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1.
Medicine (Baltimore) ; 100(29): e26769, 2021 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-34398056

RESUMO

ABSTRACT: There is evidence for ketamine use in treatment-resistant depression (TRD). Several safety and tolerability concerns arise regarding adverse drug reactions and specific subpopulations. This paper aims to investigate the relationship between dissociative and psychometric measures in course of intravenous ketamine treatment in TRD inpatients with major depressive disorder and bipolar disorder.This study result represents safety data in a population of 49 inpatients with major depressive disorder and bipolar disorder subjects receiving eight 0.5 mg/kg of ketamine intravenous infusions, with a duration of 40 min each, as an add-on treatment to standard-of-care pharmacotherapy, registered in the naturalistic observational protocol of the tertiary reference unit for mood disorders (NCT04226963). The safety psychometrics assessed dissociation and psychomimetic symptomatology with the Clinician-Administered Dissociative States Scale (CADSS) the Brief Psychiatric Rating Scale (BPRS).The significant differences in CADSS scores between measurements in course of the treatment were observed (P = .003). No significant differences between BPRS measurements were made after infusions. In each case, both BPRS and CADSS values dropped to the "absent" level within 1 hour from the infusion. Neither CADSS nor BPRS scores were associated with the treatment outcome.The study demonstrates a good safety profile of intravenous ketamine as an add-on intervention to current psychotropic medication in TRD. The abatement of dissociation was observed in time with no sequelae nor harm. The study provides no support for the association between dissociation and treatment outcome.This study may be underpowered due to the small sample size. The protocol was defined as a study on acute depressive symptomatology without blinding.


Assuntos
Anestésicos Dissociativos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Ketamina/uso terapêutico , Administração Intravenosa , Adolescente , Adulto , Idoso , Anestésicos Dissociativos/administração & dosagem , Transtornos Dissociativos , Feminino , Humanos , Ketamina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Escalas de Graduação Psiquiátrica , Resultado do Tratamento , Adulto Jovem
2.
Medicine (Baltimore) ; 100(31): e26836, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397850

RESUMO

BACKGROUND: Endometrial tissue plays an important role in the regulation of female fertility and there is evidence that endometrial pathology (including endometriosis) is closely related to endocrine disorders. On the other hand, various neuroendocrine changes can be significantly affected by psychosocial stress. In connection with these findings, we tested the relationship between neuroendocrine changes, sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms in women with endometriosis. METHODS: A total of 65 patients with endometriosis were included in the study. Clinical examinations were focused on the biochemical analysis of neuroendocrine markers of endometriosis (cancer antigen 125 [CA 125] and cancer antigen 19-9 [CA 19-9]), estradiol, psychometric evaluation of sexual dysfunction, psychosocial/traumatic stress, and dissociative symptoms. RESULTS: The results showed significant Spearman correlations between the values of the revised range of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale), psychosocial/traumatic stress (Trauma Symptoms Checklist) (R = 0.31), and dissociative symptoms (Somatoform Dissociation Questionnaire) (R = 0.33). Positive correlations were also found between CA 125 and CA 19-9 (R = 0.63), and between CA 125 and the results of the values of the revised scale of sexual difficulties for sexual dysfunction (Revised Female Sexual Distress Scale) (R = 0.29). Also psychosocial/traumatic stress (Trauma Symptoms Checklist) significantly correlated with CA 125 (R = 0.38) and with CA 19-9 (R = 0.33). CONCLUSION: These results represent the first findings regarding the relationship of the neuroendocrine markers CA 125 and CA 19-9 and sexual dysfunction with trauma/stress-related symptoms and dissociative symptoms in women with endometriosis.


