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      La despersonalización: aspectos clínicos y neurobiológicos Translated title: Despersonalization: Clinical and Neurobiological Aspects

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          Abstract

          Introducción: A pesar de haberse descrito hace más de un siglo, la despersonalización continúa siendo un fenómeno poco comprendido y pobremente conceptualizado. Objetivo: Proporcionar una visión actualizada del fenómeno a la luz de la psicopatología descriptiva y desarrollos empíricos recientes en neurobiología y comparación transcultural. Método: Se realizó una revisión selectiva con énfasis en la literatura reciente de la despersonalización. Desarrollo y conclusión: La literatura reciente está representada por tres vertientes investigativas, de las cuales se pueden extraer las siguientes conclusiones: (a) El fenómeno de despersonalización tiene una estructura compleja caracterizada por varias dimensiones independientes. En este sentido parece constituir más un síndrome que un síntoma. (b) Estudios neurobiológicos recientes sugieren la existencia de una desconexión funcional entre la percepción y sus concomitantes afectivos, lo cual hace que la experiencia conciente parezca desprovista de “colorido emocional”. (c) La prevalencia de la despersonalización parece sensible a variables sociológicas y culturales, de tal modo que culturas caracterizadas por alto individualismo parecen conferir vulnerabilidad al fenómeno.

          Translated abstract

          Introduction: Although described more than a century ago, depersonalization continues to be a poorly understood and poorly conceptualized phenomenon. Objective: To supply a current vision of depersonalization in the light of descriptive psychopathology and recent empirical developments in neurobiology and transcultural comparisons. Method: Selective review of literature on depersonalization with emphasis on recent literature. Development and conclusion: Research found in recent literature moves along three tracks, from which these conclusions can be extracted: (a) The phenomenon of depersonalization has a complex structure characterized by several independent dimensions. In this sense it seems to constitute more of a syndrome than a symptom. (b) Recent neurobiological studies suggest the existence of a functional disconnection between perception and its affective concomitants which renders the conscious experience as devoid of “emotional coloring”. (c) The prevalence of depersonalization seems to be sensitive to sociological and cultural variables so that cultures with high individualism seem to confer vulnerability to the phenomenon.

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          Most cited references54

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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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            Cultures and organizations: Software of the mind

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              Autonomic response in depersonalization disorder.

              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. 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. 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). 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.
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                Author and article information

                Contributors
                Role: ND
                Journal
                rcp
                Revista Colombiana de Psiquiatría
                rev.colomb.psiquiatr.
                Asociacion Colombiana de Psiquiatria. (Bogotá )
                0034-7450
                March 2008
                : 37
                : 1
                : 40-55
                Affiliations
                [1 ] Universidad de Cambridge England
                Article
                S0034-74502008000100004
                921b4ab5-05f8-4d14-9758-cb589254e1bd

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Colombia

                Self URI (journal page): http://www.scielo.org.co/scielo.php?script=sci_serial&pid=0034-7450&lng=en
                Categories
                PSYCHIATRY

                Clinical Psychology & Psychiatry
                Despersonalization,neurobiology,perception,despersonalización,neurobiología,percepción

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