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DPDR的发病机制涉及多个层面，包括神经影像学发现、神经递质系统、心理认知模型等。本分类收录关于DPDR神经生物学机制、认知心理机制及整合模型的研究文献。

文献列表​

作者: Lebois L.; Li M.; Baker J.; Wolff J.; Wang D.; Lambros A.; Grinspoon E.; Winternitz S.; Ren J.; Gönenç A.; Gruber S.; Ressler K.; Liu H.; Kaufman M.
年份: 2021
DOI: 10.1176/appi.ajp.2020.19060647
原文链接: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8030225/
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1176/appi.ajp.2020.19060647](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1176/appi.ajp.2020.19060647)

摘要（中文）: 本研究对65名有童年虐待史和当前PTSD的女性进行静息态功能连接分析，发现默认模式和额顶控制网络间的连接与解离严重程度相关，脑网络连接可提供对症状严重程度的无偏估计。

摘要（英文）: Objective: Dissociative experiences commonly occur in response to trauma, and while their presence strongly affects treatment approaches in posttraumatic spectrum disorders, their etiology remains poorly understood and their phenomenology incompletely characterized. Methods to reliably assess the severity of dissociation symptoms, without relying solely on self-report, would have tremendous clinical utility. Brain-based measures have the potential to augment symptom reports, although it remains unclear whether brain-based measures of dissociation are sufficiently sensitive and robust to enable individual-level estimation of dissociation severity based on brain function. The authors sought to test the robustness and sensitivity of a brain-based measure of dissociation severity. Methods: An intrinsic network connectivity analysis was applied to functional MRI scans obtained from 65 women with histories of childhood abuse and current posttraumatic stress disorder (PTSD). The authors tested for continuous measures of trauma-related dissociation using the Multidimensional Inventory of Dissociation. Connectivity estimates were derived with a novel machine learning technique using individually defined homologous functional regions for each participant. Results: The models achieved moderate ability to estimate dissociation, after controlling for childhood trauma and PTSD severity. Connections that contributed the most to the estimation mainly involved the default mode and frontoparietal control networks. By contrast, all models performed at chance levels when using a conventional group-based network parcellation. Conclusions: Trauma-related dissociative symptoms, distinct from PTSD and childhood trauma, can be estimated on the basis of network connectivity. Furthermore, between-network brain connectivity may provide an unbiased estimate of symptom severity, paving the way for more objective, clinically useful biomarkers of dissociation and...

一句话概括: 默认模式和额顶控制网络连接可预测解离严重程度，提供客观生物标志物。

[2] A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions​

作者: McKinnon M.; Boyd J.; Frewen P.; Lanius U.; Jetly R.; Richardson J.; Lanius R.
年份: 2016
DOI: 10.1016/j.neuropsychologia.2016.07.017
原文链接: 无
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/j.neuropsychologia.2016.07.017](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/j.neuropsychologia.2016.07.017)

摘要（中文）: 本综述探讨解离症状与注意、执行功能、记忆和社会认知功能障碍的关系。提出两个神经生物学机制：丘脑水平的功能性感觉传入阻滞和关键脑网络间功能连接改变可能介导解离症状与认知功能障碍的联系。

摘要（英文）: Dissociative experiences, involving altered states of consciousness, have long been understood as a consequence or response to traumatic experiences, where a reduced level of consciousness may aid in survival during and after a traumatic event. Indeed, the dissociative subtype of post-traumatic stress disorder (PTSD-DS) was added recently to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). Dissociative symptoms are present across a host of neuropsychiatric conditions, including PTSD, psychotic spectrum illnesses, anxiety and mood disorders. Transdiagnostically, the presence of dissociative symptoms is associated with a greater illness burden and reduced treatment outcomes. Critically, dissociative symptoms are related to impaired performance on measures of attention, executive functioning, memory, and social cognition and may contribute to the widespread cognitive dysfunction observed across psychiatric illnesses. Despite this knowledge, the relation between dissociative symptoms and reduced cognitive function remains poorly understood. Here, we review the evidence linking dissociative symptoms to cognitive dysfunction across neuropsychiatric disorders. In addition, we explore two potential neurobiological mechanisms that may underlie the relation between dissociative symptoms and cognitive dysfunction in trauma-related neuropsychiatric conditions. Specifically, we hypothesize that: 1) functional sensory deafferentation at the level of the thalamus, as observed in the defence cascade model of dissociation, may underlie reduced attention and arousal leading to progressive cognitive dysfunction and; 2) altered functional connectivity between key brain networks implicated in cognitive functioning may represent a critical neurobiological mechanism linking dissociative symptoms and cognitive dysfunction in patients with PTSD-DS and transdiagnostically.