Assuntos
Antígeno Ca-125/sangue , Antígeno CA-19-9/sangue , Endometriose , Trauma Psicológico , Disfunções Sexuais Fisiológicas , Transtornos Somatoformes , Adulto , Correlação de Dados , Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/psicologia , Endometriose/sangue , Endometriose/complicações , Endometriose/psicologia , Feminino , Humanos , Sistemas Neurossecretores/metabolismo , Técnicas Psicológicas , Trauma Psicológico/complicações , Trauma Psicológico/diagnóstico , Trauma Psicológico/fisiopatologia , Psicologia , Disfunções Sexuais Fisiológicas/sangue , Disfunções Sexuais Fisiológicas/psicologia , Transtornos Somatoformes/diagnóstico , Transtornos Somatoformes/fisiopatologia , Transtornos Somatoformes/psicologia
3.
Behav Ther ; 52(5): 1067-1079, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34452662

RESUMO

Fears of pain, injury, and death may represent key barriers to acting on suicidal thoughts. Dissociation, which involves a disconnection from one's body, may reduce fears and sensations of pain associated with harming the body, in turn facilitating suicide attempts. This study examined whether dissociation differentiated individuals with a history of suicide attempts from those with a history of suicide ideation, and investigated whether other relevant constructs explain this relationship. Sample 1 included 754 undergraduates (Mage = 21, 79% female) who completed a battery of self-report measures. Sample 2 included 247 undergraduates (Mage = 19, 74% female) who completed a self-report measure of dissociation, a clinical interview regarding suicide history, and four counterbalanced behavioral pain tolerance tasks. In both samples, dissociation was elevated in lifetime attempters compared to ideators (d = 0.28; d = 0.46; ps = 0.01) and slightly elevated in lifetime ideators compared to nonsuicidal individuals (d = 0.19, p = .02; d = 0.24, p = .47), though this effect was non-significant in the latter sample. In Sample 1, dissociation no longer differentiated attempters from ideators after controlling for clinical covariates. In Sample 2, dissociation was unrelated to behavioral pain tolerance tasks, and these tasks did not account for the association between dissociation and attempts. Overall, dissociation differentiated individuals with a history of suicide attempts from those with ideation alone in both samples. Pain tolerance did not explain this association; instead, it is possible that the relationship of dissociation to suicide attempts is due to "third variables" associated with both phenomena, such as symptoms of borderline personality disorder or posttraumatic stress disorder.


Assuntos
Transtorno da Personalidade Borderline , Ideação Suicida , Adulto , Transtornos Dissociativos , Feminino , Humanos , Masculino , Limiar da Dor , Fatores de Risco , Tentativa de Suicídio , Adulto Jovem
4.
J Psychiatr Res ; 141: 353-357, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34304040

RESUMO

Conversion disorder, also called Functional Neurological Symptom Disorder is poorly understood by many in the medical profession and is associated with considerable health care costs. Sigmund Freud, in an early, pre-psychoanalytic period paper, suggested that hysterical motor paralyses arose from a "functional or dynamic lesion" which was no different from an organic one, but rather an altered expression of it. He linked this functional brain disturbance to an excess of affect, a faulty conceptualization on the part of the symptomatic individual of how the affected organ works, and elements of dissociation and dual consciousness. One hundred and thirty years later converging functional imaging studies provide support for the excess affect component of his hypothesis. A small but growing fMRI literature has revealed bottom-up hyperactive neural activity in limbic regions and a potential failure of top-down regulation from prefrontal regions. Aberrant functional connectivity of limbic-motor regions now provides a mechanistic model that sheds light on an early Freudian theory explaining, in part, how symptoms of Conversion Disorder arise.


Assuntos
Transtorno Conversivo , Encéfalo/diagnóstico por imagem , Transtorno Conversivo/diagnóstico por imagem , Transtornos Dissociativos , Humanos , Imageamento por Ressonância Magnética , Masculino , Neuroimagem
5.
Tijdschr Psychiatr ; 63(6): 455-461, 2021.
Artigo em Holandês | MEDLINE | ID: mdl-34231865

RESUMO

BACKGROUND: Conversion and dissociation in their relationship have made a lot of pendulum movements over time between moving together and away from each other. In the run-up to the introduction of DSM-5, it was argued that conversion should be classified as a dissociative disorder, but this didn't happen. AIM: In this article, the clinical scientific evidence is examined for the relationship between conversion and dissociation. We provide an overview of the recent clinical studies that examine both syndromes together. We also investigate the main overlapping predisposing characteristics and psychopathological explanatory models of both syndromes. METHOD: Literature review in PubMed and PsycArticles. RESULTS: Our findings confirm that there is a large comorbidity between conversive and dissociative symptoms in clinical reality. Both syndromes have a high prevalence of reported trauma and emotion dysregulation. However, evidence for present biomarkers is still llimited. The underlying explanation models are applicable for both conversion and dissociation. CONCLUSION: We want to draw attention to the plea to bring conversion disorders back together with dissociative disorders. Moreover, the possible presence of trauma, the influential role of psychosocial stressors, the present psychiatric co-morbidity and the style of emotion regulation seem to justify the approach to conversion problems from a biopsychosocial perspective rather than from a purely biomedical perspective.


