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Depersonalisation is a common dissociative experience characterised by distressing feelings of being detached or 'estranged' from one's self and body and/or the world. The COVID-19 pandemic forcing millions of people to socially distance themselves from others and to change their lifestyle habits. We have conducted an online study of 622 participants worldwide to investigate the relationship between digital media-based activities, distal social interactions and peoples' sense of self during the lockdown as contrasted with before the pandemic. We found that increased use of digital media-based activities and online social e-meetings correlated with higher feelings of depersonalisation. We also found that the participants reporting higher experiences of depersonalisation, also reported enhanced vividness of negative emotions (as opposed to positive emotions). Finally, participants who reported that lockdown influenced their life to a greater extent had higher occurrences of depersonalisation experiences. Our findings may help to address key questions regarding well-being during a lockdown, in the general population. Our study points to potential risks related to overly sedentary, and hyper-digitalised lifestyle habits that may induce feelings of living in one's 'head' (mind), disconnected from one's body, self and the world., (© 2022. The Author(s).)

Objectives: COVID-19 outbreak can impact mental health including health care workers. The aim of this study was to assess the psychological impact of COVID-19 in French community pharmacists., Material and Methods: We carried out a postal-based survey to assess the psychological impact of COVID-19 in French owner community pharmacists based on three validated self-report questionnaires: Perceived Stress scale, Impact of Event Scale-revised and Maslach Burnout Inventory., Results: The sample consists of 135 community pharmacists. Twenty-three pharmacists reported significant post-traumatic stress symptoms (17%). High burnout symptoms were found in 33 (25%), 46 (34.9%) and 4 (3%) participants. Females scored higher than males for all questionnaires (P=0.01)., Conclusions: This study is the first study which showed the psychological impact of COVID-19 in community pharmacists. Based on validated self-report questionnaires, up to 35% of pharmacists reported psychological disturbances. Interventions to promote psychological well-being of healthcare workers need to be developing., (Copyright © 2020 Académie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Burnout is an occupational hazard for physicians at all stages of training and medical practice. The purpose of the current study was to determine whether residency factors, with the use of an activity monitor, including the amount of exercise, have any impact on burnout among orthopaedic surgery residents in varying years of training., Methods: Orthopaedic residents at a single institution were recruited immediately before beginning a new clinical rotation and followed for four weeks. On enrollment, the participants were given a wrist-worn activity monitor (Fitbit Flex) and instructed on its use for tracking physical activity. REDCap was used to collect burnout levels (as assessed by using the Maslach Burnout Inventory and the Patient Health Questionnaire-9), which were completed a total of five times, once at enrollment and weekly during the study period., Results: Twenty-seven residents were enrolled, including 13 junior residents (interns and second years) and 14 senior residents (third, fourth, and fifth years). Seven residents were on fracture rotations, whereas 20 were not. As measured by using the Maslach Burnout Inventory, juniors were more emotionally exhausted (P = 0.01) and depersonalized (P = 0.027). No difference in the objective physical activity data as measured by using the Fitbit Flex and no difference in the self-reported hours of sleep were observed. Residents on orthopaedic trauma rotations also reported significantly higher rates of emotional exhaustion and depersonalization (P < 0.001) than other residents and were more physically active on average (P < 0.030)., Discussion: Although depersonalization and depression are common symptoms seen among orthopaedic surgery residents, this study demonstrated that quality of life improves markedly as they progress through their residency training. Residents on orthopedic trauma rotations have greater levels of emotional exhaustion and depersonalization. This pilot study suggests that burnout prevention programs should begin at the start of training to provide residents with strategies to combat and then reinforced while on orthopaedic trauma rotations., Level of Evidence: Level III Diagnostic Study.

Abnormal space experience (ASE) is a common feature of schizophrenia, despite its absence from current diagnostic manuals. Phenomenological psychopathologists have investigated this experiential disturbance, but these studies were typically based on anecdotal evidence from limited clinical interactions. To better understand the nature of ASE in schizophrenia and attempt to validate previous phenomenological accounts, we conducted a qualitative study of 301 people with schizophrenia. Clinical files were analyzed by means of Consensual Qualitative Research, an inductive method for analyzing descriptions of lived experience. Our main findings can be summed up as follows: (1) ASEs are a relevant feature in schizophrenia (70.1% of patients reported at least 1 ASE). (2) ASE in schizophrenia are characterized by 5 main categories of phenomena (listed from more represented to less represented): (a) experiences of strangeness and unfamiliarity (eg "Everything appeared weird. Face distorted, world looks terrible, nasty"); (b) experiences of centrality/invasion of peripersonal space (eg "Handkerchief on scaffolding: message telling him something"); (c) alteration of the quality of things (eg "Buildings leaning down"); (d) alteration of the quality of the environment (eg "Person sitting six feet away seemed to be at an infinite distance"); and (e) itemization and perceptive salience (eg "All patients [in ward] have bright eyes"). (3) ASEs are much more frequent in acute (91.9%) than in chronic (28.15%) schizophrenia patients. Moreover, our findings further empirical support for phenomenological accounts of schizophrenia, including those developed by Jaspers, Binswanger, Minkowski, and Conrad, among others and provide the background for translational research., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: To characterize burnout, as defined by high emotional exhaustion (EE) or depersonalization (DP), among interventional radiologists using a validated assessment tool., Materials and Methods: An anonymous 34-question survey was distributed to interventional radiologists. The survey consisted of demographic and practice environment questions and the 22-item Maslach Burnout Inventory-Human Services Survey (MBI). Interventional radiologists with high scores on EE (≥ 27) or DP (≥ 10) MBI subscales were considered to have a manifestation of career burnout., Results: Beginning on January 7, 2019, 339 surveys were completed over 31 days. Of respondents, 263 (77.6%) identified as male, 75 (22.1%) identified as female, and 1 (0.3%) identified as trans-male. The respondents were interventional radiology attending physicians (298; 87.9%), fellows (20; 5.9%), and residents (21; 6.2%) practicing at academic (136; 40.1%), private (145; 42.8%), and hybrid (58; 17.1%) centers. Respondents worked < 40 hours (15; 4.4%), 40-60 hours (225; 66.4%), 60-80 hours (81; 23.9%), and > 80 hours (18; 5.3%) per week. Mean MBI scores for EE, DP, and personal achievement were 30.0 ± 13.0, 10.6 ± 6.9, and 39.6 ± 6.6. Burnout was present in 244 (71.9%) participants. Identifying as female (odds ratio 2.4; P = .009) and working > 80 hours per week (odds ratio 7.0; P = .030) were significantly associated with burnout., Conclusions: Burnout is prevalent among interventional radiologists. Identifying as female and working > 80 hours per week were strongly associated with burnout., (Copyright © 2019 SIR. Published by Elsevier Inc. All rights reserved.)

