Depersonalization-derealization syndrome

Literally translated, the term “depersonalization” means the depersonalization or disappearance of one’s own “I.” Sometimes the concepts of mental alienation or anesthesia are used to describe this illness in psychiatry. It is characterized by emotional detachment in relation to anyone or anything, including oneself. The disorder is very difficult to treat and always requires careful diagnosis and constant medical supervision even during remission. But the specialists of the Leto mental health center know perfectly well what to do even in the most difficult cases, and how to achieve a positive result in the vast majority of patients.

Causes

The etiology of the disease may be associated with:

• severe stress, especially at an early age;
• episodes of physical violence;
• hereditary predisposition, but in such cases the chances of curing depersonalization are low, since the symptoms gradually develop into schizophrenia;
• pathologies of the central nervous system, in particular epilepsy, but if the cause of the disorder is neurological diseases, the occurrence of a state of “already seen” (deja vu) or “never seen” (jamais vu) is typical.

CAUSES OF DEPERSONALIZATION

Depersonalization-derealization syndrome is a mental disorder that occurs within the framework of:

• neurotic disorders;
• neurological disorders;
• suffered shock (for example, after a serious injury);
• frequent stress;
• schizophrenia;
• manic syndrome;
• depressive syndrome.

The condition in question can be short-term or long-term, and in the latter case, such a mental disorder often leads to suicide. If the depersonalization-derealization syndrome is short-term, then most likely it is triggered by some kind of nervous shock (death of a loved one, trauma, and so on). The short-term course of the condition in question always ends in complete recovery without any consequences, although this may take several months.

Clinical signs

Depersonalization-derealization syndrome as an independent disorder is extremely rare; usually such a condition accompanies schizophrenia, some forms of psychosis and other somatic and mental illnesses. Symptoms manifest in adolescence and young adulthood (15–30 years), women are more often affected.

With depersonalization syndrome, the patient is aware of the changes occurring in his psyche and experiences them painfully (at least in the initial stages). Usually in everyday life, everything that surrounds a mentally healthy person is perceived and viewed by him as something familiar, understandable and completely explainable. Certain elements of the environment are used to satisfy biological and spiritual needs. With depersonalization-derealization syndrome, alienation occurs both from the surrounding world and from one’s own personality.

At the initial stage, the feeling and awareness of one’s body and the world around is lost. Perception loses its naturalness, liveliness, and spontaneity. The patient constantly experiences psycho-emotional discomfort, ponders the correctness of statements on this or that matter, and subjects all his actions to scrupulous analysis.

Depersonalization disorders are radically different from a person's previous experiences. Often the patient does not have enough words to describe them, which forces him to resort to various metaphors; sometimes his own terminology appears with which he describes the sensations. Statements are in the nature of assumptions, therefore in speech they constantly use comparative phrases and expressions (as if, as if, it seems, etc.).

Depersonalization disorder is a fairly common form of mental pathology [5, 13]. M. Sierra [41-46], considering depersonalization from a cross-cultural point of view, noted a wide range of its prevalence rates from 7 to 80% in different regions of the world. In the general population, when assessed at the time of the relevant study, it occurs with a frequency of 0.8 to 2.0%. In psychiatric hospitals, depersonalization disorder is detected in 80% of patients [26]. If we are talking about transitional forms of depersonalization (for example, derealization), then their prevalence is higher: during life they occur in 26-74% of the general population, while 31-66% of such cases are associated with the effect of one or another traumatic (stressful) event. impact. Studies that used standardized diagnostic interviews showed that the disorders studied, when taken into account during a month of a person's life, occur in the UK with a frequency of 1.2-1.7%, in Canada - 2.4%. To the above data, we can add that such disorders in war veterans with post-traumatic stress disorder (PTSD) occur in 30% of cases, in patients with unipolar depression - in 60%, in patients with panic disorder - in 82.6% [32, 34, 35 , 41].

The main clinical manifestations of depersonalization in classical psychiatry are considered to be a disorder of awareness of one’s “I” as a person and the loss or distortion of awareness of the subjective identity of one’s own mental acts, i.e. We are talking about the pathology of self-awareness, a violation of the value of one’s “I”, its independence, activity and isolation from the surrounding world.

Clinical manifestations of disorders of self-awareness are presented in the form of such symptom complexes as depersonalization, experiences of alienation, and anosognosia [19, 20, 28].

S.F. Semenov [14] identified several syndromes. The first is depersonalization syndrome, the clinical picture of which is extremely polymorphic, but the main clinical criteria for impaired self-awareness are the same. This is a feeling of alienation, of change in one’s “I”. Secondly, mental automatisms, by which the author understood the alienation of one’s own mental acts, often complicated by various delusional ideas, especially delusions of mastery and physical influence. Mixed variants combine symptoms of depersonalization and mental automatism.

He attributed the phenomena of mental automatism to the most pronounced form of violation of self-awareness, i.e. Kandinsky-Clerambault syndrome. The author distinguished several of their clinical variants, interconnected by transitional and mixed forms: a) alienation of mental acts, the phenomenon of mental automatism; b) alienation of the sensory-emotional coloring of perception; c) depressive type of disturbance of sensory perception with a feeling of “farness” from the entire external world, and sometimes from one’s own body; d) weakening and distortion of the sense of reality of one’s own sensations and the external world due to violations of cortical gnostic functions. Thus, according to S.F. Semenov, depersonalization is the basis of disorders of self-awareness.

