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Mayer-Gross

Member Since 31 Dec 2010
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Topics I've Started

Lecture by Ruth Lanitus on dissociative subtype of PTSD

13 August 2020 - 04:20 PM

It has been very limited with the research into depersonalization disorder since the depersonalization research unit stopped in 2015. But, there has been a lot of research in PTSD and the dissociative subtype that features of depersonalization and derealization. Among people with PTSD it is estimated that 15% of the have the dissociative subtype. There are some significant overlapping between the dissociative subtype of PTSD and depersonalization disorder. They both share symptoms of emotional numbing, detachment, derealisation. So, it is assumed that the emotional regulation done by the brain is likely the same. So, findings in the dissociative subtype of PTSD can also be used in depersonalization. The leading researcher into the dissociative subtype of PTSD is the Canadian prof in psychiatry, Ruth Lanitus. Here is lecture with her from 2019 based in recent brain scans in PTSD and its dissociative subtype. The recording in not so good as it is recorded from distance but it can be seen. Her point is the dissociation comes from overregulation of emotion done by the ventromedial prefrontal cortex- emotions are suppressed. An area deep in the midbrain called the “periaqueductal gray”/PAG is in the ventral part active in the dissociative state, - all the time. It is a old structure in the brain we share with reptiles. A structure millions of years old.

In normal PTSD the periaqueductal gray is active in the dorsal part, -all the time. They are in a constant state of alert/fight and flight mode. Their emotions are under regulated as the ventromedial prefrontal cortex is underactive- opposite to the dissociative subtype. They can have emotional outburst, have range due to  this under regulation. Their constant state of alert does they have difficulty to find rest and be relaxed.

The dissociative state is a immobilization response that the brain have chosen because a fight and flight response could not be taken. Danger was perceived as being to close. Symptoms like out of body, derealisation is likely connected to the activation of the periaqueductal gray. Emotional numbing is likely result of the overactivity/emotional regulation done by the ventromedial prefrontal cortex. 
 

So, she have recent data from brain scan that shows the involvement of the periaqueductal gray. This is not found in other studies in depersonalization. They likely could scan that area until recently. She points towards ventromedial prefrontal cortex as central in this regulation. The ventromedial prefrontal cortex -both left and right have also been found overactive in studies in depersonalization. It is a location very difficult to manipulate with until recently, as it is to deep to stimulate with rTMS. There have been development of new coils that can likely affect it. But, it is not used by rTMS providers yet. 
 

her lecture is here. 
https://www.youtube....5uW5y4c8&t=270s


Review of brain imaging studies and dissociation published until today.

09 July 2020 - 02:58 PM

Those who have an interest in brain imageing studies, have questions like, “where do depersonlisation start in the brain”, why do rTMS fail in so many? This review of all different types of brain imageing studies done in, dissociative identity disorder, depersonalisation disorder, borderline disorder and the dissociative subtype of PTSD might give some ideas.

 

In reality one shall focus on the data for depersonalisation disorder and the dissociative subtype of PTSD. All emotional regulation in the brain is done by the prefrontal cortex. When you use rTMS you try to stimulate or inhibit a location in the prefrontal cortex. The model used for depersonalisation is it is a brain response to Anxiety and danger where there is no option to make a fight and flight. The brain makes a immobilisation and shots down so nothing can be felt. The price for this response is a sense of loss of self, emotional numbing and unreality.

 

The location in the brain from where this response is started have been conflicting over the years. It have been the hope that if this location could be found, it could be turn off with the use of rTMS.

 

At Depersonalisation research Unit They came with the right ventro lateral prefrontal cortex, though other location was found overactive in depersonalisation, like the medial prefrontal cortex. They chose the ventrolateral prefrontal cortex for their very small of rTMS. I have tried this location and it did not work. I have then thought that the location might be wrong. In this review here that have many more recent studies and the ventromedial prefrontal cortex is likely the location found in most studies to be overactive and make Depersonalisation.