Individuals with post-traumatic stress disorder (PTSD) typically experience states of reliving and hypervigilance; however, the dissociative subtype of PTSD (PTSD+DS) presents with additional symptoms of depersonalization and derealization. Although the insula is critical to emotion processing, its association with these contrasting symptom profiles is yet to be fully delineated. Accordingly, we investigated insula subregion resting-state functional connectivity patterns among individuals with PTSD, PTSD+DS, and healthy controls. Using SPM12 and PRONTO software, we implemented a seed-based resting-state functional connectivity approach, along with multiclass Gaussian process classification machine learning, respectively, in order to evaluate unique patterns and the predictive validity of insula subregion connectivity among individuals with PTSD (n = 84), PTSD+DS (n = 49), and age-matched healthy controls (n = 51). As compared to PTSD and PTSD+DS, healthy controls showed increased right anterior and posterior insula connectivity with frontal lobe structures. By contrast, PTSD showed increased bilateral posterior insula connectivity with subcortical structures, including the periaqueductal gray. Strikingly, as compared to PTSD and controls, PTSD+DS showed increased bilateral anterior and posterior insula connectivity with posterior cortices, including the left lingual gyrus and the left precuneus. Moreover, machine learning analyses were able to classify PTSD, PTSD+DS, and controls using insula subregion connectivity patterns with 80.4% balanced accuracy (p < .01). These findings suggest a neurobiological distinction between PTSD and its dissociative subtype with regard to insula subregion functional connectivity patterns. Furthermore, machine learning algorithms were able to utilize insula resting-state connectivity patterns to discriminate between participant groups with high predictive accuracy., (© 2019 Society for Psychophysiological Research.)

Background: Burnout is a common occurrence among GPs, decreasing quality of and access to care and impacting both physician and patient health. The link between burnout and low medical density has never been studied., Objectives: This study aimed to assess the prevalence of burnout and its related factors, including low medical density, among GPs., Method: We conducted a cross-sectional survey. A self-administered questionnaire was sent to all of the 1632 GPs in Normandy, France, in September 2015. The Maslach Burnout Inventory was used to assess the three burnout dimensions: emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA)., Results: In all, 501 GPs sent back their questionnaire (response rate: 30.7%); 487 questionnaires were analysed. Burnout had been experienced by 43.3% of the physicians in the sample. Nearly 24% of the respondents scored high EE, 27.3% scored high DP, and 13.3% scored low PA. Low medical density [odds ratios (OR): 2.16 (1.31-3.54)], and intent to quit [OR: 4.40 (2.59-7.47)] were strongly linked to the three burnout dimensions. Burnout was not linked with quantitative workload., Conclusion: Burnout among GPs was common. Low medical density and intent to quit were strong predictors of burnout. Given the current medical demographic crisis, these results highlight the relationship between burnout and medical shortage. Qualitative workload may have a more significant influence on burnout than quantitative workload. Recruiting more GPs is necessary, but may prove insufficient in fighting burnout. Preventive and curative actions are required, especially in areas with low medical density., (© The Author(s) 2018. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Physician burnout is an ongoing problem that affects both physician wellbeing and patient care. Burnout is characterized by emotional exhaustion and depersonalization. Studies have explored ways to prevent and alleviate burnout. Receiving training in acupuncture may reduce physician burnout., Objective: The purpose of this study is to determine if acupuncture training is associated with less patient depersonalization and less emotional exhaustion among physicians., Methods: These self-reported data were collected from a cross-sectional survey of family physicians at the Uniformed Services Academy of Family Physicians 2017 conference. Physicians answered questions regarding their level of acupuncture training as well as questions about burnout (depersonalization and emotional exhaustion)., Results: The overall response rate was 66% (325/492). Of these, 233 cases provided complete datasets. In a model controlling for years' practice and clinical pace, acupuncture training was significantly associated with decreased depersonalization, F (1, 194) = 5.82, P < .05., Conclusion: Study data show an association between decreased physician depersonalization and acupuncture training, suggesting acupuncture training may be a helpful strategy to reduce family physicians' depersonalization of patients., Competing Interests: Conflict of interest: none declared., (© Copyright 2019 by the American Board of Family Medicine.)

Background: A recent study has shown variability on the perception of verticality during unilateral centrifugation among patients with type 2 diabetes mellitus; it is yet unknown if it is related to symptoms of unreality., Objective: In patients with type 2 diabetes mellitus compared to age matched healthy volunteers, to assess depersonalization/derealization (DD) symptoms before and after unilateral centrifugation, according to the subjective visual vertical (SVV)., Methods: 47 patients with type 2 diabetes mellitus and 50 age matched healthy volunteers participated in the study. They replied to standardized questionnaires of symptoms related to balance, depression, and anxiety. Then, after neuro-otological evaluation, they completed a DD inventory before and after unilateral centrifugation (300°/s, 3.85 cm) with SVV estimation., Results: Right/left asymmetric SVV during centrifugation was identified in 17 patients (36%) and no SVV change during centrifugation was identified in 6 patients (13%). Before centrifugation, patients with asymmetric SVV already reported some of the DD symptoms, while patients with no SVV change reported almost no DD symptoms. Unilateral centrifugation provoked an increase of DD symptoms in both healthy volunteers and the entire group of patients (repeated measures ANOVA, p < 0.01), except in the 6 patients with no SVV change. Before centrifugation, the DD score showed influence from the SVV subgroup and the evidence of depression (MANCoVA, p < 0.01); after centrifugation, which provoked asymmetry of the right/left utricular input, only the influence from depression persisted. No influence was observed from the characteristics of the subjects, including retinopathy, peripheral neuropathy (assessed by electromyography) or weight loss, or from the total score on the questionnaire of symptoms related to balance., Conclusions: In patients with type 2 diabetes mellitus and healthy volunteers, utricular stimulation by unilateral centrifugation may provoke DD symptoms, with an influence from depression. The results support that the aphysiological utricular input given by unilateral centrifugation may contribute to create a misleading vestibular frame of reference, giving rise to 'unreal' perceptions.

