Evidence-based treatment for Depersonalisation-derealisation Disorder (DPRD)

Abstract

BackgroundDepersonalisation-derealisation disorder (DPRD) is a distressing and impairing condition with a pathophysiology that is not well understood. Nevertheless, given the growing interest in its pathogenesis, and the publication of a number of treatment trials, a systematic review of randomised controlled pharmacotherapy and psychotherapy trials is timely.MethodsA systematic search of articles on DPRD published from January 1980 to August 2012, using Cochrane methods, was conducted. All randomised controlled trials (RCTs) of pharmacotherapy, psychotherapy, somatic interventions and a blend of these modalities for the treatment of depersonalisation disorder were included in the review. Searches were carried out on multiple databases. The bibliographies of all identified trials were checked for additional studies and authors were contacted for published trials. No unpublished trials were found and no restrictions were placed on language and setting. Data extraction sheets were further designed to enter specified data from each trial and risk of bias information was identified. PRISMA guidelines were also followed to ensure that our methodology and reporting were comprehensive. Of the unique 1296 papers that were retrieved, four studies met the inclusion criteria and were reviewed.ResultsFour RCTs (all within the duration of 12 weeks or less) met study criteria and were included (180 participants; age range 18–65 years). The four RCTs included two lamotrigine studies, one fluoxetine study and one biofeedback study. Evidence for the treatment efficacy of lamotrigine was found in one study (Cambridge Dissociation Scale, CDC: p < 0.001) with no evidence of effect for lamotrigine in the second study (CDS: p = 0.61 or Present State Examination: p = 0.17). Fluoxetine and biofeedback were not more efficacious than the control condition, although there was a trend for fluoxetine to demonstrate greater efficacy in those with comorbid anxiety disorder. The four studies had 'low' or 'unclear' risk of bias.ConclusionThe limited data from randomised controlled trials on the pharmacotherapy and psychotherapy of DPRD demonstrates inconsistent evidence for the efficacy of lamotrigine, and no efficacy for other interventions. Additional research on this disorder is needed.

Postpartum Onset Depersonalization- a Rare Case Report

“…3 On the contrary, our case was managed using non-pharmacological approach. Further, he mentions that there is yet to be recognized psychological treatment for depersonalization though there have been case report citing the use of behavior therapy, directive therapy, Psycho-analytical therapy and Cognitive -Behavioral model of depersonalization.…”

“…4 In our case, onset of depersonalization was 72hrs post partum but the patient orientation was not affected. Somer Eli et al 3 review indicated that depersonalization symptoms can occur in medical condition especially neurological for instance migraine and epilepsy and psychiatric morbidities including depression, panic disorder, post traumatic stress disorder, schizophrenia and stress. There is no history of aforementioned diseases except for stress, as childbirth is often a traumatic experience perceived as stress.…”

“…There is no history of aforementioned diseases except for stress, as childbirth is often a traumatic experience perceived as stress. 3 Cohen P 5 reported minocycline and cited innumerable medications which may be associated with depersonalization disorder. On contrary, the patient was not on any of the medications that could have accounted for the symptoms.…”

“…2 Further, studies have demonstrated inconsistent evidence for efficacy of both psychotropic and psychological intervention in management of depersonalization disorder. 3 It seems this postpartum case with primary depersonalization which was effectively managed with psycho-education and Yoga is first to be reported.…”

“…2 Some literature points out women are more commonly affected as compared to men whereas others have mentioned it affects both gender equally. 2,3 Proportion of individual in which depersonalization occurs primarily or in isolated form is minimal. 2 Further, studies have demonstrated inconsistent evidence for efficacy of both psychotropic and psychological intervention in management of depersonalization disorder.…”