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Biomedical subjects

Mary L Phillips

Publications and source records attributed to Mary L Phillips.

45 records · Page 3Linked to original sources
PubMed2003

Depersonalization disorder: a functional neuroanatomical perspective.

Clinical reports of depersonalization suggest that attenuated emotional experience is a central feature of the condition. Patients typically complain of emotional numbness and some patients ascribe their feelings of unreality to a lack of affective "colouring" in things perceived. Recent neuroimaging and psychophysiological studies support these assumptions as they show both attenuated autonomic responses in depersonalization, and decreased activity within neural regions important for the generation of affective responses to emotive stimuli. Furthermore, findings from neuroimaging studies indicate increased prefrontal cortical activity in depersonalised patients, particularly within regions associated with contextualization and appraisal of emotionally-salient information rather than mood induction per se. Taken together, these finding suggest that symptoms of depersonalization, and in particular emotional numbing, may be related to a reversal of normal patterns of autonomic and neural response to emotive stimuli.

Affect↗
PubMed2003

The effect of negative emotional context on neural and behavioural responses to oesophageal stimulation.

Sensory experience is influenced by emotional context. Although perception of emotion and unpleasant visceral sensation are associated with activation within the insula and dorsal and ventral anterior cingulate gyri (ACG), regions important for attention to and perception of sensory and emotional information, the neural mechanisms underlying the effect of emotional context upon visceral sensation remain unexplored. Using functional MRI, we examined neural responses to phasic, non-painful oesophageal sensation (OS) in eight healthy subjects (seven male; age range 27-36 years) either during neutral or negative emotional contexts produced, respectively, by presentation of neutral or fearful facial expressions. Activation within right insular and bilateral dorsal ACG was significantly greater (P < 0.01) during OS with fearful than with neutral faces. In a second experiment, we measured anxiety, discomfort and neural responses in eight healthy male subjects (age range 22-41 years) to phasic, non-painful OS during presentation of faces depicting either low, moderate or high intensities of fear. Significantly greater (P < 0.01) discomfort, anxiety and activation predominantly within the left dorsal ACG and bilateral anterior insulae occurred with high-intensity compared with low-intensity expressions. Clusters of voxels were also detected in this region, which exhibited a positive correlation between subjective behaviour and blood oxygenation level-dependent effect (P < 0.05). We report the first evidence for a modulation of neural responses, and perceived discomfort during, non-painful visceral stimulation by the intensity of the negative emotional context in which the stimulation occurs, and suggest a mechanism for the effect of negative context on symptoms in functional pain disorders.

Adult↗
PubMed2003

Chronic depersonalization following illicit drug use: a controlled analysis of 40 cases.

AIMS: To examine demographic and clinical features of a group of patients reporting chronic depersonalization (DP) following illicit drug use, and to assess whether depersonalization arising in these circumstances constitutes a distinct clinical syndrome. DESIGN: Case-control comparison using self-reports, standardized questionnaires and clinical assessments in a specialized clinic. SETTING: A tertiary referral depersonalization clinic and research unit affiliated to a psychiatric hospital and research centre. PARTICIPANTS: A total of 164 individuals with chronic DP symptoms who had been in contact with the clinic. Forty of these individuals related the onset of symptoms to an episode of illicit drug use. MEASUREMENTS: A wide range of demographic and clinical variables measured using questionnaires and standardized rating scales. FINDINGS: The drug-induced DP group were significantly younger and had a preponderance of males compared to the non-drug group. Certain clinical and phenomenological differences were found between these groups, but in general the groups are strikingly similar. This is reinforced by the fact that when the drug-induced group was compared with an age and sex-matched subset of the non-drug group, differences between groups largely disappeared. CONCLUSIONS: Drug-induced DP does not appear to represent a distinct clinical syndrome. The neurocognitive mechanisms of the genesis and maintenance of DP are likely to be similar across clinical groups, regardless of precipitants.

Adolescent↗
PubMed2003

A placebo-controlled, cross-over trial of lamotrigine in depersonalization disorder.

There is evidence to support the view that glutamate hyperactivity might be relevant to the neurobiology of depersonalization. We tested the efficacy of lamotrigine, which reduces glutamate release, as a treatment for patients with depersonalization disorder. A double-blind, placebo-controlled, cross-over design was used to evaluate 12 weeks of treatment of lamotrigine. Subjects comprised nine patients with DSM-IV depersonalization disorder. Changes on the Cambridge Depersonalization Scale and the Present State Examination depersonalization/derealization items were compared across the two cross-over periods. Lamotrigine was not significantly superior to placebo. None of the nine patients was deemed a responder to the lamotrigine arm of the cross-over. Lamotrigine does not seem to be useful as a sole medication in the treatment of depersonalization disorder.

Adult↗
PubMed2003

Depersonalisation disorder: clinical features of 204 cases.