Assuntos
Transtorno Conversivo , Transtornos Dissociativos , Comorbidade , Transtorno Conversivo/diagnóstico , Transtorno Conversivo/epidemiologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Transtornos Dissociativos/diagnóstico , Transtornos Dissociativos/epidemiologia , Emoções , Humanos
6.
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285029

RESUMO

A 20-year-old man was admitted to an inpatient psychiatric unit for self-professed dissociative identity disorder. His presentation of multiple personalities without amnesia, dissociation or depersonalisation led to further examination of personality and cultural factors that may contribute to this uncommon presentation. Careful clinical investigation supported a diagnosis of schizotypal personality disorder with elements of fantastical thinking influenced by media presentations of dissociative identity disorder.


Assuntos
Transtorno Dissociativo de Identidade , Transtorno da Personalidade Esquizotípica , Adulto , Amnésia , Transtornos Dissociativos , Transtorno Dissociativo de Identidade/diagnóstico , Humanos , Masculino , Transtorno da Personalidade Esquizotípica/diagnóstico , Adulto Jovem
7.
Epilepsy Behav ; 122: 108156, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34175664

RESUMO

Limited research exists exploring the experiences of psychological therapy providers (PTPs) working with people with dissociative seizures (DS). PTPs play a key role in the treatment of DS, yet sit at the end of a long, often ineffective process of diagnosis and waiting before treatment can commence. This qualitative study was undertaken involving 12 PTPs from specialist DS services throughout England and Scotland. Semi-structured interviews were carried out, using thematic analysis to evaluate the data. Four key themes were identified, "neurological to psychological", "putting the person with DS at the center", "treatment process", and "issues and impact of therapy with patients with DS". The findings showed that an unclear and uncomprehended diagnosis, together with waiting times had a detrimental impact on patients at the starting point of therapy. People with DS were perceived as a heterogeneous group whose treatment needed to be individualized, using the PTPs' full 'toolkit' of modalities and techniques, with a focus on improving quality of life, rather than reducing seizures. The study highlighted the complexity for PTPs of working with major but also accumulated minor traumas, compounded by the impact of DS on both PTPs and treatment. The desire of PTPs to be totally patient-focused meant that individualized treatment was considered essential and meant that participants were doubtful about the possibility of compiling an effective manual for the psychological treatment for DS.


Assuntos
Transtorno Conversivo , Qualidade de Vida , Transtornos Dissociativos/terapia , Humanos , Pesquisa Qualitativa , Convulsões/terapia
8.
Brain Behav ; 11(7): e02200, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34105902

RESUMO

INTRODUCTION: Recent research suggests that traumatized patients are characterized by disrupted resting-state functional connectivity. We examined whether neural networks involved in resting-state change over the course of a phase-oriented inpatient treatment for complex traumatized and dissociative disorder patients. We also investigated associations between these network alterations and clinical symptoms and emotion regulation skills. METHODS: Pre- and post-treatment, electroencephalography (EEG) was recorded during resting-state in patients (n = 23) with a complex dissociative disorder (CDD) or complex posttraumatic stress disorder (cPTSD). Patients also completed clinical and emotion regulation questionnaires. To reduce variance in the collected data, patients were exclusively tested as one prototypical dissociative part referred to as Apparently Normal Part (ANP). Functional network connectivity was examined and compared with a matched healthy control group (n = 37), also measured twice. RESULTS: Prior to treatment and compared with controls, patients had a significantly lower functional connectivity strength within eyes-open and eyes-closed resting-state networks in the theta and alpha frequency band. Following treatment, functional connectivity strength within these networks was comparable to the control group and comprised areas belonging to the default mode network (DMN) and prefrontal as well as anterior cingulate control regions. Treatment-related network normalizations in the theta frequency band were associated with a self-reported increase in the use of cognitive reappraisal strategies and reduction in emotion regulation difficulties. CONCLUSION: Phase-oriented trauma treatment can strengthen resting-state network connectivity and can increase the capacity of complex traumatized and dissociative patients as ANP to handle emotional challenges effectively.


