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      Despersonalización en pacientes quemados Translated title: Depersonalization in Burned Patients

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          Abstract

          Introducción: Las tasas de mortalidad en pacientes que sufren quemaduras ha disminuido, el reto ahora es la calidad de vida de los supervivientes, en quienes se han encontrado altas prevalencias de trastornos mentales. Objetivo: Describir la prevalencia de trastorno de despersonalización en pacientes quemados. Método: Revisión de la literatura médica publicada sobre el tema, utilizando las bases de datos MedLine, Ovid y Tripdatabase. Resultados: Está bien documentado que los síntomas disociativos, entre ellos la despersonalización, acompañan las reacciones de estrés agudo que se desencadenan por traumas mayores, y que ciertos estilos cognitivos predisponen a los individuos que se exponen a traumas a desarrollar psicopatología, primordialmente trastorno por estrés postraumático. Conclusión: A pesar de estos conocimientos, escasos estudios se han realizado para establecer la prevalencia de los fenómenos de despersonalización-desrealización en pacientes quemados, un campo de estudio que ofrece infinidad de oportunidades

          Translated abstract

          Introduction: Mortality rates in patients suffering from burns have decreased, and the challenge now is quality of life of survivors, who have a high prevalence of mental disorders. Objective: To describe the prevalence of depersonalization disorder in burned patients. Methods: Review of the literature published on the subject, using the databases Medline, Ovid and Tripdatabase. Results: It is well documented that dissociative symptoms including depersonalization accompany acute stress reactions that are triggered by major trauma, and that cognitive styles predispose certain individuals exposed to trauma to develop psychopathology, mostly posttraumatic stress disorder. Conclusion: Despite this knowledge few studies have been conducted to establish the prevalence of phenomena of depersonalization-derealization in burned patients

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          Most cited references27

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          Depersonalization: neurobiological perspectives.

          Depersonalization remains a fascinating and obscure clinical phenomenon. In addition to earlier Jacksonian neurobiological adumbrations, and conventional psychodynamic accounts, views started to be expressed in the 1930s that depersonalization might be a vestigial form of behavior, and since the 1960s that it might be a phenomenon related to the temporal lobe. Recent advances in the neurobiology of the limbic system, and the application of Geschwind's concept of disconnection in the corticolimbic system, have opened the possibility of developing testable models. This paper includes a review of these ideas and of the clinical features of depersonalization, particularly of its emotional changes, suggesting that they are important for the neurobiological understanding of depersonalization. It also draws attention to clinical similarities between the experiential narratives produced by patients suffering from depersonalization and those with corticolimbic disconnections. On the basis of this, a new model is proposed according to which the state of increased alertness observed in depersonalization results from an activation of prefrontal attentional systems (right dorsolateral prefrontal cortex) and reciprocal inhibition of the anterior cingulate, leading to experiences of "mind emptiness" and "indifference to pain" often seen in depersonalization. On the other hand, a left-sided prefrontal mechanism would inhibit the amygdala resulting in dampened autonomic output, hypoemotionality, and lack of emotional coloring that would in turn, be reported as feelings of "unreality or detachment."
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            Core outcomes for adult burn survivors: a clinical overview.

            Burn trauma ranges from the minor burn to the devastating injury, which can impact on all aspects of a person's life including aesthetic appearance, relationships with others and psychological, social and physical functioning. Measurement of outcome in burns patients is therefore complex and multi-faceted. The increasing numbers of major burn survivors implies that understanding health outcomes in these patients has assumed high priority. This paper sets out a conceptual framework for unifying outcome measurement, which may be useful to all members of the multidisciplinary team who are contemplating outcome assessment in their burn patients. It outlines seven core domains of assessment which are (i) skin; (ii) neuromuscular function; (iii) sensory and pain; (iv) psychological function; (v) physical role function; (vi) community participation; and (vii) perceived quality of life. Within each domain, we present a brief clinical review of the most commonly administered measurement tools that have been, or potentially could be, used to assess aspects of these core domains. Where possible, the psychometric properties and clinical utility of these tools are presented. A concise discussion of key methodological issues which should be addressed in this assessment process is then provided, together with suggestions for future research.
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              Dissociative symptoms and trauma exposure: specificity, affect dysregulation, and posttraumatic stress.

              Although dissociation is often described as a posttraumatic response, the actual statistical association between trauma exposure and dissociative symptoms is surprisingly small. This suggests that that some dissociative phenomena may be unrelated to trauma, or may be related in more complex ways. Analysis of the normative data for the Multiscale Dissociation Inventory revealed significant dissociative symptoms in only 8% of trauma-exposed individuals from the general population. However, 90% of those with at least one clinically significant dissociation scale on the Multiscale Dissociation Inventory reported a trauma history, and significant dissociation was found in only 2% of nontraumatized individuals. A history of interpersonal violence, number of different types of trauma exposure, posttraumatic stress, and affect dysregulation were univariate predictors of dissociative symptomatology in trauma-exposed participants, but only posttraumatic stress and affect dysregulation were multivariate predictors. Trauma is probably an important, but insufficient, condition for the development of dissociative symptomatology. Additional risk factors, such as high posttraumatic stress and/or reduced affect regulation capacities, may determine whether trauma exposure results in clinically significant dissociation.
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                Author and article information

                Journal
                rcp
                Revista Colombiana de Psiquiatría
                rev.colomb.psiquiatr.
                Asociacion Colombiana de Psiquiatria. (Bogotá, Distrito Capital, Colombia )
                0034-7450
                January 2010
                : 39
                : 1
                : 168-177
                Affiliations
                [01] Bogotá orgnamePontificia Universidad Javeriana orgdiv1Hospital Universitario San Ignacio orgdiv2Departamento de Psiquiatría y Salud Mental Colombia nino-jorge@ 123456javeriana.edu.co
                Article
                S0034-74502010000100012 S0034-7450(10)03900112
                406efabe-f6d3-4d52-8d5c-be8c9f909cf9

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 02 February 2010
                : 10 December 2009
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 27, Pages: 10
                Product

                SciELO Colombia

                Categories
                Articulo de Revisión

                pain,burn,dissociative symptoms,depersonalization,dolor,quemadura,disociación,despersonalización

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