Скачать или смотреть What is Depersonalization and Why Does it Feel So WEIRD?

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Some spiritual traditions hold forth that the ego is an illusion, that our attachment to Self is the source of suffering, and that our true nature is Being, devoid of notions of Self and Other. Transcendental meditation rejects all dichotomies in the pursuit of Oneness with Existence; many gurus seek to achieve this state of detachment voluntarily. Similarly, psychonauts who enjoy hallucinogenic mushrooms and who take LSD recreationally are familiar with a dose-dependent, potentially profound dissociation that many clinicians would characterize as psychosis (these substances are also classified as psychotomimetics). Conversely, the dissociative anesthetic ketamine, long-utilized in surgical theaters, is now widely used in lower doses for the treatment of major depression.

In this video I share a recent case study to explain and demonstrate the subtleties of both depersonalization, as well as its counterpart, derealization, two dissociative symptoms, in the context of an early-onset, recurrent, severe, endogenous major mood disturbance. All endogenous major depression and bipolar disorders are, by definition, on a psychotic spectrum: while these conditions are designated as "without psychotic features" in most individuals, mood-congruent psychosis is always possible in the more severe manifestations. In this video, I argue that the presence of dissociative symptoms is a potential harbinger of actually losing touch with reality, if the mood disturbance is left untreated. I also emphasize how the vast majority of cases are genetic, such that the family history is always notable.

Providers-in-Training will come across several other useful teaching points in this fascinating true case study.

00:00 Intro: A Case Study
00:43 The Chief Complaint
01:02 Something Wrong With the Brain
02:00 Questions You Should Ask Your Doctor
03:34 The Meaning of Random Tears
04:23 Textbook Description: Dissociation
06:35 Depersonalization
07:47 DSM-5 Nosology
08:39 Derealization
09:15 Psychonauts & Gurus: Intact Reality Testing?
10:28 Too Depressed to be Anxious
12:14 Self-Injurious Behavior
13:51 Don't Forget: Cognitive Symptoms
15:55 Eliciting a Family History
20:20 Avolition
21:30 Ruling Out Bipolar Disorder
22:02 A Blunted Affect
24:02 Social Phobia
27:39 Initial Treatment