Depersonalisation Flashcards
(33 cards)
What is depersonalisation
Alteration in the perception or experience of the self so that one feels detached from an as if one is an outside observer of ones mental process or body (DSM IV)
What is DPDR
Strange and disturbing sense of unreality in ones experience of oneself (DP) and ones surroundings (DR)
What are the five major domains in DPD?
Depersonalisation
Derealisation
Desomatisation
De-affectualisation
Deideation
Depersonalisation
Being separate from oneself; observing oneself as if from outside; feeling like a robot
Derealisation
Threatening sense of unfamiliarity or unreality in the environment; others feels like actors
Desomatisation
Loss or alteration of bodily sensations; sense of disembodiment; raised pain threshold
Deaffectualisation
Loss of emotional reactivity; emotions feel like they lack spontaneity and subjective validity; may affect intimate relationships
Deideation
Difficulty concentrating; cotton wool head
Treatment modalities (SLaM)
Cognitive behavioural therapy
Pharmacotherapy with lamotrigine (monotherapy vs combination therapy with an SSRI)
Clinical ax
Hx including the nature of episodes (episodic/ intermittent); associated sx; clinical ax scales
What are the differentials for DPD
Temporal lobe epilepsy
Anxiety
Depression
Psychosis
What investigations should be carried out in DPD?
CT/MRI
Blood tests inc. thyroid function
Cambridge depersonalisation scale
29-item scale self rated scale
Assesses experiences in the last 6 months
Scores experiences based on frequency and duration
Each item can score a max of 10 points
DPD and anxiety
Hx of anxiety/ panic attacks
Comorbid anxiety
Pharmacological mx of DPD
Lamotrigine (monotherapy or combination therapy with an SSRI)
Clonazepam
Naltrexone
Clomipramine
Psychostimulants e.g methylphenidate, modafinil)
Lamotrigine for DPD
Reduces excitatory amino acid transmission, mainly glutamate
Blocks sodium channels
Stabilises neuronal membrane
Blocks NMDA receptor ketamine related DPDR
Effective to reduce DP sx in combination therapy
Non pharmacological mx
CBT
Attentional training e.g mindfulness
Repetitive transcranial magnetic stimulation to right ventrolateral prefrontal cortex
CBT - diary entries for chronic sx
Hourly dairy entries rated from 0-10 based on severity
CBT - diary entries for infrequent sx
Record the situation
Rate the severity
Duration
Mood
Thoughts
Behaviour
How do we analyse diary entries?
Analyse for fluctuations
Organise by worse vs better
Consider underlying mechanisms
Schedule activities based on diary entries
Helps to highlight role of anxiety and low mood
Grounding strategies for DPD?
Grounding strategies aim to refocus a persons attention on the present using:
- surroundings
- words/ statements
- image
- posture
- objects
- focus on each of the senses
Need to use them ASAP when symptoms start coming on
How do we deal with unhelpful thoughts in DPD
Challenge negative automation thoughts with counter evidence
Thinking process focused CBT interventions for DPDR
Strategies that reduce rumination and worry
Understanding and manipulation sx focused attention
Behaviour focused CBT interventions for DPDR
Weigh the pros and cons of checking behaviours
Avoid avoidance by graded exposure to old activities
