Adolescent ; Humans ; Sex Factors ; Dissociative Disorders

OBJECTIVE: Unipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms. METHODS: Thrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II). RESULTS: We found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors. CONCLUSION: Our study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.
Bipolar Disorder* ; Comorbidity ; Depression ; Diagnostic Errors ; Dissociative Disorders ; Humans ; Mood Disorders ; Neurobiology ; Outpatients ; Treatment Failure

OBJECTIVE: To explore the role of trauma and dissociation over self-injurious behaviors (SIB) and suicide attempts (SA) in adolescents. METHODS: A total of 207 adolescents participated in the study. After conducting diagnostic interview, participants were divided into five groups as subjects with dissociative disorders (DD), attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD) and anxiety disorders (AD), and a control group (CG) without any psychiatric disorder. ADHD, MDD and AD groups were considered as non-dissociative disorders (non-DD group) in the present study. RESULTS: There is no significant difference between groups in terms of number and age of the subjects (p>0.05). Among all participants SIB was reported in 32.2% of females (n=37) and 25% of males (n=23) while SA was reported in 29.6% of females (n=34) and 4.4% of males (n=4). Adolescents with DD were found to experience higher rates of SIB and SA than the other groups. Dissociation was the most important variable contributing to SIB and female gender was the most efficient variable for SA. Total trauma scores were also found to be significantly higher in DD group followed by non-DD and CG respectively. CONCLUSION: SIB and SA are complex behavioral problems which may be associated with many psychiatric factors. However higher level dissociation seems as an important mediating factor, even regardless of psychiatric diagnosis, in the development of SIB and SA. More research is needed to further explore the factors effective over SIB and SA in adolescents.
Adolescent* ; Anxiety Disorders ; Attention Deficit Disorder with Hyperactivity ; Depressive Disorder, Major ; Dissociative Disorders ; Female ; Humans ; Male ; Mental Disorders ; Negotiating ; Problem Behavior ; Self-Injurious Behavior ; Suicide*

Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.
Asia ; Child ; Child Abuse ; Diagnosis ; Diagnosis, Differential ; Diagnostic and Statistical Manual of Mental Disorders ; Dissociative Disorders ; Far East ; Humans ; Inpatients ; Korea* ; Multiple Personality Disorder ; Neuroimaging ; Prevalence

PURPOSE: The purposes of the study were to investigate childhood traumatic experiences and social support that might influence dissociative symptoms in Marine soldiers. METHODS: A cross-sectional study design was used with participants who were soldiers (n=122) assigned to one Marine corps in Ganghwa Island in the study. Data were collected on September 2015 through self-report using the Childhood Trauma Questionnaire, Social Provisions Scale (SPS), and Dissociative Experience Scale. Descriptive analysis, t-test, ANOVA, Pearson's correlation coefficients and stepwise multiple regression were performed. RESULTS: A total of 11.5% self-reported experiencing over three types of trauma; emotional neglect 34.4%, physical neglect 32.8%, emotional abuse 11.5%, physical abuse 11.5%, and sexual abuse 9.8%. For all subscales of the SPS, means of item were as high as three out of four points. A total of 9.0% were likely to be dissociative disorder. Sexual abuse, attachment, and opportunity for nurturance were found to be significant factors influencing dissociative symptoms. CONCLUSION: Future military enlistment in Marines should include assessment of childhood trauma and dissociation to identify maladaptive soldiers. Because soldiers who experienced childhood sexual abuse are likely to show dissociative symptoms, military nurses should assess their social support and try to enhance attachment in order to prevent dissociative symptoms.
Cross-Sectional Studies ; Dissociative Disorders ; Humans ; Military Personnel* ; Sex Offenses

