Epistemis

Depersonalization

Specialty: Psychiatry.

  • Feeling of personal unreality
  • strangeness of one's own body
  • mental splitting

Why it occurs

  • Primary depersonalization/derealization disorder
  • Panic disorder (as a hyperhyperventilatory or extreme panic symptom)
  • Post-traumatic stress disorder (PTSD) with dissociative symptoms
  • Consumption of psychoactive substances (cannabis, ketamine, hallucinogens, solvents)
  • Temporal lobe epilepsy
  • Migraine attack with dissociative aura

Initial workup

Quantitative electroencephalogram (EEG) or with sleep deprivation to rule out temporary epileptogenic foci; Brain MRI; dissociative experiences scale (DES); toxicological screening.

red flags

Presence of focal neurological symptoms, visual or olfactory alterations prior to the dissociative episode, or sudden onset loss of consciousness.

Standard management

  • Lamotrigine — antiepileptic that acts on glutamatergic neurotransmission, showing effectiveness in chronic dissociation
  • Escitalopram — SSRIs to treat comorbid anxiety or underlying panic disorder
  • Naltrexone — opioid antagonist used off-label to mitigate severe dissociative symptoms

Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.

PreviousAutopsychic disorientation
Area
Psychiatry
Listed causes
6
Treatment options
3
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