The aim of our study was to examine whether the participation in Balint group is associated with the reducing burnout syndrome among primary health care doctors. This investigation was conducted on a population of 210 doctors employed in primary health centers in Belgrade. Out of 210 doctors, 70 have completed Balint training for a period of at least 1 year, whereas 140 doctors have never attended this training (the Non-Balint group). The level of burnout among physicians was assessed with the Serbian translation of the original 22-item version of the Maslach Burnout Inventory - Human Services Survey which defines burnout in relation to emotional exhaustion, depersonalization and personal accomplishment. We found that 45.0% of the Non-Balint participants and 7.1% of the Balint-trained participants responded with symptoms of high level of emotional exhaustion, with a statistically significant difference (p < 0.001). In relation to depersonalization, 20% of the Non-Balint subjects were highly depersonalized compared to 4.4% of the Balint-trained subjects, with a statistically significant difference (p < 0.001). Regarding the personal accomplishment, 21.4% of the Non-Balint subjects and 7.1% of the Balint-trained subjects had a perception of low personal accomplishment, with a statistical significance (p < 0.001). In the multiple ordinal logistic model, with emotional exhaustion as a dependent variable, statistically significant predictor was female gender (OR = 2.51; p = 0.021), while Balint training was obtained as a protective factor (OR = 0.12; p < 0.001). Non-specialists were detected as a risk factor for depersonalization (OR = 2.14; p = 0.026) while Balint group was found as a protective factor (OR = 0.10; p < 0.001), according to the multiple ordinal logistic regression analysis. Regarding the reduced personal accomplishment, our results indicated that nonspecialists were at risk for this subdimension (OR = 2.09; p = 0.025), whereas Balint participants were protected (OR = 0.18; p < 0.001). Participation in Balint groups is associated with the reduced burnout syndrome among primary health care doctors.

Burnout Syndrome is a condition which could most commonly be associated with negative effects on the quality of work and life. Some occupations are more likely to suffer from this syndrome, for example workers in the health sector. This survey was therefore conducted among hospital workers of the Marche Region in order to analyze levels of Burnout and any possible correlation of these levels with lifestyle changes., Methods: The survey was carried out using a self-administered, anonymous questionnaire in two sections: the first consisted of the Maslach Burnout Inventory (MBI) and the second contained questions about the healthcare operator's lifestyle. The MBI investigates levels of Emotional Exhaustion (EE), Depersonalization (DP) and finally of Personal Accomplishment (RP) in respondents. Survey results were processed using descriptive statistics, applying the Chi-square statistic and an Odds Ratio (p<0.05)., Results: 53.4% of the questionnaire was duly completed. The scale with the highest incidence among interviewees was Depersonalization. Even though the high-level percentage for the DP and EE scale was equal to 22.3%, when adding the high-level percentage to the medium level percentage, the difference between low and medium-high level was found to be around 20% for all areas. Analyzing the correlation between lifestyle choices, and in particular the consumption of alcohol and smoking with Burnout Syndrome, a statistically significant Odds Ratio was observed in the DP scale vs alcohol (OR=4.67), the RP scale vs cigarette smoke (OR=2.50), and finally in the EE area vs cigarette smoke (OR=2.92)., Conclusion: Our results are in line with other studies which show increasing levels of EE and DP in healthcare workers. Healthcare workers who have been in the same job for a considerable amount of time (15+ years) show the highest levels of EE and DP. Subjects with high levels of Depersonalization show a worrying exposure to alcohol abuse, while those with high levels of Emotional Exhaustion tend to make use of both alcohol and tobacco, demonstrating negative lifestyle choices; in spite of this, results for personal accomplishment being relatively low and therefore not cause for worry, subjects still show high levels of exposure to cigarette smoke.

Background: Previous studies showed increased levels of absenteeism, drug abuse, depression, and symptoms allied with burnout in emergency nurses. This meta-analysis aimed to quantify the three dimensions of burnout in emergency nurses and estimate the proportion of nurses who experience higher than tolerable levels of burnout., Materials and Methods: A systematic search was conducted on PubMed, Scielo, Xueshu Baidu and Informa databases with a cut-off time between 1997 and 2017 to retrieve published papers in any language that had estimated the burnout levels in emergency nurses by using MBI scale., Results: We identified a total of 11 eligible studies. The total mean estimate was moderate for emotional exhaustion (25.552), but clearly trending towards higher level, whereas depersonalization (10.383) and lack of personal accomplishment (30.652) showed higher burnouts levels. The proportion of emergency nurses suffering from high emotional exhaustion, high depersonalization, and low personal accomplishment was 40.5%, 44.3%, and 42.7%, respectively., Conclusion: Burnout is detrimental to achieving high-quality healthcare services and causes a loss of productivity. It is high time for nursing leader and management personnel to identify appropriate measures to counteract burnout., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objectives: To study burnout among pediatric residents at King  Abdulazaiz University Hospital in Jeddah, Saudi Arabia. Methods: This is a cross-sectional survey that was administered to all pediatric residents enrolled in the Saudi Paediatric Board program (PGY1-PGY4) in a large tertiary academic hospital in the Western region of Saudi Arabia (King Abdulaziz University Hospital). The survey were sent via E-mail to 50 registered general pediatric residents.  Results: Seventy percent of the pediatric residents completed the survey. More than 70% of residents experiencing severe burnout. Forty-three percent suffering emotional exhaustion, 71.8% experiencing depersonalization and 40.6% suffering from low accomplishment., Conclusion: Burnout syndrome appear to be a serious threat to resident well-being in our program. Moreover, pediatric residents in our institute experienced higher levels of depersonalization than their peers nationally and internationally.