It has been claimed that the progress of psychiatry has lagged behind that of other medical disciplines over the last few decades. This may suggest the need for innovative thinking and research in psychiatry, which should consider neglected areas as topics of interest in light of the potential progress which might be made in this regard. This review is concerned with one such field of psychiatry: dissociation and dissociative disorders. Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity. While dissociative identity disorder (DID) is the most pervasive condition of all dissociative disorders, partial representations of this spectrum may be diagnosed as dissociative amnesia (with or without fugue), depersonalization disorder, and other specified dissociative disorders such as subthreshold DID, dissociative trance disorder, acute dissociative disorders, and identity disturbances due to exposure to oppression. In addition to constituting disorders in their own right, dissociation may accompany almost every psychiatric disorder and operate as a confounding factor in general psychiatry, including neurobiological and psycho-pharmacological research. While an anti- dissociative drug does not yet exist, appropriate psychotherapy leads to considerable improvement for many patients with dissociative disorders.
Amnesia ; Depersonalization ; Diagnosis ; Dissociative Disorders ; Humans ; Multiple Personality Disorder ; Neurobiology ; Psychopathology ; Psychotherapy ; Thinking

PURPOSE: The purpose of the study was to identify the discriminating power of dissociation as defined by depression, obsession, and Minnesota Multiphasic Personality Inventory(MMPI; psychopathology) in patients with psychological trauma. METHODS: Participants were patients (N=114) from "S" clinic for psychological trauma. Data were collected from April to June 2014 through semi-structured interviews and self-reports using a modified Lifetime Incidence of Traumatic Events, Dissociative Experience Scale (DES), Beck Depression Inventory-2, Maudsley Obsessional Compulsive Inventory, and MMPI-2. RESULTS: Participants were grouped in to two groups depending on DES scores; dissociative (n=15) and non-dissociative (n=99). Depression, F-scale (infrequency), Ma (Hypomania), and Hs (Hypochondriasis) scale of MMPI correctly discriminated 86.8% of the sample. There were also significant differences in Obsession, K-scale (korrection), D (Depression), Hy (Hysteria), Pd (Psychopathic Deviate), Pa (Paranoia), Pt (Psychasthenia), Sc (Schizophrenia), Si (Social Introversion) scales of MMPI between two groups, but they were not significant discriminant factors. CONCLUSION: Future interventions for patients with high levels of dissociation and psychological trauma should focus on the prevention of suicide and chronic dissociation by assessing depression-related factors; suicidal behavior, impulsivity, aggression, and alexithymia. Therapists should also interpret patients' MMPI profiles carefully, especially in the presence of an extremely elevated F-scale.
Affective Symptoms ; Aggression ; Depression ; Dissociative Disorders ; Humans ; Impulsive Behavior ; Incidence ; Minnesota ; MMPI ; Obsessive Behavior ; Suicide ; Weights and Measures

Guillain-Barre syndrome (GBS) and syringomyelia are diseases of different entities. GBS is an acute post-infectious autoimmune disease which is mediated by autoantibodies against the myelin of peripheral nerves. Syringomyelia is a chronic disease characterized by a cavity extending longitudinally inside the spinal cord. A 67-year-old man is being hospitalized due to severe numbness and ascending weakness in all limbs. On neurological examination, the motor power of all limbs are decreased and show absence of deep tendon reflexes (DTRs). The patient is being diagnosed with GBS on the basis of the acute clinical course, nerve conduction studies of segmental demyelinating polyneuropathy, and a finding of albuminocytologic dissociation in the cerebrospinal fluid. The patient is presented with a new set of symptoms thereafter, which composes of sensory changes in the upper extremities, the urinary dysfunction including frequency and residual urine, spastic bilateral lower extremities, and increased reflexes of the knee and the biceps at follow-up examinations. The spinal magnetic resonance imaging in the sagittal section revealed a syrinx cavity between the fifth cervical and the first thoracic vertebral segment in the cord. The somatosensory evoked potential show sensory pathway defects between both the brachial plexus and the brain stem. Thus, this patient is being diagnosed with both GBS and syringomyelia. We report a case of symptomatic syringomyelia coexisting with GBS. Since the GBS is presented with a progressive muscle weakness and reduced DTRs, the muscle weakness and stiffness in the extremities suggests a concurrent syringomyelia might be easily overlooked.
Aged ; Autoantibodies ; Autoimmune Diseases ; Brachial Plexus ; Brain Stem ; Chronic Disease ; Dissociative Disorders ; Evoked Potentials, Somatosensory ; Extremities ; Follow-Up Studies ; Guillain-Barre Syndrome* ; Humans ; Hypesthesia ; Knee ; Lower Extremity ; Magnetic Resonance Imaging ; Muscle Spasticity ; Muscle Weakness ; Myelin Sheath ; Neural Conduction ; Neurologic Examination ; Peripheral Nerves ; Polyneuropathies ; Reflex ; Reflex, Stretch ; Spinal Cord ; Syringomyelia* ; Upper Extremity