一句话概括: 解离与认知功能障碍相关，丘脑传入阻滞和网络连接改变是潜在机制。

[3] Dissociation as a disorder of integration–On the footsteps of Pierre Janet​

作者: Scalabrini A.; Mucci C.; Esposito R.; Damiani S.; Northoff G.
年份: 2020
DOI: 10/ggwh4v
原文链接: 10/ggwh4v
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10/ggwh4v](https://pubmed.ncbi.nlm.nih.gov/?term = 10/ggwh4v)

摘要（中文）: 19世纪Pierre Janet提出解离是心理功能整合受损的表现状态。本综述将Janet的原始概念与当前脑成像研究结合，提出三个动态整合的神经机制：区域水平的时空绑定、网络水平的时空同步和全局水平的时空整合化，这些机制可能与解离的不同症状表现相关。

摘要（英文）: At the end of the 19th century Pierre Janet described dissociation as an altered state of consciousness manifested in disrupted integration of psychological functions. Clinically, such disruption comprises compartmentalization symptoms like amnesia, detachment symptoms like depersonalization/derealization, and structural dissociation of personality with changes in the sense of self. The exact neuronal mechanisms leading to these different symptoms remain unclear. We here suggest to put Janet's original account of dissociation as disrupted integration of psychological functions into a novel context, that is, a neuronal context as related to current brain imaging. This requires a combined theoretical and empirical approach on data supporting such neuronal reframing of Janet. For that, we here review (i) past and (ii) recent psychological and neuronal views on dissociation together with neuroscientific theories of integration, which (iii) are supported and complemented by preliminary fMRI data. We propose three neuronal mechanisms of dynamic integration operating at different levels of the brain's spontaneous activity-temporo-spatial binding on the regional level, temporo-spatial synchronization on the network level, and temporo-spatial globalization on the global level. These neuronal mechanisms, in turn, may be related to different symptomatic manifestation of dissociation operating at different levels, e.g., compartmentalization, detachment, and structural, which, as we suggest, can all be traced to disrupted integration of neuronal and psychological functions as originally envisioned by Janet.

一句话概括: 解离是心理功能整合受损，三个层次神经整合机制受损导致不同解离症状。

[4] Temporal lobe epilepsy and the phobic anxiety-depersonalization syndrome. II. Practical and theoretical considerations​

作者: Roth M.; Harper M.
年份: 1962
DOI: 10/d6994n
原文链接: 10/d6994n
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10/d6994n](https://pubmed.ncbi.nlm.nih.gov/?term = 10/d6994n)

摘要（中文）: 暂无摘要

摘要（英文）: 暂无摘要

一句话概括: 颞叶癫痫与焦虑恐惧-去人格化综合征的理论和实践探讨。

[5] Depersonalization disorder: thinking without feeling​

作者: Phillips M.; Medford N.; Senior C.; Bullmore E.; Suckling J.; Brammer M.; Andrew C.; Sierra M.; Williams S.; David A.
年份: 2001
DOI: 10.1016/s0925-4927(01)00119-6
原文链接: [https://api.elsevier.com/content/article/PII:S0925492701001196?httpAccept = text/xml](https://api.elsevier.com/content/article/PII:S0925492701001196?httpAccept = text/xml)
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/s0925-4927(01)00119-6](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/s0925-4927(01)00119-6)

摘要（中文）: 去人格化障碍患者对厌恶刺激的主观情绪体验缺失，fMRI显示情绪相关脑区（岛叶和枕颞皮层）激活降低，而右侧腹内侧前额叶激活。核心现象——主观情绪体验缺失——与情绪敏感脑区反应降低和情绪调节脑区反应增强相关。

摘要（英文）: Patients with depersonalization disorder (DP) experience a detachment from their own senses and surrounding events, as if they were outside observers. A particularly common symptom is emotional detachment from the surroundings. Using functional magnetic resonance imaging (fMRI), we compared neural responses to emotionally salient stimuli in DP patients, and in psychiatric and healthy control subjects. Six patients with DP, 10 with obsessive-compulsive disorder (OCD), and six volunteers were scanned whilst viewing standardized pictures of aversive and neutral scenes, matched for visual complexity. Pictures were then rated for emotional content. Both control groups rated aversive pictures as much more emotive, and demonstrated in response to these scenes significantly greater activation in regions important for disgust perception, the insula and occipito-temporal cortex, than DP patients (covarying for age, years of education and total extent of brain activation). In DP patients, aversive scenes activated the right ventral prefrontal cortex. The insula was activated only by neutral scenes in this group. Our findings indicate that a core phenomenon of depersonalization--absent subjective experience of emotion--is associated with reduced neural responses in emotion-sensitive regions, and increased responses in regions associated with emotion regulation.

