"My mind goes dead … I cannot speak": an expression of DPD

Area of Science:

• Neuroscience
• Psychiatry

Background:

• Depersonalisation-Derealisation Disorder (DPD) is a dissociative condition characterized by persistent feelings of unreality.
• Underlying neurological deficits can influence the presentation and experience of DPD.

Observation:

• A patient with left frontal encephalomalacia presented with an atypical DPD profile and environmental triggers.
• Neuropsychiatric assessment revealed depersonalisation, derealisation, de-somatisation, and de-affectualisation.
• Neuropsychological evaluation indicated language and mild cognitive deficits.

Findings:

• The patient responded well to treatment with Selective Serotonin Reuptake Inhibitors (SSRI) and Lamotrigine.
• Neuropsychological deficits may contribute to DPD episodes by increasing cognitive load during information processing.
• Suppressed insula and auditory cortex activation could underlie the unusual DPD symptoms.

Implications:

• This case suggests that structural brain abnormalities can lead to unique DPD symptom presentations.
• Understanding the interplay between cognitive deficits and DPD is crucial for effective treatment.
• The findings support the use of SSRI and Lamotrigine in managing complex DPD cases.