Assuntos
Transtornos de Estresse Pós-Traumáticos , Encéfalo , Mapeamento Encefálico , Transtornos Dissociativos/terapia , Humanos , Pacientes Internados , Imageamento por Ressonância Magnética , Vias Neurais/diagnóstico por imagem , Transtornos de Estresse Pós-Traumáticos/terapia
9.
Artigo em Inglês | MEDLINE | ID: mdl-34065023

RESUMO

Understanding the predictors of belief in COVID-related conspiracy theories and willingness to get vaccinated against COVID-19 may aid the resolution of current and future pandemics. We investigate how psychological and cognitive characteristics influence general conspiracy mentality and COVID-related conspiracy theories. A cross-sectional study was conducted based on data from an online survey of a sample of Czech university students (n = 866) collected in January 2021, using multivariate linear regression and mediation analysis. Sixteen percent of respondents believed that COVID-19 is a hoax, and 17% believed that COVID-19 was intentionally created by humans. Seven percent of the variance of the hoax theory and 10% of the variance of the creation theory was explained by (in descending order of relevance) low cognitive reflection, low digital health literacy, high experience with dissociation and, to some extent, high bullshit receptivity. Belief in COVID-related conspiracy theories depended less on psychological and cognitive variables compared to conspiracy mentality (16% of the variance explained). The effect of digital health literacy on belief in COVID-related theories was moderated by cognitive reflection. Belief in conspiracy theories related to COVID-19 was influenced by experience with dissociation, cognitive reflection, digital health literacy and bullshit receptivity.


Assuntos
COVID-19 , Letramento em Saúde , Cognição , Estudos Transversais , Transtornos Dissociativos , Humanos , SARS-CoV-2
10.
J Psychiatr Res ; 140: 53-59, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34091347

RESUMO

OBJECTIVE: Psychiatric impact of COVID-19 is still explored and previous data suggest potential risks of anxiety, depression and PTSD related to COVID-19. We aimed to explore the predictive value of risk factors during hospitalization (T0) for COVID-19 for anxiety, depression and PTSD and at three months (T1) because they could differ over these two time points. METHODS: We performed a screening of mental suffering in hospitalized patients for COVID-19, as well as specialized care and three months longitudinal follow-up. We evaluated at T0 and at T1 the prevalence of anxiety, depression and PTSD in survivors who benefited from early detection and treatment, and assessed possible risk factors in adults surviving COVID-19 between the 30th March and the 1st of July 2020. RESULTS: 109 patients were screened at T0 and 61 of these were reassessed at T1. At T0, we found 44.9% pathological score on peritraumatic dissociation experiences questionnaire (PDEQ), 85.4% of post-traumatic stress disorder symptoms (PTSS), 14.6% of pathological rate of post-traumatic stress disorder scale 5 (PCL5) and at T1, 86.9% of PTSS, 10.6% of pathological rate of PCL5. Finally, PDEQ score at T0 during hospitalization was positively correlated to PCL-5 score at T1 (ß = 0.26, p = 0.01) and that was confirmed in multivariate analysis (ß = 0.04, p = 0.02 for the log of PCL-5 per point on the PDEQ). CONCLUSION: Screening of psychiatric symptoms during hospitalization for COVID-19 should be systematic, especially peritraumatic dissociation to offer an early treatment and prevent PTSD, which seemed frequent for hospitalized patients for COVID-19 at three months.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Adulto , Transtornos Dissociativos/epidemiologia , Humanos , Estudos Longitudinais , SARS-CoV-2 , Transtornos de Estresse Pós-Traumáticos/epidemiologia
11.
J Psychiatr Res ; 138: 485-491, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33965737