一句话概括: DPD患者情绪脑区激活降低、前额叶调控增强，导致情绪体验缺失。

[6] Basal norepinephrine in depersonalization disorder​

作者: Simeon D.; Guralnik O.; Knutelska M.; Yehuda R.; Schmeidler J.
年份: 2003
DOI: 10/dvb8mj
原文链接: 10/dvb8mj
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10/dvb8mj](https://pubmed.ncbi.nlm.nih.gov/?term = 10/dvb8mj)

摘要（中文）: 本初步研究检测去人格化障碍的基底去甲肾上腺素水平。DPD组24小时尿去甲肾上腺素显著高于对照组，且与解离严重程度呈强负相关（r = -0.88）。提示随着解离严重程度增加，基底去甲肾上腺素反而下降。

摘要（英文）: In contrast to the noradrenergic dysregulation described in PTSD, little is known regarding noradrenergic function in dissociative disorders. The purpose of this preliminary study was to investigate basal norepinephrine in depersonalization disorder (DPD). Nine subjects with DSM-IV DPD, without lifetime PTSD, were compared to nine healthy comparison (HC) subjects. Norepinephrine was measured via 24-h urine collection and three serial plasma determinations. Groups did not differ significantly in plasma norepinephrine levels. Compared to the HC group, the DPD group demonstrated significantly higher urinary norepinephrine, only prior to covarying for anxiety. The DPD group also demonstrated a highly significant inverse correlation between urinary norepinephrine and depersonalization severity (r = -0.88). Norepinephrine and cortisol levels (reported in a prior study) were not intercorrelated. We concluded that although dissociation accompanied by anxiety was associated with heightened noradrenergic tone, there was a marked basal norepinephrine decline with increasing severity of dissociation. The findings are in concordance with the few reports on autonomic blunting in dissociation and merit further investigation.

一句话概括: DPD患者去甲肾上腺素与解离严重程度负相关，提示自主神经钝化。

[7] Face processing in depersonalization: An fMRI study of the unfamiliar self​

作者: Ketay S.; Hamilton H.; Haas B.; Simeon D.
年份: 2014
DOI: 10.1016/j.pscychresns.2014.02.003
原文链接: [https://api.elsevier.com/content/article/PII:S0925492714000304?httpAccept = text/xml](https://api.elsevier.com/content/article/PII:S0925492714000304?httpAccept = text/xml)
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/j.pscychresns.2014.02.003](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/j.pscychresns.2014.02.003)

摘要（中文）: 9名DPD参与者和10名对照在fMRI下观看自我和陌生人面孔。DPD组对自我vs陌生面孔在多个脑区表现出显著更强的激活，提示自我熟悉性加工异常。

摘要（英文）: Depersonalization disorder (DPD) is characterized by a core sense of unfamiliarity. Nine DPD participants and 10 healthy controls underwent functional magnetic resonance imaging while viewing self and unfamiliar faces. Compared with control subjects, the DPD group exhibited significantly greater activation in several brain regions in response to self vs. stranger faces. Implications are discussed.

一句话概括: DPD患者自我面孔加工脑区激活异常，提示自我熟悉性感知受损。

作者: Murphy R.
年份: 2023
DOI: 无
原文链接: 无
PubMed: 无

摘要（中文）: 解离和现实解体涉及与自我和周围环境疏离感相关的心智异常。DPDR的发病与压力防御级联（包括自主神经功能、HPA轴和神经环路）及更复杂的解离特征（如情绪调节障碍和身体图式解体）相关。DPDR不仅涉及感觉整合扰乱，还涉及多个大规模脑网络。