Aims: To analyse the association between psychological, labour and demographic factors and burnout in palliative care nursing., Background: There is a lack of published research evaluating burnout in palliative care nursing., Methods: This observational cross-sectional study involved 185 palliative care nurses in Mexico. The primary variables were burnout defined by its three dimensions (emotional exhaustion, depersonalization and personal accomplishment). As secondary variables, psychological, labour and demographic factors were considered. A binary logistic regression model was constructed to determine factors associated with burnout., Results: A total of 69 nurses experienced high emotional exhaustion (37.3%), 65 had high depersonalization (35.1%) and 70 had low personal performance (37.8%). A higher proportion of burnout was found in the participants who were single parents, working >8 hr per day, with a medium/high workload, a lack of a high professional quality of life and a self-care deficit., Conclusion: Our multivariate models were very accurate in explaining burnout in palliative care nurses. These models must be externally validated to predict burnout and prevent future complications of the syndrome accurately., Implications for Nursing Management: Nurses who present the factors found should be the focus of interventions to reduce work stress., (© 2017 John Wiley & Sons Ltd.)

Objective: To investigate changes in body ownership and chronic neuropathic pain in patients with spinal cord injury (SCI) using multisensory own body illusions and virtual reality (VR)., Methods: Twenty patients with SCI with paraplegia and 20 healthy control participants (HC) participated in 2 factorial, randomized, repeated-measures design studies. In the virtual leg illusion (VLI), we applied asynchronous or synchronous visuotactile stimulation to the participant's back (either immediately above the lesion level or at the shoulder) and to the virtual legs as seen on a VR head-mounted display. We tested the effect of the VLI on the sense of leg ownership (questionnaires) and on perceived neuropathic pain (visual analogue scale pain ratings). We compared illusory leg ownership with illusory global body ownership (induced in the full body illusion [FBI]), by applying asynchronous or synchronous visuotactile stimulation to the participant's back and the back of a virtual body as seen on a head-mounted display., Results: Our data show that patients with SCI are less sensitive to multisensory stimulations inducing illusory leg ownership (as compared to HC) and that leg ownership decreased with time since SCI. In contrast, we found no differences between groups in global body ownership as tested in the FBI. VLI and FBI were both associated with mild analgesia that was only during the VLI specific for synchronous visuotactile stimulation and the lower back position., Conclusions: The present findings show that VR exposure using multisensory stimulation differently affected leg vs body ownership, and is associated with mild analgesia with potential for SCI neurorehabilitation protocols., (Copyright © 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Academy of Neurology.)

Context: Direct care workers in long-term care can develop close relationships with their patients and subsequently experience significant grief after patient death. Consequences of this experience for employment outcomes have received little attention., Objectives: To investigate staff, institutional, patient, and grief factors as predictors of burnout dimensions among direct care workers who had experienced recent patient death; determine which specific aspects of these factors are of particular importance; and establish grief as an independent predictor of burnout dimensions., Methods: Participants were 140 certified nursing assistants and 80 homecare workers who recently experienced patient death. Data collection involved comprehensive semistructured in-person interviews. Standardized assessments and structured questions addressed staff, patient, and institutional characteristics, grief symptoms and grief avoidance, as well as burnout dimensions (depersonalization, emotional exhaustion, and personal accomplishment)., Results: Hierarchical regressions revealed that grief factors accounted for unique variance in depersonalization, over and above staff, patient, and institutional factors. Supervisor support and caregiving benefits were consistently associated with higher levels on burnout dimensions. In contrast, coworker support was associated with a higher likelihood of depersonalization and emotional exhaustion., Conclusion: Findings suggest that grief over patient death plays an overlooked role in direct care worker burnout. High supervisor support and caregiving benefits may have protective effects with respect to burnout, whereas high coworker support may constitute a reflection of burnout., (Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)

This review article summarizes neuropsychological descriptions of abnormal body representations in brain-damaged patients and recent neuroscientific investigations of their sensorimotor underpinnings in healthy participants. The first part of the article describes unilateral disorders of the bodily self, such as asomatognosia, feelings of amputation, supernumerary phantom limbs and somatoparaphrenia, as well as descriptions of non-lateralized disorders of the bodily self, including Alice in Wonderland syndrome and autoscopic hallucinations. Because the sensorimotor mechanisms of these disorders are unclear, we focus on clinical descriptions and insist on the importance of reporting clinical cases to better understand the full range of bodily disorders encountered in neurological diseases. The second part of the article presents the advantages of merging neuroscientific approaches of the bodily self with immersive virtual reality, robotics and neuroprosthetics to foster the understanding of the multisensory, motor and neural mechanisms of bodily representations., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: There is a paucity of evidence on working hours and their psychological correlates in police officers of the federated ranks in England., Aims: An exploratory study to establish the extent to which a sample of English police officers worked long hours and the association between long working hours and common mental disorder (CMD)., Methods: Officers of the federated ranks (constable, sergeant, inspector) from two English county forces completed a questionnaire to report their typical weekly working hours and symptoms of CMD. We also collected socio- and occupational-demographic data. We defined long working hours as ≥49 h in a typical week in accordance with 48-h weekly limit specified in the 1993 European Directive on the Organisation of Working Time. We established associations between long working hours and self-reported CMDs using binary logistic regression to generate odds ratios (ORs) and 95% confidence intervals (CIs) adjusted for potential confounding variables., Results: Twenty-seven per cent (n = 327/1226) of respondents reported long working hours. The ORs for psychological distress (OR 2.05, 95% CI 1.57-2.68), emotional exhaustion (OR 1.99, 95% CI 1.52-2.59), and depersonalization (OR 1.30, 95% CI 1.00-1.71) were significantly increased for long working hours after adjustment for socio- and occupational-demographic characteristics., Conclusions: More than one quarter of sampled police officers reported working long hours and were significantly more likely to report CMD. National and longitudinal research is required to confirm these findings, which suggest management of working hours may effectively promote psychological well-being., (© The Author 2016. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

