Case Study: Depersonalization and Vestibular Impairment

Abstract

Background We describe herein the case of a patient whose primary complaints were episodic vertigo and “depersonalization,” a sensation of detachment from his own body.

Purpose This case study aims to further clinical knowledge and insight into the clinical evaluation of vertiginous patients with complaints of depersonalization.

Research Design This is a case study.

Data Collection and Analysis A retrospective chart review of vestibular function testing done on a vertiginous patient with complaints of depersonalization was performed.

Results Vestibular function testing revealed absent cervical and ocular vestibular evoked myogenic potentials on the left side with normal vHIT or video Head Impulse Test, videonystagmography, and rotational chair results, suggesting peripheral vestibular impairment isolated to the left saccule and utricle.

Conclusion The otolith end organ impairment explains the patient's postural deviation to the left side during attempts to ambulate. We recommend that clinicians should be attentive to patient complaints of depersonalization and perform vestibular evoked myogenic potential testing to determine whether evidence of at least a unilateral peripheral otolith end organ impairment exists.

Keywords

depersonalization - vertigo - vestibular function - otolith end organ

Publikationsverlauf

Eingereicht: 14. Mai 2020

Angenommen: 18. September 2020

Artikel online veröffentlicht:
24. Mai 2021

• References

• 1 Jacobson GP, Piker EG, Hatton K. et al. Development and preliminary findings of the dizziness symptom profile. Ear Hear 2019; 40 (03) 568-576
• 2 Snaith RP. The hospital anxiety and depression scale. Health Qual Life Outcomes 2003; 1: 29
• 3 Sierra M, Berrios GE. The Cambridge depersonalization scale: a new instrument for the measurement of depersonalization. Psychiatry Res 2000; 93 (02) 153-164
• 4 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.. Arlington, VA: American Psychiatric Publishing; 2013
• 5 Aderibigbe YA, Bloch RM, Walker WR. Prevalence of depersonalization and derealization experiences in a rural population. Soc Psychiatry Psychiatr Epidemiol 2001; 36 (02) 63-69
• 6 Jáuregui Renaud K. Vestibular function and depersonalization/derealization symptoms. Multisens Res 2015; 28 (5-6): 637-651
• 7 Toupet M, Van Nechel C, Hautefort C. et al. Influence of visual and vestibular hypersensitivity on derealization and depersonalization in chronic dizziness. Front Neurol 2019; 10: 69
• 8 Kolev OI, Georgieva-Zhostova SO, Berthoz A. Anxiety changes depersonalization and derealization symptoms in vestibular patients. Behav Neurol 2014; 2014: 847054
• 9 Jáuregui Renaud K. Vestibular function and depersonalization/derealization symptoms. Multisens Res 2015; 28 (5-6): 637-651
• 10 Tschan R, Wiltink J, Adler J, Beutel ME, Michal M. Depersonalization experiences are strongly associated with dizziness and vertigo symptoms leading to increased health care consumption in the German general population. J Nerv Ment Dis 2013; 201 (07) 629-635
• 11 Sang FY, Jáuregui-Renaud K, Green DA, Bronstein MA, Gresty MA. Depersonalisation/derealization symptoms in vestibular disease. J Neurosureg Psychiatry 2006; 77 (06) 760-766
• 12 Jauregui-Renaud K, Sang FYP, Gresty MA, Green DA, Bronstein AM. Depersonalization/derealization symptoms and updating orientation in patients with vestibular disease. J Neurol Neurosurg Psychiatry 2008; 79 (03) 276-283
• 13 Grigsby JP, Johnston CL. Depersonalization, vertigo and Ménière's disease. Psychol Rep 1989; 64 (02) 527-534
• 14 Lopez C, Elzière M. Out-of-body experience in vestibular disorders—a prospective study of 210 patients with dizziness. Cortex 2018; 104: 193-206
• 15 Lopez C. A neuroscientific account of how vestibular disorders impair bodily self-consciousness. Front Integrative Neuroscience 7. Article 2013; 7: 91
• 16 Besnard S, Lopez C, Brandt T, Denise P, Smith PF. Editorial: the vestibular system in cognitive and memory processes in mammalians. Front Integr Nuerosci 2015; 9: 55
• 17 Frank SM, Greenlee MW. The parieto-insular vestibular cortex in humans: more than a single area?. J Neurophysiol 2018; 120 (03) 1438-1450
• 18 Simeon D, Abugel J. Feeling Unreal: Depersonalization Disorder and the Loss of the Self. New York, NY: Oxford University Press; 2006
• 19 McCaslin DL, Jacobson GP. Vestibular evoked myogenic potentials (VEMPs). In: Jacobson GP, Shepard NT (Eds): Balance function assessment and management. San Diego: Plural Publishing; 2016: 533-579