According to K. Jaspers [21], we can talk about the phenomena of depersonalization in the absence of consciousness of one’s own activity (activity) with alienation from the world of perceptions, loss of a normal sense of one’s own body and subjective ability to imagine and perceive, and a violation of the consciousness of the automatism of volitional processes. Regarding this A.V. Snezhnevsky [17] wrote that K. Jaspers and other German psychiatrists understand depersonalization as a rather narrow disorder (one of the manifestations of disorder and alienation of the consciousness of “I”). A.V. himself Snezhnevsky [17, 18] argued that depersonalization syndrome should be considered more broadly—as a disorder that covers all manifestations of a disorder of self-awareness. Speaking about disorder of self-awareness and depersonalization as equivalent concepts, he admitted the existence of several of their forms. Position of A.V. Snezhnevsky, in our opinion, more fully reflects clinical reality.

One of the largest studies of the clinical phenomenon under consideration was carried out by T.A. Kafarov [3, 4] - in his work “Psychopathology of self-awareness in the pathokinesis of schizophrenia” he defines a disorder of self-awareness as follows: “Disorders of self-awareness are conditions in which an adequate assessment of one’s “I” as a physical object, a subject of mental activity and as an individual with a certain social status as a whole or separately.” An additional diagnostic criterion, in his opinion, is violations of premorbid stability and integrity of the “I” image.

Despite the importance of the problem of depersonalization, relatively few special studies have been devoted to it in the literature, and it remains one of the least studied psychopathological phenomena. There are still no generally accepted definitions of depersonalization syndrome. This is partly due to extremely unclear terminology. Each school gives different meanings to the term depersonalization. This is partly due to the inadequacy of the word itself: it is often translated literally as “depersonalization,” i.e. loss of self. Depersonalization includes various disorders: split personality, the phenomenon of “made-ness,” disturbances in the body diagram, gross derealization, opto-vestibular disorders, etc. However, it should be recalled that L. Dugas [29], who coined this term, emphasized that depersonalization there is not a loss of the sense of “I”, but a feeling (feeling) of the loss of one’s “I”, which is one of the many manifestations of the mental disorder designated by this term. There are other terms as well. Of these, in the Russian language the definition is “feeling of alienation”, according to V.A. Zhmurov [2], is the most adequate. However, the word “depersonalization” has become firmly established in the literature, and its replacement seems inappropriate at present. Its modern understanding among most domestic clinicians is presented as a disorder of a person’s self-awareness, expressed in a feeling of loss of its unity, distortion and alienation of some or all of its mental or physical processes [].

According to Yu.L. Nuller [10-12], existing classifications of depersonalization are based either on a purely phenomenological principle (auto-, somato- and allopsychic depersonalization), or on the disease within which it occurs (schizophrenic, depressive, neurotic, organic) [16].

The difficulties of the phenomenological classification of the pathology of self-consciousness are largely due to three main reasons: 1) the obvious complexity of the phenomenon of psychosis as such and endogenous psychoses in particular; 2) the lack of development of the conceptual apparatus of clinical psychiatry; 3) insufficient use of psychological methods to study the phenomenon of depersonalization [7-9]. Meanwhile, it is the use of the pathopsychological method and its inclusion at different stages of the clinical and dynamic analysis of the disease that creates the possibility of a deeper phenomenological study of disorders of self-awareness. An example is the work performed in the 60s by V.N. Myasishchev [6].

V.N. Myasishchev [6] agreed with the authors who believed that the basis of depersonalization is a disorder of general feeling. He wrote: “This is not a disorder of proprioception or interoception, but something less specific and more general. This disorder most closely approximates the loss of the emotive components of human experience.” In psychology, even before this term acquired a nosological meaning, there was a concept of a defining primary mental element. Some considered it sensation, others - emotion, and still others - will. V.N. Myasishchev believed that when there is a violation of the connection, the unity of sensation and the accompanying emotive tone, numerous depersonalization and derealization symptoms represent complex derivatives of this primary lesion.

Summarizing the above, we can give the following definition of the disorder in question: depersonalization is a violation of a person’s self-awareness, accompanied by the alienation of some or all mental processes: a feeling of change, loss, alienation or splitting of one’s “I”. Distortion of self-perception can be manifested both by the loss of the unity of the “I” as a whole, and by the alienation of individual parts of the body. Depersonalization can vary in severity.

In milder cases, there is an internal change in feelings and thoughts that become different from the previous ones; in more severe cases, there is a loss of one’s own “I”. Depersonalization can be expressed by the phenomenon of splitting the “I,” in which patients experience a split personality, the coexistence of two differently thinking and acting personalities in one person (which meets the criteria for dissociative identity disorder according to DSM-1V-TR). Depersonalization is usually accompanied by reflection, the patient’s desire to describe and analyze his condition in detail.