RESUMO

BACKGROUND: Dissociative symptoms have been constantly found in schizophrenia (SCZ). Traumatic experience seems to relate to dissociative symptoms and brain volume alterations in SCZ. The current study aimed to clarify the inter-relations of dissociative symptoms, traumatic experience, and brain volume in SCZ. METHODS: We employed voxel-based morphometry to compare the distributions of gray matter volumes (GMV) in 37 SCZ patients and 26 healthy volunteers (HV). All participants underwent T1-weighted images on a 1.5 T MRI system. Traumatic experience was examined by the Brief Betrayal Trauma Survey. Pathological and non-pathological dissociation were measured by the Dissociative Symptoms Scale and the Dissociative Experiences Scale, respectively. RESULTS: A GMV reduction was found in SCZ patients in the right thalamus. Importantly, a significant group by pathological dissociation interaction was observed in the medial frontal cortex (MFC), bilateral anterior insular area, and precuneus. A negative correlation between MFC/insular GMV and pathological dissociation was observed in HV; higher non-pathological dissociation and smaller volume in MFC/insula were associated with pathological dissociation. In contrast, higher traumatic experience, higher non-pathological dissociation, and larger volume in MFC/insula were associated with pathological dissociation in SCZ. CONCLUSION: The negative association between MFC/insula GMV and pathological dissociation in HV was not observed in SCZ patients. The absent negative association in SCZ suggests a unique neural underpinning in SCZ with dissociative pathology, in which medial frontal and temporal regions play crucial roles.


Assuntos
Substância Cinzenta , Esquizofrenia , Encéfalo , Córtex Cerebral , Transtornos Dissociativos/diagnóstico por imagem , Substância Cinzenta/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Esquizofrenia/complicações , Esquizofrenia/diagnóstico por imagem
12.
Epilepsy Behav ; 121(Pt A): 108044, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34051606

RESUMO

OBJECTIVE: To investigate neuroanatomical changes in patients with psychogenic nonepileptic seizures (PNES) compared to major depressive disorder (MDD) and healthy controls. METHODS: Forty-two drug-naïve PNES subjects and 25 patients with MDD, matched for demographic characteristics and level of depression (as measured by Beck Depression Inventory-II, BDI-II), were consecutively recruited. Patients performed an extensive neuropsychiatric assessment including: Hamilton Anxiety Rating Scale, Traumatic Experience Checklist, Dissociative Experiences Scale, Toronto Alexithymia Scale and Somatoform Dissociation Questionnaire (SDQ-20). All patients, together with 78 healthy matched controls, underwent 3T brain MRI followed by surface-based morphometry. RESULTS: Cortical thickness analysis revealed significant cortical thinning in bilateral medial orbitofrontal cortex (OFC) and left rostral anterior cingulate cortex (ACC) in patients with MDD compared to subjects with PNES and controls. Interestingly, increased thickness of the right pars triangularis was found in PNES subjects compared to controls. PNES showed higher scores in SDQ-20 (p < 0.001) compared to MDD, which was corroborated by neuroimaging data, where somatoform dissociation scores correlated with morphological changes in the left medial OFC. CONCLUSION: Our results show selective cortical thinning over the medial OFC in patients with PNES compared to wider regions of thinning in patients with MDD. Somatoform dissociation was the only psychopathological assessment significantly different in PNES and MDD.


Assuntos
Transtorno Depressivo Maior , Ansiedade , Transtornos de Ansiedade , Transtornos Dissociativos , Humanos , Convulsões
13.
Neurology ; 97(5): e464-e475, 2021 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-34031196

RESUMO

OBJECTIVE: Knowledge regarding psychiatric disorders in children and adolescents with psychogenic nonepileptic seizures (PNES) is limited. This study outlines the spectrum and risk of psychiatric disorders in childhood-onset PNES. METHODS: We performed a nationwide matched cohort study of children and adolescents with PNES 5 to 17 years of age at the time of diagnosis between January 1, 1996, and December 31, 2014. Two matched comparison groups were included: children and adolescents with epilepsy (ES) and children and adolescents without PNES or epilepsy, called healthy controls (HC). Outcomes were prevalent psychiatric disorders before index (i.e., date of diagnosis or corresponding date for HC) and incident psychiatric disorders 2 years after index. Relative risks (RRs) were calculated and adjusted for potential confounders. RESULTS: We included 384 children and adolescents with validated PNES, 1,152 with ES, and 1,920 HC. Among the cases of PNES, 153 (39.8%) had prevalent psychiatric disorders and 150 (39.1%) had incident psychiatric disorders. Compared to the ES and HC groups, children and adolescents with PNES had elevated risks of both prevalent psychiatric disorders (adjusted RRPNES/ES 1.87, 95% confidence interval [CI] 1.59-2.21, adjusted RRPNES/HC 5.54, 95% CI 4.50-6.81) and incident psychiatric disorders (adjusted RRPNES/ES 2.33, 95% CI 1.92-2.83, adjusted RRPNES/HC 8.37, 95% CI 6.31-11.11). A wide spectrum of specific psychiatric disorders displayed elevated RRs. CONCLUSIONS: Children and adolescents with PNES are at higher risk of a wide range of psychiatric disorders compared to children and adolescents with ES and HC. A careful psychiatric evaluation is warranted to optimize and individualize treatment.