The mechanism by which the brain integrates visual and emotional information remains incompletely understood, and can be studied through focal lesions that selectively disrupt this process. To date, three reported cases of visual hypoemotionality, a vision-specific form of derealization, have resulted from lesions of the temporo-occipital junction. We present a fourth case of this rare phenomenon, and investigate the role of the inferior longitudinal fasciculus (ILF) in the underlying pathophysiology. A 50-year-old right-handed male was found to have a right medial temporal lobe tumor following new-onset seizures. Interstitial laser ablation of the lesion was complicated by a right temporo-parieto-occipital intraparenchymal hemorrhage. The patient subsequently experienced emotional estrangement from visual stimuli. A lesion overlap analysis was conducted to assess involvement of the ILF by this patient's lesion and those of the three previously described cases, and diffusion tensor imaging was acquired in our case to further investigate ILF disruption. All four lesions specifically overlapped with the expected trajectory of the right ILF, and diminished structural integrity of the right ILF was observed in our case. These findings implicate the ILF in visual hypoemotionality, suggesting that the ILF is critical for integrating visual information with its emotional content., (© The Author (2016). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.)

Introduction: Depression and burnout are frequent comorbidities among nurses. Despite similar symptoms, their management differ. Therefore, their timely diagnosis is essential., Aim: To identify demographic and work-related risk and protective factors of burnout and depression, and facilitate their diagnosis., Method: A cross-sectional study among 1,713 nurses was carried out. Depression and burnout were assessed by the shortened Beck Depression Questionnaire and Maclach Burnout Inventory, respectively. Risk and protective factors were explored using t-tests and analysis of variance., Results: The prevalence of depression and moderate-to-high burnout was 35.1% and 34-74%, respectively. Having a partner/child and longer employment in the outpatient setting protected from burnout. Lack of a partner and male sex emerged as risk factors of depression and depersonalisation, respectively., Conclusions: High prevalence of depression and burnout among nurses poses a significant public health issue. Familiarity with the disease-specific risk and protective factors identified in this research may facilitate timely diagnosis and effective disease management.

Background: Impaired well-being and high work-family conflict are critical issues among GPs. This research examined an understudied psychosocial risk factor for these outcomes, namely GPs' perception that they invest more in the relationship with their patients than what they receive in return (i.e. lack of reward in their relationship with patients)., Objective: To test the effect of lack of reward as a risk factor for poor well-being and work-family conflict among GPs., Methods: Longitudinal study (12 months time lag). 272 GPs in Switzerland [mean age 54.5 (SD = 8.3), 73% male] volunteered to participate in the study. 270 participants completed the baseline survey and 252 completed the follow-up survey. Of these, six retired between the baseline and the follow-up survey, resulting in a sample size of 246 participants at t2. Outcome measures were burnout, sleep problems, self-perceived health and work-family conflict., Results: Strength and direction of prospective effects were tested using cross-lagged models. Lack of reward was related to an increase in emotional exhaustion (β = 0.15), sleep problems (β = 0.16) and work-family conflict (β = 0.19) and a decrease in self-perceived health (β = -0.17). Effects on depersonalization and personal accomplishment were not significant. Regarding reversed effects of impaired well-being on lack of reward, emotional exhaustion (β = 0.14) and self-perceived health (β = -0.13) predicted future level of lack of reward., Conclusion: Lack of reward by patients is a risk factor in GPs' mental health., (© The Author 2014. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Although well-being and psychophysical health of nursery school and kindergarten teachers have important implications also on the health and well-being of their recipients, studies dedicated to these workers are quite rare, particularly in Italy., Aim: The aim of the study was to observe psychophysical health conditions in a sample of nursery school and kindergarten teachers employed in the Education Services Division of the Municipality of Turin., Method: The study was cross-sectional; 884 self-reporting questionnaires were distributed and 734 teachers (representing 53% of those employed at the Education Services of the Municipality of Turin) correctly filled out the questionnaire., Results: Respectively 53.4% and 50% of participants reported medium or high levels of emotional exhaustion and depersonalization, while 18.5% showed low levels of personal accomplishment. Responders reported moderate levels of work ability in 38.9% and poor levels in 5.6%. The majority of the respondents (98.7%) did not report depressive symptoms; 42.9% of the sample suffered moderate to severe limiting musculoskeletal pain. Age and profession were associated with emotional exhaustion, personal accomplishment, and musculoskeletal pain. However, work ability and depression were only associated with age. No associations were found with depersonalization., Conclusions: The present study shows that health conditions of nursery school and kindergarten teachers were critical and that age contributed to the explanation of these conditions.

Patients with an acquired sensory dysfunction may experience symptoms of detachment from self or from the environment, which are related primarily to nonspecific symptoms of common mental disorders and secondarily, to the specific sensory dysfunction. This is consistent with the proposal that sensory dysfunction could provoke distress and a discrepancy between the multi-sensory frame given by experience and the actual perception. Both vestibular stimuli and vestibular dysfunction can underlie unreal experiences. Vestibular afferents provide a frame of reference (linear and angular head acceleration) within which spatial information from other senses is interpreted. This paper reviews evidence that symptoms of depersonalization/derealization associated with vestibular dysfunction are a consequence of a sensory mismatch between disordered vestibular input and other sensory signals of orientation.