Depersonalization in Russian psychiatry is usually considered as a disorder of self-awareness outside of hysteria. However, there is a point of view according to which depersonalization can develop during hysterical twilight stupefaction. Depersonalization is most typical for endogenous mental illnesses [7-9] - depressive states and schizophrenia, but it can develop in epilepsy, somatogenic mental disorders, as well as in the structure of dysmorphophobia syndrome [5, 13].

I.I. Sergeev and A.L. Basova [15], based on the classical taxonomy of depersonalization according to K. Haug [30] and its division into auto-, somato- and allopsychic variants, studied in detail the variant of delusional depersonalization. According to their data, the majority of patients with delusional depersonalization exhibit autopsychic delusional depersonalization. It can manifest itself as Cotard's delusion, delusion of doubles, mental reincarnation, obsession. Somatopsychic delusional depersonalization was established in 35.7% of patients with delusional depersonalization. It was represented by delusions of physical reincarnation and nihilistic hypochondriacal delusions. Allopsychic delusional depersonalization was found in 16.7% of patients with delusional depersonalization. In these cases, there was a delusional experience of change, unreality or absence of the surrounding world. The patients were convinced that a “theater was being played out” around them (delusion of staging), they found themselves in another world existing simultaneously with ours (“delusion of parallel worlds”), or the world around them did not exist at all (nihilistic megalomaniac delirium, “delusion of the destruction of the world” ).

In many patients, the mentioned variants of depersonalization were combined. In rare (7%) cases, total delusional depersonalization occurred, manifested by delusions of total reincarnation and nihilistic megalomanic delusions. Based on the semantic essence of delusional disorders of self-awareness, the authors identified three main phenomena of delusional depersonalization: 1) splitting; 2) reincarnation; 3) disappearance. Delusional depersonalization was accompanied by severe behavioral disorders, which were largely determined by the prevailing phenomenon of delusional depersonalization: splitting, reincarnation, and disappearance.

M. Sierra [41, 42, 44, 46] considers depersonalization disorders by severity, presenting their spectrum - from fairly frequently observed single and fleeting experiences (in 70% of college students and 23% of individuals in the general population) to symptoms of comorbid diseases combined with anxiety, obsessive-compulsive disorder, etc., and finally, to severe, disabling depersonalization. In a number of his works, this author also considers drug-induced depersonalization [24], depersonalization in various mental and neurological diseases (epilepsy, migraine, traumatic brain injury, etc.).

In ICD-10, depersonalization syndrome is classified under category P48 “Other neurotic disorders” [53]. Here are the diagnostic criteria for depersonalization disorder according to this classification:

A. For a reliable diagnosis, the disorder must contain the first or second, or both of these signs in combination with the third and fourth:

1) symptoms of depersonalization - the patient feels that his sensations and/or actions are not his own, removed, torn from him;

2) symptoms of derealization - feelings that everything around the patient (people, objects, etc.) is unreal, distant, artificial, seems colorless and lifeless;

3) the patient’s critical attitude towards the symptoms of depersonalization and/or derealization - the patient’s feeling that the disorders he has are subjective and spontaneous in nature, and not imposed from the outside by someone or something;

4) clear consciousness - no signs of toxic confusion or epilepsy;

B. In the event of a syndrome occurring within depressive, phobic, obsessive-compulsive or schizophrenic disorders, diagnostic preference is given to the latter, and derealization and/or depersonalization are considered secondary.

According to the American classification DSM-IV [22], depersonalization is categorized as F300.6. Here are the following diagnostic criteria:

A. A persistent or periodic experience of alienation of one's mental processes or one's body, as if the subject experiencing this state were an outside observer (for example, the feeling of being a person in a dream).

B. With depersonalization, the assessment of reality does not suffer.

B. The disorder causes clinically significant distress or impairment in social, occupational, or other areas of functioning.

D. Feelings of depersonalization do not occur exclusively in the context of a mental disorder such as schizophrenia, panic disorder, acute stress reaction, or other dissociative disorder. It is not directly related to the effects of a psychoactive substance (for example, drug or medication abuse) and is not caused by common diseases (for example, temporal lobe epilepsy).

There is currently no generally accepted medication for the treatment of depersonalization disorder[]. They use tranquilizers (phenazepam, clonazepam, diazepam), selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, antiepileptic drugs (lamotrigine). In recent years, great hope has been placed on the combined use of drugs from different groups.

Of the domestic psychiatrists, Yu.L. worked a lot in the field of treatment of depersonalization disorders. Nuller [10-12, 36, 37]. We can talk about the corresponding technique of Yu.L. Nullera: The author believes that it is best to begin treatment with a diazepam test, then begin phenazepam therapy on the same or the next day. The initial daily dose of phenazepam is 3-4 mg in two or three doses. In this case, if depersonalization is not reduced completely or there is no sharp and significant improvement, the dose is increased by 1-2 mg per day every 2-3 days until the depersonalization symptoms completely disappear or are significantly reduced (by 75-80% on the depersonalization scale) . Therapeutic doses can reach 5-10 mg per day, and in some cases increase even more (up to 20-30 mg). After achieving the full therapeutic effect, it is necessary to maintain the same dose of the drug for at least 7 days, and then gradually reduce it by 1-2 mg every 3-4 days. If even a slight deterioration occurs, the dose should be increased to the previous one or even more, and only after the manifestations of depersonalization disappear again and the condition remains stable for 7-10 days, you can carefully begin to reduce the dose of phenazepam again - 1 mg every 4 days. If, in the absence of depersonalization symptoms, the patient experiences sleep disturbances and/or anxiety, the use of tranquilizers should not be interrupted. For sleep disorders, phenazepam can be replaced with nitrozepam 5-10 mg at night.