Assuntos
Transtornos Dissociativos/complicações , Transtornos Dissociativos/psicologia , Transtornos Mentais/complicações , Transtornos Mentais/psicologia , Convulsões/complicações , Convulsões/psicologia , Adolescente , Sintomas Afetivos/complicações , Sintomas Afetivos/epidemiologia , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Eletroencefalografia , Feminino , Humanos , Incidência , Classificação Internacional de Doenças , Masculino , Transtornos Mentais/epidemiologia , Pais , Prevalência , Sistema de Registros , Medição de Risco
14.
BMC Psychiatry ; 21(1): 266, 2021 05 24.
Artigo em Inglês | MEDLINE | ID: mdl-34024281

RESUMO

BACKGROUND: Although numerous studies have supported the role of childhood maltreatment in the etiology of psychosis, underlying mechanisms have not been well understood yet. The present study aimed to investigate the mediating role of particular forms of dissociation in the relationship between five major types of childhood abuse and psychotic symptoms among patients with schizophrenia spectrum and other psychotic disorders. METHODS: In this cross-sectional correlation study, 70 first-episode psychotic patients and 70 chronic psychotic patients were selected by systematic random sampling (with the sampling interval of 3) from among inpatients and outpatients referring to Baharan Psychiatric hospital, Zahedan, Iran, and were matched based on age, gender, and education level. Moreover, 70 age-, gender-, and education level-matched community controls were recruited from hospital staff and their relatives and friends. All of the participants completed a research interview and questionnaires. Data on experiences of childhood maltreatment, psychosis, dissociation, and demographics were collected and analyzed by SPSS V25 software. RESULTS: The obtained results revealed that the mean scores of sexual abuse, emotional abuse, and physical abuse were higher in psychotic patients than community controls (without any significant difference between first-episode psychotic patients and chronic psychotic patients). Furthermore, the highest mean scores of dissociative experiences belonged to chronic psychotic patients. Multiple-mediation also indicated that absorption and dissociative amnesia played a mediating role in the relationship between sexual abuse and positive symptoms. Moreover, this study demonstrated the role of physical abuse in predicting psychotic symptoms even in the absence of sexual abuse. CONCLUSIONS: This study illustrated specific associations among childhood maltreatment, dissociative experiences, and psychotic symptoms in the clinical population. Thus, to provide appropriate interventions, patients with schizophrenia spectrum and other psychotic disorders were asked about a wide range of possible adverse childhood experiences and dissociative experiences. Nevertheless, further studies using prospective or longitudinal designs need to be carried out to realize the differential contribution of various forms of childhood maltreatment and their potential interactions, more precisely.


Assuntos
Maus-Tratos Infantis , Transtornos Psicóticos , Delitos Sexuais , Criança , Estudos Transversais , Transtornos Dissociativos/etiologia , Humanos , Irã (Geográfico)/epidemiologia , Estudos Prospectivos , Transtornos Psicóticos/epidemiologia , Transtornos Psicóticos/etiologia , Inquéritos e Questionários
15.
Curr Psychiatry Rep ; 23(6): 37, 2021 04 28.
Artigo em Inglês | MEDLINE | ID: mdl-33909198

RESUMO

PURPOSE OF REVIEW: The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. RECENT FINDINGS: Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.


