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

ABSTRACT

Introduction

Here we present a case of Depersonalisation–Derealisation Disorder which involves an unusual environmental trigger and profile of symptoms in a patient with an underlying left frontal encephalomalacia.

Methods

The clinical information has been collected from multiple neurological, psychiatric, neuropsychological examinations and from the patient’s medical records.

Results

The neuropsychiatric assessment showed depersonalisation, derealisation, de-somatisation and de-affectualisation, along with a good response to SSRI + Lamotrigine; all typical features of DPD. The neuropsychological assessment showed language problems, and other mild cognitive difficulties that may provide a neuropsychological foundation contributing to the DPD episodes.

Discussion and conclusion

Given Mr R’s underlying neuropsychological deficit, hearing voices without speech-associated gestures might place excessive demands on his ability to process the information, exacerbating his feelings of threat. This sets up the pattern of suppressed insula activation, and possibly the suppression of the auditory cortex leading to the presented unusual DPD symptoms.

KEYWORDS:

• Depersonalisation disorder
• case report
• dysphasia
• derealisation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

As this is a single case report and raw data could lead to patient identification, the data from this manuscript will be kept confidential by the authors of this study.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this paper.

Notes on contributors

D. Goeta

D. Goeta is a trainee psychiatrist in San Carlo Borromeo General Hospital, Milan, Italy. She has a special interest in neuropsychiatry and spent an elective period at in the neurology and neuropsychiatry services at St George's Hospital.

M. Mula

M. Mula MD, PhD, FRCP, FEAN is Consultant Epileptologist and Reader in Neurology at St George's University Hospital and St George's University of London.

M. Mayhew

M. Mayhew PhD is a clinical psychologist specialising in clinical neuropsychology. He currently works on an inpatient stroke ward at the Royal Free Hospital in London, and has previously completed a PhD in addictions neuropsychology”.

NA Poole

NA Poole MD (Res), MSc, FRPsych is a consultant neuropsychiatrist at St George's Hospital with a special interest in functional neurological disorders and the neuropsychiatry of movement disorders.