According to the described scheme, 42 patients with severe depersonalization in low-grade schizophrenia, atypical manic-depressive psychosis, and organic brain disease were treated with phenazepam.

All those treated experienced phenomena of auto- and somatopsychic depersonalization; in most cases they were accompanied by a feeling of “mental pain.” In 13 patients, psychopathological symptoms disappeared completely, in 12 they decreased significantly, in 9 the improvement was moderate, and in 8 there was no positive effect.

Overall, clear positive results were achieved in 25 (59%) patients, which, given their therapeutic resistance, should be regarded as a significant success.

Based on the fact that depersonalization disorder is based on serotonergic dysfunction, some researchers have used SSRIs for treatment [38]. This applies primarily to D. Simeon et al. [49], who found that under the influence of fluoxetine and clomipramine, symptoms of depersonalization may disappear. There is a clinical report on the positive effects of SSRIs in patients with multiple sclerosis with depersonalization disorder [51]. The positive effect of SSRIs in patients with depersonalization disorder was previously discovered by E. Hollander et al. [31]. However, the level of heterogeneity and comorbidity in the treated patients was very high. D. Simeon et al. [48] ​​studied the effectiveness of clomipramine in 7 patients with primary depersonalization disorder, and improvement was found in only 2 cases. D. Simeon [47] used a large clinical sample of patients with depersonalization disorder to study the effectiveness of fluoxetine. In a placebo-controlled randomized study, no positive effect was obtained.

Regarding the use of antipsychotics, there is a small number of works in this area.

M.V. Akhapkina [1] used a combination of antidepressants and antipsychotics in the treatment of depersonalization disorders. As for neuroleptics, for depressive-depersonalization syndrome with an anxious nature of depression, stelazine was used at a dose of 10-15 mg/day, leponex at a dose of 50-75 mg/day, for melancholy and apathetic depression - stelazine at a dose of 5-10 mg/day . For depersonalization-thymopathic, depersonalization-phobic, and depersonalization-hypochondriacal syndromes, the doses of antipsychotics were slightly higher: Stelazine - 15-30 mg/day, Leponex - 50-100 mg/day. For paranoid hypochondria, haloperidol was used - 6-15 mg/day. For depressive-depersonalization syndrome, antidepressants were used in medium doses orally and intravenously: for anxious depression - amitriptyline at a dose of 150-250 mg/day, for sad and apathetic depression - melipramine 150-250 mg/day, anafranil 100-225 mg/day; for depersonalization-thymopathic, depersonalization-phobic and depersonalization-hypochondriacal syndromes, which were characterized by a shallow level of affective disorders, antidepressants were used in small doses; Amitriptyline was mainly used - 50-150 mg/day. In addition, for severe anxiety and phobias, tranquilizers were prescribed: phenazepam - 3-6 mg/day, relanium - 30-40 mg/day. If patients had paroxysm-like conditions, finlepsin was prescribed - 400-600 mg/day. Complete or significant reduction of depersonalization disorders was observed in patients with depressive-depersonalization type of syndrome; a slight reduction in depersonalization disorders was observed in patients with depersonalization-phobic and depersonalization-hypochondriacal syndromes. Less effective treatment was observed in depersonalization-thymopathic, depersonalization-hypochondriacal and depersonalization-phobic syndromes. Some authors indicate a positive effect of quetiapine (Seroquel) in depersonalization disorder [40].

N. Medford et al. [33], having established the ineffectiveness of SSRIs in patients with depersonalization disorder, began to look for other pharmacotherapeutic drugs for the treatment of such disorders, in particular among anticonvulsants. Their choice fell on lamotrigine. Acting on presynaptic membranes, it reduces the release of glutamic acid. The glutamine receptor antagonist N-methyl-D-aspartate ketamine blocks these receptors, thereby improving the depersonalization phenomenon [23].

In preliminary studies by M. Sierra et al. [43] found a positive effect of lamotrigine in depersonalization disorder. However, in further placebo-controlled studies [44-46], the authors did not observe any significant improvement.

According to the British Medical Association and the Royal Pharmacological Society of Great Britain [27], the initial dose of lamotrigine should be 25 mg. If it is ineffective, clonazepam is useful.

There is also data in the literature [50] on the elimination of caffeine-induced depersonalization with benzodiazepines and fluoxetine.

P. Sachdev [39] managed to achieve successful treatment of primary depersonalization disorder with clonazepam in combination with citalopram.

A number of authors [25, 37, 52] indicate the positive effect of the opioid receptor antagonist naloxone in depersonalization disorder.

Thus, despite the heterogeneity of the results obtained, the use of pharmacotherapy for depersonalization disorder is considered the most justified and promising. In some cases, it allows one to overcome therapeutic resistance in this type of mental pathology, which can be of great practical importance.