PURPOSE: To report the clinical features of Adie's tonic pupil. METHODS: The medical records of 22 patients who had been diagnosed with Adie's tonic pupil from February 1998 to February 2009, were retrospectively reviewed. On March 2010, a cross-sectional examination was performed in 16 patients (19 eyes) who underwent a follow-up of more than 1 year. Measurements included pupil size in room light, bright light and in darkness; near point of accommodation; presence of segmental iris palsy; light-near dissociation; denervation supersensitivity; corneal sensitivity; and deep tendon reflex (DTR). RESULTS: Among the patients studied, 16 were women in Adie's tonic pupils. Only 3 of patients had bilateral involvement. The mean age of onset was 38.3 years. The mean size of Adie's tonic pupils was 2.3 mm larger than the fellow eyes. Segmental iris palsy was detected in 93.8% of the patients. Denervation supersensitivity was observed in all patients. Light-near dissociation was present in 88.2% and over 90% of the patients had decreased DTR in the biceps, triceps, knee and ankle jerk. CONCLUSIONS: This cross-sectional study showed Adie's tonic pupil tended to become miotic and recover accommodation power over the years.
Age of Onset ; Animals ; Ankle ; Cross-Sectional Studies ; Denervation ; Dissociative Disorders ; Eye ; Female ; Follow-Up Studies ; Humans ; Iris ; Knee ; Light ; Medical Records ; Paralysis ; Pupil ; Reflex, Stretch ; Retrospective Studies ; Tonic Pupil

PURPOSE: To evaluate the outcomes of surgical treatment modality in unstable sacral fractures combined with spinal and pelvic ring injury depending on the presence of spino-pelvic dissociations. MATERIALS AND METHODS: The subjects were 16 patients, with unstable sacral fractures combined with spinal and pelvic ring injuries, were operated from July 2004 to January 2011. The patients were divided into 2 groups depending on the presence of spino-pelvic dissociations: those with dissociations were group 1, and those without dissociations were group 2. Group 1 was treated with spino-pelvic fixations using iliac screw, while group 2 was treated with percutaneous iliosacral screw fixations. The availability of the radiological bony union with its application periods, and clinical results using visual analogue scale (VAS) and oswestry disability index (ODI) were evaluated, retrospectively. RESULTS: Out of 16 patients, 8 patients in group 1 were treated with spino-pelvic fixation using iliac screw, and 8 patients in group 2 were treated with percutaneous iliosacral screw fixation. The mean bony union period was 17.4 weeks in group 1, and 19.6 weeks in group 2. The Mean VAS and ODI scores on the last follow-up were 2.5 points and 15.6 points in group 1, 2 points and 18.8 points in group 2, respectively. Both groups had favorable clinical results at the last follow-up. CONCLUSION: For surgical treatments of unstable sacral fractures, spino-pelvic fixation using iliac screws is advised for cases with combined spino-pelvic dissociation, while percutaneous iliosacral screw fixation is advised for cases without combined dissociation.
Dissociative Disorders ; Follow-Up Studies ; Humans