This location is to deep in the brain for a normal rTMS coil to stimulate. Only after 2017 a coil was developed to go so deep in the brain. It might explain that many have a very poor response to rTMS. The location have never been the right one and the coil needed have not been avalible.

 

The review of brain scans is here: https://www.scienced...4?via=ihub#bib3


Videos with a depersonalised getting rTMS/theta burst stimulation over the right VLPFC

01 January 2020 - 05:33 PM

Found this series of videos of a guy who gets rTMS over the right VLPFC. He started with normal rTMS over the right VLPFC and was shifted to theta burst stimulation that is a lot quicker. Neuronavigation is used for location. Some texts says that theta burst over the right VLPFC can be difficult to tolerate for 50% due to contractions of the nerves around the eyes. In the video one gets theta burst at the right VLPFC and he has contractions. They do not seem to painful for the few min. it takes. In the video from 4.min he tells about changs in emotions, more energy, feeling more present. The video is here and is one of several on the subject. He will also get rTMS at the right TPJ. I would go to angular gyrus instead of that location.  The treatment is done in Schweitzerland and costs around 400.dollars pr. session for him. So, that is a no go for me. I think 150-200.euros in normal in many europeans countries.  


anxiety and insomnia in depersonalisation

19 December 2019 - 09:58 AM

There has been som who says that they are suffering from insomnia due to their depersonalisation. There is a trail in France with rTMS on the angular gyrus that is found overactive in depersonalisation. 

 

There has been a rTMS trial for insomnia and anxiety in a patient group (not depersonalisation) where rTMS was given in 1.Hz as the trail in depersonalisation trail at the right parietal cortex,- angular gyrus is in that area. 

 

Here is the results.


RESULTS: 

Ten days of 1 Hz rTMS to the right parietal lobe significantly improved both anxiety and insomnia symptoms in the active group. Although the anxiety severity was not significantly correlated with insomnia severity at baseline, the improvement in the Hamilton Rating Scale for Anxiety (HRSA) scores were positively correlated with improvement in the Pittsburgh Sleep Quality Index (PSQI) scores.

CONCLUSIONS: 

The present study is the first randomized sham-controlled study to assess the effectiveness of low frequency rTMS on the right parietal lobe in patients with comorbid GAD and insomnia. Our results suggested that 1 Hz low frequency rTMS administered over the parietal cortex is effective for both anxiety and insomnia symptoms in patients with comorbid GAD and insomnia.

 

https://www.ncbi.nlm...pubmed/29871798

Perhaps these symptoms in depersonalisation might be related to the overactivety in that area along with body alienation , distance from biographical memory, feeling of automation ect. 

 


ECT/electroconvulsive therapy for depersonalisation

17 December 2019 - 08:39 AM

I came across this publication from 1946 by psychiatrist H. J. Shorvon called "On Depersonalization syndrome". It is for that time a large publication about depersonalization and adresses treatment options of that time. Antidepressent was not discovered and ECT was often used for many mental states. There has been a claim by some it might be a treatment and according to this it have 6 out of 39 had a positive effect. 2 was cured and 4.slightly improved but 10 said they felt worse. 

 

 

 

"E.C.T.-39 cases have been treated with a course of electro-shock therapy. This is a treatment commonly used, and it is important for the results to be carefully assessed. The number of treatments given varied from three to fourteen. One of the cases states his depersonalization started after a course of E.C.T. Of the remaining 38 cases only 2 lost their depersonalization, 4 were improved, was temporarily improved,there was no change in 22 cases,and 10 patients stated they were worse. Thus,32 out of the 39 patients were unchanged or worse after the treatment. Ofthe32,5wereles depressed,10 slightly improved,and 17 remained the same. Of those that recovered or were much improved, 2 were post-puLerperal, 2 were recurrent depressives, and 2 were hvsterics with depression."

 

https://journals.sag...591574603901206