[] In 2010, the “Large Explanatory Dictionary of Psychiatric Terms” was published (Elista: Dzhalgar, 864 pp.), in which V.A. Zhmurov, citing Dugas (1898), gives the following definition of depersonalization: “a violation of self-awareness in the form of alienation of the qualities of one’s own “I” (ed.).

[] Psychotherapeutic and other treatment methods are not discussed in this review.

Types of depersonalization

There are several types of the disease.

Autopsychic depersonalization

A patient with a similar form of the syndrome does not feel his psychological “I”, does not feel what he is thinking, and is not aware of his own feelings and emotions, and does not respond properly to his surroundings on a sensory level. In an uncomplicated course, he is quite capable of maintaining a conversation and behaves adequately, but only because others expect similar actions and actions from him. But at the same time, the patient may experience serious mental discomfort, acutely experience the loss of sensory emotions (even attacks of panic attacks). Many adapt to pathological changes.

In severe cases, it is difficult for the patient to contact other people, he does not understand the motives of their behavior, and does not understand the speech addressed to them. The world is perceived through “other people’s eyes”, a person seems to see himself from the outside. Some describe their sensations as “acting out a role.”

As the disease progresses (this usually happens with schizophrenia), emotional experiences completely disappear, and any manifestations of feelings are not sincere.

Total and partial

In the partial form, there is a violation of individual mental processes, for example, only emotions or thinking. With total pathological changes affect the personality as a whole.

Somatopsychic depersonalization

The patient complains that he does not feel his own body or its individual parts (for example, head, arms or legs), and does not feel clothes. In this case, there are no neurological disorders of tactile sensitivity, characteristic of other mental illnesses and “body schema” disorders. A person may not feel hungry or full, so eating turns into an unpleasant but necessary process, and may not experience any emotions when satisfying physiological needs (for example, completely natural comfort after washing or taking a shower).

Allopsychic depersonalization of personality

Characterized by a complete change in the perception of the surrounding world.

• Hypopathic option. Real reality seems indistinct, dull, seen as if through a film or veil, objects lose volume and perspective. The picture of the world is described as a black and white photograph, a decoration. The faces of other people look like painted doll masks, and the perception of sounds and voices also changes.
• Hyperpathic form. It is observed much less frequently, and the symptoms are directly opposite to the hypopathic course of the disorder. The perception can be described by the word “too” (bright, loud, clear, etc.).

Other types of pathology

There are other variants of the course of the disease:

• Changes. The easiest and most favorable type of disease in terms of prognosis and treatment. A person is focused on comparing his state in the past and in the present, with “current” feelings and emotions described as “different”, “different”, and the surrounding environment is characterized as “unnatural”, “unfamiliar”, “artificial”. The development of anhedonia (lack of the ability to experience positive emotions) is typical, while negative experiences are felt quite acutely.
• Loss. Accompanied by the loss of previous qualities and characteristics of personality, temperament, spiritual burnout, and inability to establish personal contacts. The differences between the inner and outer world are gradually “erased”, doubts about one’s existence appear, the need for sleep and sexual desire decrease (and in severe cases completely disappear).
• Alienation. A loss of control over mental and physical aspects of the personality is typical. One’s own actions and deeds, the body are perceived as someone else’s, and there may be a violation of bodily perception.
• Splitting. Characteristic is the experience of the simultaneous existence in one individual of two autonomous personalities that are in constant opposition.

Main symptoms of depersonalization

There are cases when people experience depersonalization disorder while experiencing an acute stressful situation. However, when a previously unusual sensation persists for a long period, then we are talking about a painful mental disorder. In this case, the syndrome can occur in somatopsychic, autopsychic, allopsychic, anesthetic forms. These types can occur separately or be combined with each other.

Regardless of this, signs of progression of the disease include the following:

- the emergence of excessive self-absorption of the individual; - loss of incentive to live; - previously vividly experienced situations leave a person unshakable; - a manifestation of indifference to someone else’s grief.

A concomitant symptom is a complete change in taste habits, which is perceived by the individual as completely normal, without creeping in suspicions about problems that have arisen in the functioning of the body.

Cost of services

This list does not contain all prices for services provided by our clinic. The full price list can be found on the “Prices” , or by calling: 8(969)060-93-93. Initial consultation is FREE!

Symptoms and signs of depression

A variety of assessment and screening tools have been developed to identify symptoms and signs of depression. The former allow you to diagnose the disease, determine its type and the severity of symptoms of depression; the latter only detect the presence of depression or the possibility of developing the disease in each specific case. Increased attention to diagnosis is associated with the features of differential diagnosis and, as a consequence, with the choice of the correct tactics for treating depression.

As a rule, the signs of depression in the minds of most people are associated with worsening mood, a negative attitude towards life and a depressed state. However, these symptoms may indicate not only depression, but also other mental and physical illnesses. That is why differential diagnosis is necessary, including not only a conversation with a doctor and testing, but also a referral for a physical examination.

Neglect of differential diagnosis when a depressive disorder is suspected creates the basis for an unfavorable outcome for the following reasons:

• incorrect treatment is prescribed;
• the development of the underlying disease continues;
• Symptoms of depression intensify, even to the point of suicide attempts.