Assuntos
Transtorno da Personalidade Borderline , Transtornos de Estresse Pós-Traumáticos , Transtorno da Personalidade Borderline/terapia , Transtornos Dissociativos , Emoções , Lobo Frontal , Humanos
16.
J Phys Chem B ; 125(15): 3815-3823, 2021 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-33826329

RESUMO

While extensive studies have been carried out to determine protein-RNA binding affinities, mechanisms, and dynamics in vitro, such studies do not take into consideration the effect of the many weak nonspecific interactions in a cell filled with potential binding partners. Here we experimentally tested the role of the cellular environment on affinity and binding dynamics between a protein and RNA in living U-2 OS cells. Our model system is the spliceosomal protein U1A and its binding partner SL2 of the U1 snRNA. The binding equilibrium was perturbed by a laser-induced temperature jump and monitored by Förster resonance energy transfer. The apparent binding affinity in live cells was reduced by up to 2 orders of magnitude compared to in vitro. The measured in-cell dissociation rate coefficients were up to 2 orders of magnitude larger, whereas no change in the measured association rate coefficient was observed. The latter is not what would be anticipated due to macromolecular crowding or nonspecific sticking of the uncomplexed U1A and SL2 in the cell. A quantitative model fits our experimental results, with the major cellular effect being that U1A and SL2 sticking to cellular components are capable of binding, just not as strongly as the free complex. This observation suggests that high binding affinities measured or designed in vitro are necessary for proper binding in vivo, where competition with many nonspecific interactions exists, especially for strongly interacting species with high charge or large hydrophobic surface areas.


Assuntos
RNA Nuclear Pequeno , Ribonucleoproteína Nuclear Pequena U1 , Sítios de Ligação , Transtornos Dissociativos , Humanos , Ligação Proteica , RNA/metabolismo , RNA Nuclear Pequeno/metabolismo , Ribonucleoproteína Nuclear Pequena U1/metabolismo , Spliceossomos/metabolismo
17.
Med Hypotheses ; 150: 110567, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33799161

RESUMO

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis patients demonstrate characteristic multistage progression and movement disorders, which are analogous to hystero-epilepsy in Jean-Martin Charcot's Tuesday Lessons. First, based on a review of the Tuesday Lessons recorded by Charcot's pupils, we hypothesized that there were patients with anti-NMDAR encephalitis among those diagnosed with hystero-epilepsy in the nineteenth century. We found acute-onset multiple neuropsychiatric manifestations resembling anti-NMDAR encephalitis among patients with hystero-epilepsy. Patients with drug withdrawal syndrome, dissociative and conversion disorders and patients under hypnosis from the modern point of view were also identified. These results suggested that hystero-epilepsy in the Tuesday Lessons could encompass dissociative and conversion disorders, hypnosis, drug withdrawal syndrome, and anti-NMDAR encephalitis-like manifestations. Based on Charcot's observations and current progress in molecular biology, such as the identification of glutamate/NMDAR system dysfunction in drug withdrawal syndrome, we then hypothesized that patients with dissociative and conversion disorders and those under hypnosis could also have hypofunction of the glutamatergic system. The NMDAR hypofunction hypothesis is emerging as a pathogenesis of schizophrenia. NMDAR antagonists are known to evoke symptoms similar to schizophrenia, anti-NMDAR encephalitis and near-death experiences. In current clinical reports, spectrum disorders such as dissociative disorder and conversion disorder have been observed in patients with anti-NMDAR encephalitis. Our hypothesis will offer an expansion of the NMDAR hypofunction hypothesis from psychosis to functional neurological disorders and normal specific situations, such as hypnosis, thanatosis, and near-death experiences.


Assuntos
Encefalite Antirreceptor de N-Metil-D-Aspartato , Epilepsia , Transtornos Dissociativos , Epilepsia/complicações , Humanos , Receptores de Glutamato , Receptores de N-Metil-D-Aspartato
18.
Anal Chim Acta ; 1159: 338382, 2021 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-33867041

RESUMO

Herein, we originally aimed at developing fluorescence anisotropy biosensor platforms devoted to the homogeneous-phase detection of isocarbophos and phorate pesticides by using previously isolated DNA aptamers. To achieve this, two reporting approaches displaying very high generalizability features were implemented, based on either the complementary strand or the SYBR green intercalator displacement strategies. Unfortunately, none of the transduction methods led to phorate-dependent signals. Only the SYBR green displacement method provided a small output in the presence of isocarbophos, but at an analyte concentration greater than 100 µM. In order to identify the origin of such data, isothermal titration calorimetry (ITC) experiments were subsequently performed. It was shown that aptamers bind neither isocarbophos nor phorate in free solution with the claimed micromolar dissociation constants. This work puts forward some doubts about the previously described aptasensors that rely on the use of these functional DNA molecules. It also highlights the need to carefully investigate the binding capabilities of aptamers after their isolation and to include appropriate control experiments with scrambled or mutated oligonucleotides.