摘要（英文）: Depersonalization and derealization refer to an estranged state of mind that involves a profound feeling of detachment from one's sense of self and the surrounding environment, respectively. The phenomena co-occur on a continuum of severity, ranging from a transient experience as a normal reaction to a traumatic event to a highly debilitating condition with persistent symptoms, formally described as depersonalization/derealization disorder (DPDR). Lack of awareness of DPDR is partly due to a limited neurobiological framework, and there remains a significant risk of misdiagnosis in clinical practice. Earlier literature has focused on several brain regions involved in the experience of depersonalization and derealization, including adaptive responses to stress via defense cascades comprising autonomic functioning, the hypothalamic-pituitary-adrenal (HPA) axis, and various other neurocircuits. Recent evidence has also demonstrated the role of more complex mechanisms that are bolstered by dissociative features, such as emotional dysregulation and disintegration of the body schema. This review intends to abridge the prevailing knowledge regarding structural and functional brain alterations associated with DPDR with that of its heterogenic manifestations. DPDR is not merely the disruption of various sensory integrations, but also of several large-scale brain networks. Although a comprehensive antidote is not available for DPDR, a holistic route to the neurobiological context in DPDR may improve general understanding of the disorder and help afflicted individuals re-establish their sense of personal identity. Such information may also be useful in the development of novel pharmacological agents and targeted psychological interventions.

一句话概括: DPDR涉及多个大规模脑网络的功能与结构改变，与创伤病理相关。

[9] Interoceptive-reflective regions differentiate alexithymia traits in depersonalization disorder​

作者: Lemche E.; Brammer M.; David A.; Surguladze S.; Phillips M.; Sierra M.; Williams S.; Giampietro V.
年份: 2013
DOI: 10.1016/j.pscychresns.2013.05.006
原文链接: 无
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/j.pscychresns.2013.05.006](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/j.pscychresns.2013.05.006)

摘要（中文）: 本研究探讨DPD与述情障碍是否共享情绪调节异常脑机制。DPD患者情绪面孔加工脑区与述情障碍量表评分相关，提示述情障碍在DPD情绪失调中起重要作用，可能与内感受限制相关。

摘要（英文）: It is unclear to what degree depersonalization disorder (DPD) and alexithymia share abnormal brain mechanisms of emotional dysregulation. We compared cerebral processing of facial expressions of emotion in individuals with DPD to normal controls (NC). We presented happy and sad emotion expressions in increasing intensities from neutral (0%) through mild (50%) to intense (100%) to DPD and non-referred NC subjects in an implicit event-related fMRI design, and correlated respective brain activations with responses on the 20-item Toronto Alexithymia Scale (TAS-20) and its three subscales F1-F3. The TAS-20 predicts clinical diagnosis of DPD with a unique variance proportion of 38%. Differential regression analysis was utilized to ascertain brain regions for each alexithymia subscale. Differential regions of total alexithymia severity for happy emotion were the globus pallidus externus; for identifying feelings (TAS-20 F1 subscale), the right anterior insula; for description of feelings (F2), the right dorsal mid-anterior cingulate gyrus (BA 24); and for externally oriented cognitive style (F3), the left paracingulate gyrus (BA 32). For sad emotion, the differential region for the total TAS-20 score was the dorsal anterior cingulate gyrus (BA 24); for TAS-20 F1, the left inferior anterior insula; for TAS-20 F2, the right PCC (BA 31); and for TAS-20 F3, the right orbital gyrus (BA 10). Supporting our hypotheses, the ascertained brain regions for TAS-20 subscales subserve interoception, monitoring and reflection of internal states and emotion. The presented analyses provide evidence that alexithymia plays a substantial role in emotional dysregulation in DPD, presumably based on restrictions in interoception.

一句话概括: 述情障碍在DPD情绪失调中起重要作用，与内感受限制相关。

[10] Depersonalization Disorder: A Functional Neuroanatomical Perspective​

作者: Phillips M.; Sierra M.
年份: 2003
DOI: 10.1080/1025389031000138538
原文链接: http://www.tandfonline.com/doi/pdf/10.1080/1025389031000138538
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1080/1025389031000138538](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1080/1025389031000138538)

摘要（中文）: 情绪体验减弱是去人格化障碍的核心特征。患者通常主诉情绪麻木，并将非真实感归因于感知缺乏情感"着色"。神经影像和心理生理学研究支持这些假设，显示DPD患者对情绪刺激的自主神经反应减弱、情绪相关脑区活动降低，而前额叶皮层活动增强。症状可能与情绪反应模式的逆转相关。

摘要（英文）: Clinical reports of depersonalization suggest that attenuated emotional experience is a central feature of the condition. Patients typically complain of emotional numbness and some patients ascribe their feelings of unreality to a lack of affective "colouring" in things perceived. Recent neuroimaging and psychophysiological studies support these assumptions as they show both attenuated autonomic responses in depersonalization, and decreased activity within neural regions important for the generation of affective responses to emotive stimuli. Furthermore, findings from neuroimaging studies indicate increased prefrontal cortical activity in depersonalised patients, particularly within regions associated with contextualization and appraisal of emotionally-salient information rather than mood induction per se. Taken together, these finding suggest that symptoms of depersonalization, and in particular emotional numbing, may be related to a reversal of normal patterns of autonomic and neural response to emotive stimuli.