Only through the joint efforts of a psychiatrist and somatic doctors can it be possible to avoid errors in making the correct diagnosis. In particular, this is due to the fact that symptoms and signs of depression may mask organic damage to the nervous system (for example, hematomas, abscesses, tumors, parasites, infectious diseases). The reproductive and endocrine systems may also have pathology that contributes to the appearance of symptoms similar to those of depression, or even the disease itself.

Test: “Beck Depression Inventory”

In each group, identify one statement that best describes how you felt this week and today. Before making your choice, make sure you read all the statements in each group.

Number of questions in the test: 21

Symptoms of Depression in Teens

Depression in adolescents develops due to the influence of biological, genetic and psychosocial factors. As a rule, biological causes are associated with impaired breakdown of cortisol, melatonin secretion, deficiency of norepinephrine and serotonin, as well as changes in the frontal cortex and amygdala. In addition, an important role in the development of symptoms of depression in adolescents is played by family history, individual vulnerability to stress, and stress factors themselves (for example, parental divorce, death of relatives, adolescence, conflicts with peers, lack of maternal love).

The first signs of depression in adolescents go unnoticed due to the absence of affective disorders and due to the short-term nature of the decline in mood. As a rule, in the presence of depression, most young patients experience:

• loss of appetite;
• sleep problems, nightmares;
• behavioral disorders;
• increased aggressiveness;
• maladjustment at school;
• memory loss.

Typically, such adolescents can be observed for a long time by a pediatrician, neurologist, endocrinologist, urologist or surgeon. In other cases, a visit to a psychiatrist is initiated by parents when obvious signs of depression come to the fore:

• anxiety;
• melancholy, sadness, despondency;
• loss of interest in favorite activities;
• lack of need for communication;
• groundless feeling of guilt, shame;
• slow speech;
• tearfulness.

Symptoms of depression in women

Among the adult population of Russia, symptoms of depression in women are 1.5 times more common than in men. Moreover, the prevalence of the disease throughout the country varies from 35 to 56% of the adult working population. In half of the cases, a severe or moderate form of depression is detected.

Typical signs of depression in women include:

• apathy, loss of strength;
• negative thoughts about the future;
• increased irritability;
• lack of sexual desire;
• tendency to act rashly;
• complaints of unspecified physical pain.

In approximately a third of hospitalized women, severe forms of depression are observed against the background of somatic pathology, for example: rheumatic, cardiovascular, hematological, infectious diseases, diseases of the nervous system, gastrointestinal tract, kidneys.

Symptoms of depression in men

Due to sociocultural characteristics, men are less likely to seek psychiatric help than women. As a rule, signs of depression in men are attributed to fatigue, conflict arising due to difficult life circumstances, addiction to alcohol or smoking - a consequence of a psychopathological state.

Among the obvious symptoms of depression in men are:

• emotional instability;
• “situational” mood swings;
• sad and anxious experiences;
• insomnia, other sleep disorders;
• lack of sexual desire;
• alcohol and tobacco abuse.

Many researchers and psychiatrists note the special role of loss of feelings for loved ones and emotional connections with them, considering this condition to be one of the key signs of depression. In addition, there are often tendencies towards perfectionism, setting high standards both for oneself and for others, which remain unjustified.

Rice. 1. Goals and objectives of depression therapy at different stages (ES Friedman, IM Anderson, 2010).

How to treat depersonalization syndrome

To solve the problem of how to get rid of the disorder, it is necessary to accurately determine its cause. Naturally, in case of organic pathology, the main efforts of the doctors at the Leto clinic are aimed at eliminating it or (if this is not possible) at selecting adequate symptomatic drug therapy; if necessary (for example, a tumor, vascular formation), surgical intervention is indicated.

In other cases, drug treatment is selected individually. At the same time, attention is paid to which symptom (anxiety, apathy, depression, insomnia, etc.) predominates in the clinical picture. Antidepressants, anxiolytics, sedatives or, conversely, psychostimulants are prescribed.

Psychotherapy plays a huge role. The doctor’s task is to teach the patient how to live with depersonalization and correct the disorder as much as possible. The psychologist uses the following techniques:

• cognitive, promoting social adaptation;
• behavioral, with the help of which the patient learns to control his condition;
• sensory to normalize the sensation of the body in the surrounding space, etc.

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CLASSIFICATION OF SYNDROME

In medicine, it is customary to distinguish several forms of depersonalization-derealization syndrome:

1. Autopsychic. The patient becomes immersed in himself, he experiences fear and confusion, because he feels that he has changed, is not the same as before, his feelings and thoughts have changed, they are “spoiled”, “unreal”. This type of disease in question is often characterized by the following behavior: reluctance to communicate with friends and family, an external absence of emotional manifestations, complaints of memory loss (incomplete).
2. Allopsychic. It is this type of depersonalization syndrome that doctors call derealization - the patient perceives the surrounding reality as a dream or a game/fairy tale. Characteristic signs of such a disorder will be a lack of understanding of one’s location in familiar places, indifference/complete ignorance when meeting a familiar person, problems recognizing people (sometimes they all seem the same to the patient), and the inability to clearly determine the color and shape of objects.
3. Somatopsychic. This form is considered the most unusual because patients present strange complaints - for example, they may feel like they are not wearing clothes, or that each part of their body exists separately, and so on. We can say that the somatopsychic type of depersonalization-derealization syndrome is characterized by a pathological perception of one’s own body.

