• DEFINITION-
(DPD) Also called depersonalization-derealization syndrome is a dissociative disorder in which the client has feelings of depersonalization or derealization this alteration of reality can be either in self or in their surroundings. It can be constant or intermittent. Some people with DPD have described it as feeling “detached from their body”, or “senseless, emotionless”, “preforming life on autopilot”.
• POSSIBLE CAUSE-
According to Cleveland Clinic- o Biological and environmental factors o People with less show of emotions o PTSD, from trauma such as natural disaster, abuse, etc.
• RISK FACTORS-
According to Mayo Clinic- o Personality traits that cause pt. to avoid difficult emotions o Victim of or observed trauma,
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o Anxiety is common with this disorder o May develop other psychotic disorders because of DPD
• TREATMENT-
According to Merck Manual
Therapy-
Behavioral therapy- distraction from DPD
Cognitive behavioral therapy- blocks sensations of fake reality
Grounding techniques- uses 5 senses to connect the pt to their mind, body, and place
Medication-
*anti-anxiety may worsen DPD, use with careful observation
Classification Name
Benzodiazepines Buspirone alprazolam (Xanax, Xanax XR) clobazam (Onfi) clonazepam (Klonopin) clorazepate (Tranxene, Tranxene SD) chlordiazepoxide (Librium) diazepam (Valium, Diastat Acudial, Diastat), Ativan
Atypical Antidepressants Trazodone mirtazapine (Remeron) vortioxetine (Brintellix) vilazodone (Viibryd)
Anti-psychotics olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda) or asenapine (Saphris)
• GOALS OF
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Observe patients behaviors. Rational- they may not seem disoriented in behavior but may internalize and project it when no one is watching because they are confused about what is happening to their body.
5. Practice grounding techniques with the patient. Rational- to reorient them and so they can reorient themselves when they need it and no one is there to assist. Grab a chair, cold water, undressing and redressing, brushing their hair, looking in the mirror, etc.
6. Provide hands-on distractions for the patient. Rational- DPD is less likely to occur when the patient is interacting with real objects and can feel them.
7. Encourage the patient to participate in group talk therapy. Rational- other people may have similar disorders and may be able to share techniques they use to reorient themselves.
8. Encourage family to visit as much as possible and bring personal items from home for the patient to have. Rational- change of environment may precipitate DPD, by having familiar company and items they can ground themselves to treatment reality.
• PROGNOSIS-
Symptoms usually subside after treatment for underlying stressor such as abuse or accident; these people usually make 100% recovery. If the underlying cause is not addressed, there is high chance of reoccurring or worsening
Depersonalization is defined in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) as “experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions” (DSM-5, 2013, p. 302). According to Mayo Clinic, a symptom could be that a person feels like
* Turn the patient with slow, gentle movements. Rapid changes in position may increase ICP.
Three points for sensory perception was->were derived by the patient being able to respond to verbal stimuli and able to communicate his buttock discomforts to me. Three points for moisture was derived by observing the patient occasionally drooling on his arms that added moisture and could pose risk for ulcers. Two points for activity was derived by the patient being mostly wheelchair-bound, subsequently limited his ability to walk. Two points for mobility was derived from observing that the patient made occasional slight changes in body position while he was in his wheelchair. Two points for nutrition was derived by observing that his breakfast plate was only half eaten. Since he requires maximum assistance during the bed transfer and often slid down his bed, one pointed was chosen for friction and
a.Psychotherapy is the most common treatment for dissociative disorders. Talking with a therapist can help a person understand the causes of the condition, and
The first health care team member should be the doctor, He is the most familiar with the physiological and psychological limitations of Mr.
Provide care and support, monitor and observe. Have had the appropriate training given to deliver this effective practice. Minimise the risk of dangers to the individual and others.
This disorder is something that should not be taken lightly and should be dealt with immediately because there are numerous ways in which a person can cope with it.
Depersonalization: Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions. (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
Implement measures to improve cardiac output: perform actions to reduce cardiac workload: place client in a semi- to high Fowler's position, instruct client to avoid activities that create a Valsalva response, implement measures to promote emotional and physical rest, implement measures to improve respiratory status, discourage smoking, provide small meals rather than large ones,
Psychotherapy is a treatment option that focuses on helping the individual with ASPD recognize and control his/her behaviors. Cognitive behavioral therapy has been known to incorporate cognitive restructuring, behavior modification, exposure, psychoeducation, and skills training to help the individual understand that they are responsible for creating their problems and how their misshapen thoughts prevent them from having positive self-awareness.
Educating the family about the disease process is vital for the safety of Mr. Johnson within the home and outside of it. After reviewing the different types of assessment taking by Mr. and Mrs. Johnson, it appears that Mr. Johnson is showing signs of depression with losing interest activities and losing touch with family. Calendars, sticky notes, wrist watches, memory book and a schedule are all tools that may benefit the Johnsons. A calendar that is big enough to write in events can help orientate Mr. Johnson allowing a visual cue to help trigger memory. There is no evidence of suggesting he has issues with reading so using sticky notes and applying them on appliances will help in several ways. He can read out steps to complete kitchen tasks
The interventions that I observed was the use of contrast bath for the Chronic Regional pain, E-stim, Ultrasound, hot packs for the pain management as well as to decrease the stiffness and swelling. The activity that I observed were ROM arc to increase movement in the bilateral upper extremities, sand box to increase core strength, Theraputty, peg boards, cognition pattern puzzles, visual perception puzzles, arm bike (rollator), bolts and screw for fine motor coordination, mini mental test to intact orientation as well as memory. I observed how therapist were teaching the patients to increase independence while transferring from bed to wheelchair to commode. I observed the use of adaptive devices to make the patient as functional as possible with their daily activities such as long handled shower brush, Reacher, sock aid, leg lifter, adaptive heavy weighted utensils and many
Turing and repositioning will avoid pressure from being exerted on one spot for too long (Miles, Nowicki, and Fulbrook, 2013). The nurse will also implement safety measures to prevent falling such as keeping the bed in the lowest position and hourly rounding (Crawford and Harris, 2016). The last priority nursing intervention for this patient is to get a set of vital signs before and after physical activity and prevent orthostatic hypotension. The patient can prevent orthostatic hypotension by adequate fluid intake, slow position changes and dangling the feet off the side of the bed before standing up (L. Schimke, J. Schimke,
Dissociative identity disorder (DID) is a condition where there are two or more distinct identities that are and will become present in an individual. These personalities can and will eventually take control of the individual, many people consider having dissociative identity disorder an experience of being possessed. The individual can and most likely will experience memory loss that is more extensive than ordinary everyday forgetfulness (Dissociative Identity Disorder (Multiple Personality Disorder). Around two percent of people will experience dissociative disorder, women are more likely than men are to be diagnosed with DID. "Almost half of adults in the United States experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes” (Dissociative Disorders).
Treatments include medication, supportive psychotherapy and occasionally ECT. Medications include lithium, anticonvulsant drugs (carbamazepine (Tegretol), valproate (Depakote), gabapentin (Neurontin) and lamotrigine Lamictal), antidepressants (such as bupropion (Wellbutrin)or sertraline (Zoloft)), neuroleptics (e.g. haloperidol) and benzodiazepines (e.g. lorazepam) Treatment choices depend on the