Depersonalization and derealization syndrome: report on a case study and pharmacological management.

Dear Editor, Depersonalization disorder (DPD), a chronic condition characterized by a profound disruption of self-awareness, appears to be more common than previously thought and may possibly affect 1% of the general population. 1,2 DPD usually presents with severe distress and functional disability. Because some of the symptoms may resemble those of psychotic and anxiety disorders (affect numbing, disem-bodiment, and social anxiety), DPD is often misdiagnosed. There is no established treatment for this disorder. 2 We describe a case that illustrates the particularities of DPD and proposals for treatment. M., 27, single, with a university degree, sought psychiatric treatment with complaints that she "did not feel her body". She reported that she felt strange and empty, that her body seemed to be somewhere else and hollow, with nothing but the skin, and it seemed to be someone else's body. She had come to the point of wearing numerous bracelets to mark the boundaries of her own limbs. She also suffered from affective detachment, frequently stating " I feel like I was dead " or " I feel nothing " , but complained of intense anxiety in social situations. Reality testing was intact. Slightly depressed mood and mitigated panic-like symptoms were also identified; however, she did not fulfill the criteria for any other DSM axis I disorder, as confirmed by the MINI-plus. There were no comorbid conditions or history of drug abuse. She had a normal neurological examination, and an EEG showed no abnormalities. As the patient did not respond to risperidone 2 mg/day, it was replaced with a selective serotonin reuptake inhibitor (SSRI), which led to anxiety improvement, but the specific symptoms of DPD grew worse. A subsequent change to ven-lafaxine 225 mg/day led to a significant mood improvement and a reduction in panic-like episodes; however, deperson-alization and derealization remained unchanged. Lamotrigine was then added at an initial dose of 25 mg/day, with a gradual increase to up to 200 mg/day. The patient had significant improvement in different aspects, such as affect, interpersonal contact and social interaction. The depersonalization symptoms gradually decreased, which made it possible for the patient to go back to work. During that period, a Portuguese version of the Cambridge Depersonalization Scale (CDS) was used. 3 The scale contains 29 items, each one rated from 0-10, and a score of > 70 suggests the disorder. Before the introduction of lamotrigine, the patient scored 230. After 12 weeks of …