Treatment

Treatment should be comprehensive, including psychopharmacology. The doctor prescribes drugs from a number of psychotropic substances, depending on the course, characteristics of the syndrome and the type of depersonalization. At the first stage of development of depersonalization, the following is chosen for treatment:

• tranquilizers (Elenium or Seduxen)
• weak antipsychotics (Teralen or Melleril)
• broad-spectrum antidepressants, such as amitriptyline

For stronger antipsychotics, your doctor may prescribe etaprazine at a daily dosage of 10 to 20 mg. If the patient has cerebral-organic diseases that are combined with depersonalization syndrome, the use of aminalon, absorbable agents, and restorative treatment is also relevant.

At the second stage of development of depersonalization, most patients are diagnosed with schizophrenia. Doctors in most cases prescribe a combination of antidepressants and antipsychotic drugs. Topical antidepressants:

• melipramine
• amitriptyline

Neuroleptics for second-stage therapy:

• teralen
• melleril
• etaperazine

In case of a residual condition of the patient, pyrazidol is prescribed in a daily dosage of 25 to 50 mg and sydnocarb (10–30 mg), as well as aminalon, stimulating neuroleptics and a combination of biostimulants with tranquilizers such as trioxazine.

In the third type (at the third stage), depersonalization is prescribed:

• melipramine
• amitriptyline
• lithium salts (for prevention)

Whatever type (stage) of the syndrome in question is discovered, you need to be extremely careful with treatment with high-intensity antipsychotics, because a person’s mental state may become worse when taking them, and the risk of side effects is high.

The second component of therapy is psychotherapy . The doctor is trying to convey to the patients the idea that the fear and torment that they feel as a result of the supposed alienation of their Self are completely understandable and common among people. The patient must stop mystifying his condition. Also, one of the doctor’s tasks is to reduce the patient’s sense of fear for his mental state.

The doctor must make it clear to the patient that reflection can be reduced independently by switching attention to the environment. Thus, psychotherapy is associated with other techniques, for example, autogenic training or hypnosis.

Hypnosis and autogenic training are methods that are relevant at the first stage of the development of depersonalization syndrome. At other stages, they help few people and extremely rarely. Classic authoritarian formulas of suggestion rarely have an effect. Basically, hypnosis needs to be combined with explanatory therapy. The technique is completely different. Actually motivated, not authoritarian, suggestion, which is carried out when the patient is immersed in a drowsy state.

During the session, the hypnotherapist suggests to the patient that when anxiety appears, they can independently switch their attention to their surroundings so that the feeling of alienation becomes less.

The autogenic training system is another method that is used for depersonalization. The 1st stage of autogenic training is often used. When relaxation has been achieved and standard formulas have been applied, formulas similar to motivated suggestion begin to be applied.

When developing a treatment regimen, the doctor must choose between autogenic training and hypnosis, based on the patient’s personality traits. If a person has hysterical character traits, then it is better to use hypnosis. But basically the above 2 methods are combined.

Social rehabilitation

This treatment method is relevant for disorders of social adaptation in patients with depersonalization. This happens mainly in patients at the second stage of development of the syndrome. A special questionnaire is used to analyze a person’s social activity and personal characteristics:

• daily regime
• self-esteem
• value orientation
• hobbies and interests
• labor activity
• level of general development, etc.

Scales are used to determine the severity of violations. In this regard, stages of therapy are selected. When during treatment a person feels that his condition has improved, this fact is used as an emotional stimulus. Many patients strive to continue the treatment program because the number of their social achievements increases, which is positively assessed by the patients themselves.

Treatment of personality depersonalization disease

The treatment process is selected individually in each case, taking into account the patient’s specific reactions and the characteristics of the body’s functioning. Includes drug therapy and work with psychotherapists. Medicines are prescribed only after determining the causes of depersonalization and a diagnostic examination.

Emotional depersonalization

A type of depersonalization, which is characterized by a partial or complete loss of emotional perception and, as a result, a lack of reactions to current events. Sometimes they are expressed in a monotonous form, which is why people around them are not always able to understand the patient.

It is important to note that the loss of emotions extends not only to the positive spectrum (joy, love), but also to the negative aspects (bitterness, disappointment). The result is manic-depressive syndrome. Or a phenomenon called “psychic anesthesia” occurs. According to statistics, the emotional type of depersonalization occurs with the development of a disease of the third category. However, this does not exclude the possibility of development in other types of disorders.

Often the disorder manifests itself in people with heightened emotional reactivity. Previously expressed emotions are preserved in their memory: love for loved ones and friends, joyful moments, experiences. But now nothing evokes emotional responses. Works of art or music do not evoke past admiration or any thoughts. The person becomes indifferent to past activities and hobbies. The mood also cannot be classified into any category: neither negative nor emotional. The surrounding world does not cause any interest, because it loses its expressiveness in front of a person suffering from depersonalization.

With the somatic manifestation of the disease, pain may occur, food loses its taste, tenderness and touch no longer cause any emotional reactions. The disease also has a negative impact on intellectual activity, thinking and memory. After a short period of time, a person no longer remembers what goals and objectives he set for himself. And although the very fact of the events remains in the memory, it no longer has an emotional connotation.

