECT involves a full dose of anesthesia,it is expected that Esketamine would be better tolerated and safer than ECT. But no study assessed the relative tolerability or acceptability of these different adverse effect profiles.The best strategy for relapse prevention appears to be continuing ECT, continuing pharmacotherapy, or using some combination of both; but Esketamine continuing treatment is effective too.ConclusionsECT may be superior to Esketamine for improving depression severity in the acute phase, but long-term outcomes of these treatments are important to be considered. There are just two studies with long-term follow-up after the trial completed:one found no difference in depression severity during the 3-month follow-up, and the other reported that the remission rates were not different between groups by the 12-month follow-up period.Therefore,future research is needed to further optimize long-term treatment outcomes for both Esketamine and ECT to prevent relapse. Until then,treatment options should be individualized and patient-centered.Disclosure of InterestNone Declared

Depersonalisation – a key to understand the complexity of dissociative phenomena

The concepts of depersonalisation and derealisation refer to alteration in how an affected individual feels about oneself and their environment. Both these experiences may range from mild and episodic to severe and chronic. When clinically severe, these symptoms can be the basis for the diagnosis of depersonalisation-derealisation disorder; however, they are viewed as transdiagnostic, as they accompany various mental disorders. Literature emphasises the heterogeneous nature of the discussed construct, which includes several dimensions such as derealisation, somatopsychic depersonalisation, autopsychic depersonalisation and affective depersonalisation. This phenomenological complexity is reflected in the complex neurobiological mechanisms responsible for depersonalisation experiences, of which the theory of cortico-limbic inhibition is best described. Symptoms of depersonalisation and derealisation can be triggered by a variety of factors, such as physiological states (fatigue, stress, etc.), central nervous system abnormalities or psychoactive substances. In many cases, however, traumatic experiences are crucial, with most empirical evidence pointing to the role of emotional abuse and neglect. Trauma can alter responses of the autonomic nervous system, which mediates the symptoms of depersonalisation and derealisation (e.g. freeze response). The attachment style may be another mediator. Although depersonalisation and derealisation were conventionally assigned to the category of detachment, it has been suggested that they also bear features of compartmentalisation under certain circumstances. The analysis of the impact of various developmental processes on the formation of the complex phenomenon of depersonalisation sheds new light on the understanding of dissociative disorders and the importance of dissociation in psychopathology.

How vestibular dysfunction transforms into symptoms of depersonalization and derealization?

BackgroundPsychiatric Depersonalization/Derealization (DPDR) symptoms were demonstrated in patients with peripheral vestibular disorders. However, only semicircular canals (SCCs) dysfunction was evaluated, therefore, otoliths' contribution to DPDR is unknown. Also, DPDR symptoms in patients with central vestibular dysfunction are presently unknown. DPDR was also studied in the context of spatial disorientation and anxiety, but the relation of these cognitive and emotional functions to vestibular dysfunction requires clarification. MethodsWe tested patients with peripheral Bilateral Vestibular Hypofunction (pBVH), Machado Joseph Disease (MJD) with cerebellar and central bilateral vestibular hypofunction, and healthy controls. Participants completed the video Head Impulse Test (vHIT) for SCCs function, cervical Vestibular Evoked Myogenic Potentials test (cVEMPt) for sacculi function, Body Sensation Questionnaire (BSQ) for panic anxiety, Object Perspective-Taking test (OPTt) for spatial orientation and Cox & Swinson DPDR inventory for DPDR symptoms. ResultspBVH patients showed significant SCCs and sacculi dysfunction, spatial disorientation, elevated panic anxiety, and DPDR symptoms. MJD patients showed significant SCCs hypofunction but preserved sacculi function, spatial disorientation but normal levels of panic anxiety and DPDR symptoms. Only pBVH patients demonstrated a positive correlation between the severity of the DPDR and spatial disorientation and panic anxiety. ConclusionsDPDR develops in association with sacculi dysfunction, either with or without SSCs dysfunction. Spatial disorientation and anxiety seem to mediate the transformation of vestibular dysfunction into DPDR symptoms. DPDR does not develop in MJD with central vestibular hypofunction but a normal saccular response. We propose a three-step model that describes the development of DPDR symptoms in vestibular patients.

Cotard delusion, emotional experience and depersonalisation

ABSTRACT Introduction Cotard delusion—the delusional belief “I am dead”—is named after the French psychiatrist who first described it: Jules Cotard. Ramachandran and Blakeslee proposed that the idea “I am dead” comes to mind when a neuropathological condition has resulted in complete abolition of emotional responsivity to the world. The idea would arise as a putative explanation: if “I am dead” were true, there would be no emotional responsivity to the world. Methods We scrutinised the literature on people who expressed the delusional belief “I am dead”, looking for data on whether such patients are reported as entirely lacking in emotional responsivity. Results In numerous cases, patients with Cotard delusion are described as experiencing emotions including anxiety, fear, guilt, distress, euphoria and worry. Conclusions We conclude that complete absence of emotional responsivity cannot be what prompts the delusional idea that one is dead. We propose that, in at least some cases, the idea “I am dead” comes to mind in response to symptoms of depersonalisation or derealisation, often present in cases of Cotard delusion, and give examples of Cotard patients with abnormalities in various neural areas that could be responsible for the presence of such symptoms.