BACKGROUND: Depersonalisation disorder is a poorly understood and underresearched syndrome. AIMS: To carry out a large and comprehensive clinical and psychopathological survey of a series of patients who made contact with a research clinic. METHOD: A total of 204 consecutive eligible referrals were included: 124 had a full psychiatric examination using items of the Present State Examination to define depersonalisation/derealisation and 80 had either a telephone interview (n=22) or filled out a number of self-report questionnaires. Cases assessed were diagnosed according to DSM-IV criteria. RESULTS: The mean age of onset was 22.8 years; early onset was associated with greater severity. There was a slight male preponderance. The disorder tended to be chronic and persistent. Seventy-one per cent met DSM-IV criteria for primary depersonalisation disorder. Depersonalisation symptom scores correlated with both anxiety and depression and a past history of these disorders was commonly reported. 'Dissociative amnesia' was not prominent. CONCLUSIONS: Depersonalisation disorder is a recognisable clinical entity but appears to have significant comorbidity with anxiety and depression. Research into its aetiology and treatment is warranted.

Adolescent↗
PubMed2002

Autonomic response in depersonalization disorder.

BACKGROUND: Emotional-processing inhibition has been suggested as a mechanism underlying some of the clinical features of depersonalization and/or derealization. In this study, we tested the prediction that autonomic response to emotional stimuli would be reduced in patients with depersonalization disorder. METHODS: The skin conductance responses of 15 patients with chronic depersonalization disorder according to DSM-IV, 15 controls, and 11 individuals with anxiety disorders according to DSM-IV, were recorded in response to nonspecific elicitors (an unexpected clap and taking a sigh) and in response to 15 randomized pictures with different emotional valences: 5 unpleasant, 5 pleasant, and 5 neutral. RESULTS: The skin conductance response to unpleasant pictures was significantly reduced in patients with depersonalization disorder (magnitude of 0.017 micro siemens in controls and 0.103 micro siemens in patients with anxiety disorders; P =.01). Also, the latency of response to these stimuli was significantly prolonged in the group with depersonalization disorder (3.01 seconds compared with 2.5 and 2.1 seconds in the control and anxiety groups, respectively; P =.02). In contrast, latency to nonspecific stimuli (clap and sigh) was significantly shorter in the depersonalization and anxiety groups (1.6 seconds) than in controls (2.3 seconds) (P =.03). CONCLUSIONS: In depersonalization disorder, autonomic response to unpleasant stimuli is reduced. The fact that patients with depersonalization disorder respond earlier to a startling noise suggests that they are in a heightened state of alertness and that the reduced response to unpleasant stimuli is caused by a selective inhibitory mechanism on emotional processing.

Adult↗
PubMed2002

The spectrum of organic depersonalization: a review plus four new cases.

Depersonalization and derealization are commonly reported in the general population as a response to stress. The symptoms have also been described in patients with a primary psychiatric or organic diagnosis, where their secondary status precludes a DSM-IV diagnosis of depersonalization disorder. The authors present 4 new cases of depersonalization in patients with an underlying organic condition, along with 47 cases from the literature in which the available information permits diagnosis of organic depersonalization. Information from case series documenting depersonalization in the context of medical illnesses is also presented and the underlying etiology discussed. Epilepsy and migraine appear to be the disorders most commonly associated with depersonalization. Left-sided temporal lobe dysfunction and anxiety are suggested as factors in the development of depersonalization; however, further studies are needed to determine the relationship. The introduction to the DSM-IV of an organic subtype of depersonalization disorder would facilitate research in this area.

Adolescent↗
PubMedDate not supplied

Lamotrigine as an add-on treatment for depersonalization disorder: a retrospective study of 32 cases.

OBJECTIVES: Depersonalization disorder (DPD) is a chronic condition characterized by the persistent subjective experience of unreality and detachment from the self. To date, there is no known treatment. Lamotrigine as sole agent was not found to be effective in a previous small double-blind, randomized crossover trial. However, evidence from open trials suggests that it may be beneficial as an add-on medication with antidepressants. METHODS: We report here an extended series of 32 patients with DPD in whom lamotrigine was prescribed as an augmenting medication. Most of the patients were receiving selective serotonin reuptake inhibitors. RESULTS: Fifty-six percent (n = 18) of patients had a more than or equal to 30% reduction on the Cambridge Depersonalization Scale score at follow-up. Both maximum dose of lamotrigine used and before treatment Cambridge Depersonalization Scale scores showed positive correlations with the percentage of response. CONCLUSIONS: The results of this trial suggest that a significant number of patients with DPD may respond to lamotrigine when combined with antidepressant medication. The results are sufficiently positive to prompt a larger controlled evaluation of lamotrigine as "add-on" treatment in DPD.

Adolescent↗