In practice, the onset of mental anesthesia is diagnosed in adults (most often females) on the basis of a developing depressive state. In addition, such behavior can be a side effect of long-term use of prescribed psychotropic medications.

Autopsychic depersonalization

A characteristic feature of this type of depersonalization is a complete lack of awareness of one’s own “I”, and there is also no emotional component. Among the main complaints are the following: a person ceases to perceive his own thoughts, reactions to ongoing events and interactions with other people remain without emotion, and sometimes are completely absent.

Autopsychic depersonalization involves the loss of natural self-awareness, a sense of one’s own Self. All reactions come down to an automatic reaction. However, a person is aware of pathological changes, so there is no feeling that his consciousness is guided by higher powers. Despite the automaticity of all actions, a person fully understands that they are initiated by himself.

The development of pathological psychological anesthesia is also considered characteristic, since a person completely and to a greater extent loses any kind of emotional response (positive or negative). Similarity of reactions is found regardless of the situation. As a rule, most patients worry precisely because of the loss of emotional response.

All events and experiences are perceived as if they were happening to another person. The patient begins to observe the ongoing changes and events from the outside, taking the passive side. When the condition seriously deteriorates, the personality splits into several components. There is a feeling that someone else lives in a person besides him. Inconsistency in actions, reactions, and different ways of thinking appear.

This form of the disease is also characterized by panic and anxiety, which arises as a result of awareness of a mental disorder that has a destructive role in his life. There is also a reverse reaction, when a person does not want to admit the fact of the presence of a disease, as well as spreading pathological forms. Most often this happens due to the fear that the person is beginning to lose consciousness.

In psychiatric practice, one can often find another development of the situation when the disease proceeds more smoothly. The disease progresses gradually, without sudden jumps. Among the most common complaints of patients is the loss of their own self, and there is also a feeling that the person is becoming a similar copy of himself and observing his life from the outside.

Since autopsychic depersonalization causes serious damage to the emotional sphere and normal communication with other people, the patient often begins to minimize contact with relatives and friends. There are difficulties in remembering which activities were favorite; often a person can freeze in one groove for an indefinite period of time.

A severe form of the disease most often occurs in patients suffering from other mental disorders, for example, schizophrenia and cerebral pathologies.

Depersonalization of VSD

Among the main symptoms of the development of depersonalization in VSD, the following aspects can be distinguished:

1. Getting insufficient oxygen
2. Prevalence of depression
3. Temperature increase
4. Dizziness occurs frequently
5. Migraines of varying degrees of intensity.

As a rule, the development of dystonia often provokes a feeling of constant fatigue and weakness. In addition to complaints of impaired self-awareness, pain in the limbs also occurs. Most patients who have suffered from VSD for more than a year react especially acutely to weather changes.

The principles of treatment depend on the degree of development of the disease. Most often, inpatient treatment is carried out if uncontrollable fear develops, not a single medication helps in the fight against migraines, and self-control does not bring any results. In a critical situation, specialists can prescribe strong antipsychotics, sedatives, and tranquilizers.

To enhance the positive effect of treatment, it is also recommended to use additional therapeutic methods:

1. Completion of complex massage activities
2. Physiotherapeutic activities
3. Acupuncture
4. Use of antidepressants.

No less important is working with qualified psychologists who are able to help the patient solve the problem, stabilize his condition, and also find out the main causes of depersonalization.

Somatopsychic depersonalization

According to the theory of Yu.L. Nuller, somatopsychic depersonalization most often begins to develop in the initial period of the disease in its acute form. Among the most characteristic side symptoms that patients most often complain about is the lack of sensation of their own body or individual parts. Often ideas arise that the arms or legs have changed their shape or size.

Often the patient has the idea that he is missing clothes, they do not feel their touch on the body. However, objective sensitivity is not diagnosed, since the person continues to feel pain signals and the touch of another person. But the process takes place detachedly without any emotions. In addition, no physiological changes are detected in the limbs. Despite the fragmentation in their own sensations, patients understand reality and that their body has remained unchanged in shape.

The manifestation of a somatopsychic type of disorder can also include an absolute loss of the feeling of hunger or satiety. This is due to the fact that the previously most favorite dish no longer gives any satisfaction or positive emotions, so often a person becomes completely indifferent to eating and most often completely forgets to eat at the appointed time. As a result, not only the cyclical functioning of the body is disrupted, but side diseases associated with the functioning of the gastrointestinal tract may occur.

It is important to note that fulfilling any biological needs does not bring any satisfaction or relief, so often the patient begins to remember the need to perform some action when absolutely necessary, when the body begins to give signals.

For example, when taking a bath, complaints often arise that a person does not feel moisture on his skin or whether the water is used: hot or cold. Often the patient is not able to determine whether he has slept, since the feeling of rest is constantly absent. When visiting a psychotherapist, some people claim that they have gone without sleep for six months.

Somatic disorders cannot be avoided. Most often they are expressed in painful sensations in the back, spine, and headaches of varying intensity. At the slightest suspicion of depersonalization, the patient is subjected to a competent and comprehensive examination, since if the diagnosis is not dealt with, this can lead to the appearance of hypochondriacal delusions and split personality.