Dissociative Components in Etiopathogenesis of Depression, Possibilities of Monitoring and The-rapeutic Influence

Overview

Dissociation in its historical definition by Pierre Janet represents splitting the stream of consci-ousness in response to a traumatic event or in hypnosis. Dissociation is traditionally consideredan important etiopathogenetic factor of mental diseases and it also explains some psychopatholo-gical phenomena. This mechanism was used definitely for explanation of the group of dissociativedisorders. Influence of dissociation was proved also in other psychiatric disorders and the exi-stence of dissociative continuum from normal dissociation to its pathological forms. Also in de-pression some connections are known which point to dissociative components in depressedpatients, above all dissociation connected with symptoms of posttraumatic stress disorder, pro-bably often in connection with resistance to pharmacotherapy. In this pilot research we tested 22patients with recurrent or bipolar depression by means of DES, BDI-II and in this group 11patients wen also tested with SDQ-20.Psychic dissociation measured by means of the DES score has a median 9.48 that is more thantwice as high as dissociation in the normal population. Median BDI-II was 36.5 and it representsmajor depression. Somatoform dissociation measured by means of SDQ-20 has a median of 28 andis near to the lower limit for dissociative disorders. Correlation between DES and BDI-II is notclose but correlation between DES and SDQ-20 is a very close correlation between measuredvalues of psychic (DES) and somatoform dissociation (SDQ-20) and its value being 0.9. For BDI-II>30 (n=16) the median was DES 16.58 and median BDI-II was 40.25. For BDI-II>40 (n=9) medianwas DES 22.36 and median BDI-II was 45. Along with increasing depression dissociation measu-red by the DES also increases. 3 patients from the whole group (13.6%) probably have criteria fordissociative disorders (DES>25) and it corresponds with findings which prove that 15% of allpsychiatric patients have dissociative disorders. Treatment of these patients thus representsa clinical problem which can be resolved only by means of special diagnostic and therapeuticmethods also with respect to danger of resistance of treatment in these patients.

Key words:
dissociation, depression, posttraumatic stress disorder, treatment resistance.