Background: Early visual impairments probably partially caused by impaired interactions between magnocellular (M) and parvocellular (P) pathways (M priming deficit), and disturbances of basic self-awareness or self-disorders (SDs) are core features of schizophrenia. The relationships between these features have not yet been studied. We hypothesized that the M priming was impaired in first-episode patients and that this deficit was associated with visual aspects of SDs., Aim: To investigate early visual processing in a sample of first-episode schizophrenia patients and to explore the relationships between M and P functioning and visual aspects of SDs addressed by the Examination of Anomalous Self-Experience (EASE) interview., Method: Nine stimulating conditions were used to investigate M and P pathways and their interaction in a pattern reversal visually evoked potential (VEP) paradigm. N80 at mixed M- and P-conditions was used to investigate magnocellular priming. Generators were analyzed using source localization (Brain Electrical Source Analysis software: BESA). VEPs of nineteen first-episode schizophrenia patients were compared to those of twenty matched healthy controls by a bootstrap resample procedure. Visual aspects of SDs were analyzed through a factor analysis to separate symptom clusters of derealization phenomena. Thereafter, the associations between the main factors and the N80 component were explored using linear mixed models., Results: Factor analyses separated two EASE factors ("distance to the world", and "intrusive world"). The N80 component was represented by a single dipole located in the occipital visual cortex. The bootstrap analysis yielded significant amplitude reductions and prolonged latencies in first-episode patients relative to controls in response to mixed M-P conditions, and normal amplitudes and latencies in response to isolated P- and M-biased stimulation. Exploratory analyses showed significant negative correlations between the N80 amplitude values at mixed M-P conditions and the EASE factor "distance to the world", i.e. relatively higher amplitudes in the patient group were associated with higher subjective perceived derealization ("distance to the world")., Conclusions: The early VEP component N80 evoked by mixed M-P conditions is assumed to be a correlate of M priming, and showed reduced amplitudes and longer latencies in first-episode patients. It probably reflects a hypoactivation of the M-pathway. The negative association between visual SDs (derealization phenomena characterized by visual experiences of being more distant to the world), and the M priming deficit was counterintuitive. It might indicate a dysregulated activity of the M-pathway in patients with SDs. Further research is needed to better understand this preliminary finding., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Purpose: The purpose of this study was to assess burnout in directors of physical therapist assistant (PTA) programs and to analyze the relationship between individual and institutional variables and burnout., Methods: Surveys were completed by 120 directors from accredited PTA programs. The surveys consisted of demographic information and the Maslach Burnout Inventory-Educators Survey (MBI-ES). The MBI-ES assesses burnout in the areas of emotional exhaustion, depersonalization, and personal accomplishment., Results: PTA program directors showed moderate levels of emotional exhaustion, low levels of depersonalization, and high levels of personal accomplishment. Gender, the number of faculty in a department, and length of academic contract had no correlation with participant burnout levels. Significantly lower levels of emotional exhaustion were found in participants who were in their current position for more than 11 years and those who planned to remain in their current position or within higher education for at least 5 additional years. A significant negative correlation was found between participant age and depersonalization., Discussion: PTA program directors and their institutions should develop strategies to minimize the effects of burnout in younger program directors and those in the early years of their position.

We present a case series of 6 patients who developed persistent depersonalization disorder in adolescence after consuming cannabis. In 2 of these cases, the illness course was severely disabling. Within the growing body of literature that investigates the effects of cannabis use on mental health, the association between cannabis and depersonalization disorder is widely neglected. We review the clinical characteristics of this disorder and summarize the neurobiological evidence relating it to cannabis use. This case series extends awareness about the potentially detrimental effect of cannabis use in young individuals beyond its well-documented relationship with psychosis and other psychological sequelae., (Copyright © 2012 S. Karger AG, Basel.)

Background and Aims: We undertook this study to assess the correlation between the results of simple tests of spatial orientation and the occurrence of common psychological symptoms during the first 3 months after an acute, unilateral, peripheral, vestibular lesion., Methods: Ten vestibular patients were selected and accepted to participate in the study. During a 3-month follow-up, we recorded the static visual vertical (VV), the estimation error of reorientation in the yaw plane and the responses to a standardized questionnaire of balance symptoms, the Dizziness Handicap Inventory (DHI), the depersonalization/derealization inventory by Cox and Swinson (DD), the Dissociative Experiences Scale (DES), the 12-item General Health Questionnaire (GHQ-12), the Zung Instrument for Anxiety Disorders and the Hamilton Depression Rating Scale., Results: At week 1, all patients showed a VV >2° and failed to reorient themselves effectively. They reported several balance symptoms and handicap as well as DD symptoms, including attention/concentration difficulties; 80% of the patients had a Hamilton score ≥8. At this time the balance symptom score correlated with the DHI. After 3 months, all scores decreased. Multiple regression analysis of the differences from baseline showed that the DD score difference was related to the difference on the balance score, the reorientation error and the DHI score (p <0.01). No other linear relationships were observed (p >0.5)., Conclusions: During the acute phase of a unilateral, peripheral, vestibular lesion, patients may show poor spatial orientation concurrent with DD symptoms including attention/concentration difficulties, and somatic depression symptoms. After vestibular rehabilitation, DD symptoms decrease as the spatial orientation improves, even if somatic symptoms of depression persist., (Copyright © 2011 IMSS. Published by Elsevier Inc. All rights reserved.)

The psychopathological structure of anesthetic depressions was studied in 80 patients with progredient schizophrenia. Three variants of anesthetic depression were distinguished, viz, anxiety anesthesia with agitation, sensorial psychic anesthesia, and multiple depersonalization symptoms; melancholic anesthesia with the depressive triad, self-reproach ideas and sensorial ideatory psychic anesthesia; anesthesia proper with ideatory psychic anesthesia as the main or sole manifestation of depression. The study revealed transitions of these variants in the structure of schizophrenic episodes from anxiety anesthetic to melancholic anesthetic and further on to purely anesthetic ones. The latter type of depression proved refractory to antidepressive therapy and tended to persist for a long time.

The clinical picture of paroxysm-like progredient schizophrenia in 104 patients was characterized by a combination of schizophrenic symptomatology, paroxismal and paroxysm-like disorders. Investigation of their psychopathological structure showed that they differ from that of epileptic paroxysms. The data obtained provide a basis for distinguishing a special variant of endogenous process and developing criteria for typological classification of paroxismal and paroxysm-like disorders.

