Adolescent ; Humans ; Sex Factors ; Dissociative Disorders

Multiple Sclerosis (MS) is a chronic disabling neuroinflammatory disease. Psychiatric manifestations have a high prevalence in MS patients and may worsen the illness progression and the patients’ quality of life (QoL). Depression is a highly prevalent condition in MS patients, associated with poorer adherence to treatment, decreased functional status and QoL, and increased suicide risk. Diagnosis and treatment of this disorder is challenging because of symptom overlap. Other prevalent psychiatric comorbidities are anxiety disorders, bipolar disorder, psychotic disorders, substance misuse and personality disorders. As the illness progresses, personality changes can happen, as well as affect abnormalities. Cognitive changes occur frequently in MS patients, and affect features like processing speed, attention, learning, memory, visual spatial capabilities, and some language deficits. Disease-modifying treatments may reduce cognitive impairment because of their container action on the brain’s lesion burden. Other QoL determinants such as fatigue, pain, sexual dysfunction, exercise, resilience and social support should be taken into account, in order to promote the individuals’ well-being. Further studies are needed in order to elucidate the effectiveness of pharmacotherapy and more neuroimaging studies are required to clarify the relationship between structural changes and psychiatric comorbidities.
Anxiety Disorders ; Bipolar Disorder ; Cognition ; Cognition Disorders ; Comorbidity ; Depression ; Diagnosis ; Drug Therapy ; Fatigue ; Humans ; Learning ; Memory ; Multiple Sclerosis ; Neuroimaging ; Personality Disorders ; Prevalence ; Psychotic Disorders ; Quality of Life ; Suicide

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

OBJECTIVE: The primary goals of the present study were to assess intellectual function in participants with schizophrenia or bipolar disorder (BD) and to investigate the relationships between cognitive decline and the severity of each type of psychopathology. METHODS: The present study included 51 patients with schizophrenia and 42 with BD who were recruited from the psychiatry outpatient clinic of Jeju University Hospital between March 2011 and March 2014. The Korean Wechsler Adult Intelligence Scale (K-WAIS) was administered to each of the 93 participants, and they were categorized into two groups based on their current intelligence quotient (IQ) and their estimated premorbid IQ: severely impaired group (SIG) and mildly impaired group (MIG). The Minnesota Multiple Personality Inventory (MMPI) and the Brief Psychiatric Rating Scale (BPRS) were used to assess psychopathology. RESULTS: The SIG schizophrenia participants exhibited significantly higher scores on the frequent (F) and schizophrenia (Sc) subscales of the MMPI, but significantly lower scores on the correction (K) and psychopathic deviate (Pd) subscales compared with the MIG schizophrenia participants. Furthermore, the BPRS scores were significantly higher in the SIG schizophrenia participants relative to the MIG schizophrenia participants. The SIG BD participants had significantly higher F, masculinity-femininity (Mf), paranoia (Pa), and Sc but significantly lower Pd scores compared with the MIG BD participants. CONCLUSION: The present findings revealed a significant discrepancy between the estimated premorbid levels of cognitive function and current cognitive function in participants with schizophrenia or BD. Moreover, this discrepancy was correlated with severity of psychopathology in both groups.
Adult ; Ambulatory Care Facilities ; Bipolar Disorder* ; Brief Psychiatric Rating Scale ; Cognition ; Humans ; Intelligence ; Minnesota ; MMPI ; Multiple Personality Disorder ; Paranoid Disorders ; Psychopathology* ; Schizophrenia*

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

Mass spectrometry (MS) is a very powerful instrument that can be used to analyze a wide range of materials such as proteins, peptides, DNA, drugs, and polymers. The process typically involves either chemical or electron (impact) ionization of the analyte. The resulting charged species or fragment is subsequently identified by the detector. Usually, single mass uses source-induced dissociation (SID), whereas mass/mass uses collision-induced dissociation (CID) to analyze the chemical fragmentations Each technique has its own advantages and disadvantages. While CID is most effective for the analysis of pure substances, multiple-step MS is a powerful technique to get structural data. Analysis of veterinary drugs ampicillin, chloramphenicol, ciprofloxacin, and oxytetracycline serves to highlight the slight differences between SID and CID. For example, minor differences were observed between ciprofloxacin and oxytetracycline via SID or CID. However, distinct fragmentation patterns were observed for ampicllin depending on the analysis method. Both SID and CID showed similar fragmentation spectra but different signal intensities for chloramphenicol. There are several factors that can influence the fragmentation spectra, such as the collision energy, major precursor ion, electrospray mode (positive or negative), and sample homogeneity. Therefore, one must select a fragmentation method on an empirical and case-by-case basis.
Ampicillin ; Chloramphenicol ; Ciprofloxacin ; Dissociative Disorders ; DNA ; Electrons ; Mass Spectrometry ; Oxytetracycline ; Peptides ; Polymers ; Proteins ; Sudden Infant Death ; Veterinary Drugs