Assuntos
Aptâmeros de Nucleotídeos , Técnicas Biossensoriais , Praguicidas , DNA , Transtornos Dissociativos , Humanos
19.
Psychol Addict Behav ; 35(3): 247-262, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33646797

RESUMO

OBJECTIVE: Multilevel consequences related to gambling disorder (GD) are glaring enough to make gambling a worldwide public health issue. Dissociation has been pointed out in clinical, empirical, and theoretical contributions as a key variable accounting for the development and maintenance of GD. However, we still lack a systematization of available empirical data that may facilitate further accurate conclusions. METHOD: A systematic review and meta-analysis were performed with the goal to answer to open questions. We followed the PRISMA guidelines conducting a systematic search of 5 scientific databases (PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, and PubMed) including grey literature. RESULTS: A total of 843 records were screened, and 20 studies were included in the qualitative and quantitative analyses. A systematic review of selected studies outlines the high heterogeneity in the operationalization of the dissociation construct as well as the absence of studies examining the role played by the specific dimensions of the pathological dissociative feature in GD. A significant, positive, and moderate effect size (r = .37) was found linking GD to dissociation. Moreover, this effect appears to not be moderated by the quality of studies, age, and gender of participants nor measures used to evaluate dissociation. CONCLUSIONS: Despite empirical evidences supporting the theoretical assertions toward the relationship between GD and dissociation, few studies have reached an articulated understanding of this topic, mostly failing to identify specific dissociative features involved in GD. Furthermore, the existence of the current gap in the literature are discussed to delineate future lines of research. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Transtornos Dissociativos/psicologia , Jogo de Azar/psicologia , Humanos
20.
Am J Psychiatry ; 178(5): 383-399, 2021 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-33726522

RESUMO

Replicated international studies have underscored the human and societal costs associated with major depressive disorder. Despite the proven efficacy of monoamine-based antidepressants in major depression, the majority of treated individuals fail to achieve full syndromal and functional recovery with the index and subsequent pharmacological treatments. Ketamine and esketamine represent pharmacologically novel treatment avenues for adults with treatment-resistant depression. In addition to providing hope to affected persons, these agents represent the first non-monoaminergic agents with proven rapid-onset efficacy in major depressive disorder. Nevertheless, concerns remain about the safety and tolerability of ketamine and esketamine in mood disorders. Moreover, there is uncertainty about the appropriate position of these agents in treatment algorithms, their comparative effectiveness, and the appropriate setting, infrastructure, and personnel required for their competent and safe implementation. In this article, an international group of mood disorder experts provides a synthesis of the literature with respect to the efficacy, safety, and tolerability of ketamine and esketamine in adults with treatment-resistant depression. The authors also provide guidance for the implementation of these agents in clinical practice, with particular attention to practice parameters at point of care. Areas of consensus and future research vistas are discussed.


Assuntos
Antidepressivos/uso terapêutico , Transtorno Depressivo Maior/tratamento farmacológico , Transtorno Depressivo Resistente a Tratamento/tratamento farmacológico , Antagonistas de Aminoácidos Excitatórios/uso terapêutico , Ketamina/uso terapêutico , Atenção à Saúde , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Resistente a Tratamento/psicologia , Transtornos Dissociativos/induzido quimicamente , Humanos , Hipertensão/induzido quimicamente , Ciência da Implementação , Sintomas do Trato Urinário Inferior/induzido quimicamente , Monitorização Fisiológica , Seleção de Pacientes , Admissão e Escalonamento de Pessoal , Psicoses Induzidas por Substâncias/etiologia , Transtornos Relacionados ao Uso de Substâncias , Ideação Suicida
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