Long-sanding depressions are defined as protracted depressive conditions lasting at least 2 years with subsequent spontaneous or therapeutic high-quality remission (intermission) and fully reversed depressive disorders, recovery of the premorbid psychic functions, personality traits and quality of life. Two variants of long-standing depressions, simple and polymorphic, are distinguished based on peculiarities of the psychopathological structure. The practicability of classification of long-standing depressions and their dynamics by phase states is discussed. Chronic depressive states are distinctive for well-apparent polymorphism of disorders and gradual aggravation of depressive symptoms up to neurosis-like and delusional register without a tendency toward spontaneous normalization and with only low-quality therapeutic remission with residual productive symptomatology. Four types of chronic depressions are distinguished: melancholic, apathoadynamic, depressive-hypochondriac, and depressive-depersonalizing. Three variants of dynamics of chronic depressions are described: dynamic-inert, dynamic-labile, and dynamic with continuous aggravation of the disorder. The appropriateness of discussion of chronic depressions in terms of protracted progressive attacks and conservation of their psychopathological basis throughout the period of the disease is considered. The principles of therapy of long-standing and chronic endogenous depressions are briefly outlined.

Objective: This study aimed to clarify the differential contributions of situational and individual factors to burnout symptoms experienced by two independent groups of specialist oncology nurses working in oncology hospital units or in hospices., Method: The study involved a group of specialist oncology nurses working in hospital oncology units (n = 59) and a group of specialist oncology nurses working in hospices (n = 33). Participants were invited to provide demographic data, and indicate the clinical setting in which they worked and their work experience; the Italian versions of the Maslach Burnout Inventory (MBI) (a measure of burnout symptoms), the Hospital Anxiety and Depression Scale (HADS) (a measure of anxiety and depression), and the Attachment Style Questionnaire (ASQ) (a measure of relational style) were then administered., Results: The two groups of nurses were well matched for age, work experience, and levels of anxiety and depression. Regarding their relational style, the two groups only differed significantly on two subscales of the ASQ (i.e. "Confidence" and "Relationships as Secondary"). The two groups significantly differed in the levels of all burnout symptoms investigated (emotional exhaustion, depersonalization, and personal achievement), with nurses working in hospital units showing higher levels of burnout symptoms. Interestingly, multivariate regression analyses showed that the institutional factor (clinical setting in which nurses worked) clearly emerged as the only factor that influenced the level of all burnout symptoms, whereas the contribution of individual factors was less significant., Significance of Results: These findings help to clarify the differential contributions of institutional and individual factors to burnout symptoms in specialist oncology nurses, and corroborate the need for interventions to contain nurses' burnout symptoms.

Burnout is an important occupational problem for health care workers. We aimed to assess the burnout levels among oncology employees and to evaluate the sociodemographic and occupational factors contributing to burnout levels. The Maslach Burnout Inventory, which is designed to measure the three stages of burnout-emotional exhaustion (EE), depersonalization (DP), and personal accomplishment (PA), was used. The study sample consisted of 90 participants with a median age of 34 (range 23-56). The mean levels of burnout in EE, DP and PA stages were 23.80 +/- 10.98, 5.21 +/- 4.99, and 36.23 +/- 8.05, respectively, for the entire sample. Among the 90 participants, 42, 20, and 35.6% of the employees had high levels of burnout in the EE, DP, and PA substage, respectively. Sociodemographic and occupational factors associated with higher levels of burnout included age of less than 35, being unmarried, being childless, >40 work hours per week, working on night shifts, and <10 years experience in the medicine/oncology field. Within all oncology clinics, medical oncology employees had the highest levels of burnout. Furthermore, employees who are not pleased with working in oncology field, who would like to change their specialty if they have an opportunity, and whose family and social lives have been negatively affected by their work experienced higher levels of burnout. Burnout syndrome may influence physical and mental health of the employee and affects the quality of health care as well. Therefore, several individual or organizational efforts should be considered for dealing with burnout.

The individual facing the diagnosis of cancer is subjected to abrupt changes with regard to his inner world, his life, habits and social relationships. The patient's capacity to cope, to integrate changes in the way of living and to face the future is determined by his personal resources. However, psychological support may also be an important mean to search for and find sense to the singular experience of the illness. The narrative reconstruction within a supportive setting provides the patient a possibility to recognise his pain as an integral part of himself. A life narrative, which integrates the illness, allows the patient to re-appropriate his history again. Such a therapeutic project necessitates from the therapist a psychological and temporal availability and a capacity to create links all along the different stages of the disease.

Among the varied hallucinations associated with sleep paralysis (SP), out-of-body experiences (OBEs) and vestibular-motor (V-M) sensations represent a distinct factor. Recent studies of direct stimulation of vestibular cortex report a virtually identical set of bodily-self hallucinations. Both programs of research agree on numerous details of OBEs and V-M experiences and suggest similar hypotheses concerning their association. In the present study, self-report data from two on-line surveys of SP-related experiences were employed to assess hypotheses concerning the causal structure of relations among V-M experiences and OBEs during SP episodes. The results complement neurophysiological evidence and are consistent with the hypothesis that OBEs represent a breakdown in the normal binding of bodily-self sensations and suggest that out-of-body feelings (OBFs) are consequences of anomalous V-M experiences and precursors to a particular form of autoscopic experience, out-of-body autoscopy (OBA). An additional finding was that vestibular and motor experiences make relatively independent contributions to OBE variance. Although OBEs are superficially consistent with universal dualistic and supernatural intuitions about the nature of the soul and its relation to the body, recent research increasingly offers plausible alternative naturalistic explanations of the relevant phenomenology.

Aims: The depersonalization is a clinical condition of frequent observation that occurs often in the late adolescence and among the young adults. This condition most of the time causes anguish justified from the gravity of the symptomatic perception, involving consequently a series of clinical problems, not last the answer that such condition generates in the observer: answer not only aware, that influences strongly the diagnostic interpretation and the therapeutic approach., Materials and Methods: We tried to investigate this clinical condition within a sample of 267 subjects, 120 of them examinated in our outpatients ambulatory of psychotherapy and 147 examinated in E.R. and in inpatients unit., Results: The percentage of patients with depersonalization, similarly to other studies, is quantitatively different in the two samples. However, what seems obvious is that if the differences for what concerns the frequency and the symptomatic intensity are rather marked, otherwise for what concerns the psychodinamic aspect the differences appears less sharp., Conclusions: This observation puts in evidence, on the model of many international studies about the latent psychosis, that in psychiatry at the seriousness of the psychodynamic and prognostic aspects not always corresponds the seriousness of the symptomatic aspects.

Autoscopic phenomena are part of the reduplicative misidentification syndromes. These disorders may be a manifestation of both neurological and psychiatric conditions and consist of a double perception of the own body. These phenomena have been attributed to a dysfunction of the nondominant gyrus angularis. Two cases with this symptom are described. Case 1: A female with previous history of multiple sclerosis presented with episodes in which she saw herself in her extrapersonal space. Holter EEG was normal. An MRI scan showed multiple T2 hyperintensities. She was treated with carbamazepine and the symptom subsided. Case 2: A man presented with visual loss in the left field and episodic visualization of his own image. Examination confirmed left homonymous hemianopia. Serum glucose was 417 mg/dL. MRI was normal. Glycemia correction made the autoscopia disappear. In case 1, ephaptic transmission is proposed as the pathogenic mechanism and in the case 2, transient glucose toxicity is likely to explain the autoscopic phenomena.

Background: Depersonalisation is a subjective experience of unreality and detachment from the self often accompanied by derealisation; the experience of the external world appearing to be strange or unreal. Feelings of unreality can be evoked by disorienting vestibular stimulation., Objective: To identify the prevalence of depersonalisation/derealisation symptoms in patients with peripheral vestibular disease and experimentally to induce these symptoms by vestibular stimulation., Methods: 121 healthy subjects and 50 patients with peripheral vestibular disease participated in the study. For comparison with the patients a subgroup of 50 age matched healthy subjects was delineated. All completed (1) an in-house health screening questionnaire; (2) the General Health Questionnaire (GHQ-12); (3) the 28-item depersonalisation/derealisation inventory of Cox and Swinson (2002). Experimental verification of "vestibular induced" depersonalisation/derealisation was assessed in 20 patients and 20 controls during caloric irrigation of the labyrinths., Results: The frequency and severity of symptoms in vestibular patients was significantly higher than in controls. In controls the most common experiences were of "déjà vu" and "difficulty in concentrating/attending". In contrast, apart from dizziness, patients most frequently reported derealisation symptoms of "feel as if walking on shifting ground", "body feels strange/not being in control of self", and "feel 'spacey' or 'spaced out'". Items permitted discrimination between healthy subjects and vestibular patients in 92% of the cases. Apart from dizziness, caloric stimulation induced depersonalisation/derealisation symptoms which healthy subjects denied ever experiencing before, while patients reported that the symptoms were similar to those encountered during their disease., Conclusions: Depersonalisation/derealisation symptoms are both different in quality and more frequent under conditions of non-physiological vestibular stimulation. In vestibular disease, frequent experiences of derealisation may occur because distorted vestibular signals mismatch with the other sensory input to create an incoherent frame of spatial reference which makes the patient feel he or she is detached or separated from the world.

Out-of-body experiences are reported in a variety of diseases and physiologic conditions. We report a 44-year-old patient with epigastric auras, psychomotor and grand mal seizures, and paroxysmal experiences during which he believed to have left his body and seen himself from the outside. Electroencephalography showed a right temporal and right parietal seizure pattern on several occasions, and a lesion in the right parietal lobe was detected by cranial magnetic resonance imaging. Histological examination showed a pleomorphic xanthoastrocytoma. Following extirpation of the lesion, the patient has been seizure-free for 5 years.

In this report a patient with episodic depersonalization is described. As the depersonalization episodes had been attributed to partial seizures, this patient was treated with antiepileptic medication. However, clinical evaluation with long-term video/EEG revealed no evidence of seizure activity during the depersonalization episodes. On the other hand, further evaluation revealed findings that are frequently associated with focal epilepsy. In addition to episodic depersonalization, this patient had secondary generalized seizures. The relationship between episodic depersonalization, temporal lobe pathology, and epilepsy is discussed against the background of this case.

A 19-year-old patient had developed a depersonalisation disorder following the use of considerable amounts of cannabis for several weeks two years before. The symptoms decreased sharply after treatment with a serotonergic antidepressant. In cases of persistent or recurrent symptoms of depersonalisation, both psychiatric and somatic causes should be looked for. In cases of primary depersonalisation, the use of (soft) drugs should be considered in the differential diagnosis. Various forms of pharmaco- and psychotherapy seem to be able to reduce the symptoms. However, the effectiveness of no treatment has yet been proven.

Background: It is well documented that doctors experience a high level of stress in their profession, and that this can lead to physical, psychological, and emotional harm, in particular, burnout. Overseas (especially in the UK and USA), research investigating the levels of stress, burnout, and associated psychiatric morbidity in health professionals, across many specialties, has been carried out with a view to prevention of these adverse outcomes., Aims: To assess the level of burnout in a sample of New Zealand physicians, the associated work and personal characteristics, and the need for development of a support peer supervision or support system., Methods: Questionnaires that measured a number of work and personal characteristics, including the Maslach Burnout Inventory, the General Health Questionnaire, and additional questions regarding mistakes, and need for support, were sent to 83 physicians in the Waikato and Bay of Plenty areas. Analysis involved descriptive statistics, with t-tests for comparison with other studies, Pearson Product-Moment correlations between variables and analysis of variance where appropriate., Results: Of the 50 respondents, 28% experienced high levels of two or three aspects of burnout (emotional exhaustion, depersonalization, low personal accomplishment). Emotional exhaustion correlated with a greater need for support. Most respondents favoured a one-to-one support system., Conclusion: This study highlights the presence of significant workplace difficulties for physicians and the need to develop a preventative support system for the protection of physicians and the patients in their care.