一句话概括: DPD核心是情绪体验逆转，自主神经和神经反应模式异常。

[11] Depersonalization: A selective impairment of self-awareness​

作者: Sierra M.; David A.
年份: 2011
DOI: 10.1016/j.concog.2010.10.018
原文链接: [https://api.elsevier.com/content/article/PII:S1053810010002060?httpAccept = text/xml](https://api.elsevier.com/content/article/PII:S1053810010002060?httpAccept = text/xml)
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/j.concog.2010.10.018](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/j.concog.2010.10.018)

摘要（中文）: 去人格化由前额叶-边缘（特别是前岛叶）抑制机制导致，表现为情绪麻木和感知脱节。功能神经影像和心理生理学研究支持该模型，显示DPD患者对厌恶情绪刺激表现出前额叶激活增强和岛叶/边缘区激活降低。

摘要（英文）: Depersonalization is characterised by a profound disruption of self-awareness mainly characterised by feelings of disembodiment and subjective emotional numbing. It has been proposed that depersonalization is caused by a fronto-limbic (particularly anterior insula) suppressive mechanism-presumably mediated via attention-which manifests subjectively as emotional numbing, and disables the process by which perception and cognition normally become emotionally coloured, giving rise to a subjective feeling of 'unreality'. Our functional neuroimaging and psychophysiological studies support the above model and indicate that, compared with normal and clinical controls, DPD patients show increased prefrontal activation as well as reduced activation in insula/limbic-related areas to aversive, arousing emotional stimuli. Although a putative inhibitory mechanism on emotional processing might account for the emotional numbing and characteristic perceptual detachment, it is likely, as suggested by some studies, that parietal mechanisms underpin feelings of disembodiment and lack of agency feelings.

一句话概括: 前额叶-岛叶抑制机制导致DPD情绪麻木和感知脱节。

[12] Depersonalization disorder: pharmacological approaches​

作者: Sierra M.
年份: 2008
DOI: 10.1586/14737175.8.1.19
原文链接: 无
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1586/14737175.8.1.19](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1586/14737175.8.1.19)

摘要（中文）: DPD是慢性和痛苦性疾病，普通抗抑郁药和抗精神病药疗效有限。阿片受体拮抗剂（如纳曲酮和纳洛酮）对部分患者有效，拉莫三嗪作为单一药物无效但作为SSRIs辅助用药有益，氯硝西泮合并SSRIs对高基线焦虑患者有益。

摘要（英文）: Depersonalization disorder (DPD) is a chronic and distressing condition with a prevalence in the general population between 0.8 and 2%. Several neurobiological studies in the last decade have shown that patients have suppressed limbic activation to emotional stimuli. Such findings are in line with a model which suggests that the condition is generated by an anxiety-triggered, 'hard-wired' inhibitory response to threat. Such a mechanism would ensure the preservation of adaptive behavior, during situations normally associated with overwhelming and potentially disorganizing anxiety. In DPD, such a response would become chronic and dysfunctional. Depersonalization remains a condition for which no definitive treatment exists, and for which conventional medications, such as antidepressants or antipsychotics, have been found to be of little value. Fortunately, a few promising lines of pharmacological treatment have emerged in recent years, although more rigorous studies are needed. For example, a number of studies suggest that opioid receptor antagonists such as naltrexone and naloxone are useful in at least a subgroup of patients. In spite of initial expectations, the use of lamotrigine as a sole medication has not been found useful. However, open-label trials suggest that its use as an add-on treatment with selective serotonin reuptake inhibitors (SSRIs) is beneficial in a substantial number of patients. Similarly, the use of clonazepam, particularly in conjunction with SSRI antidepressants, appears to be beneficial in patients with high levels of background anxiety. In line with the stress-related model of depersonalization, those neurotransmitter systems of relevance to depersonalization are known to play important inhibitory roles in the regulation of the stress response.

一句话概括: DPD需多元药物治疗，阿片受体拮抗剂和拉莫三嗪辅助SSRIs可能有效。

[13] Depersonalization: Neurobiological perspectives​

作者: Sierra M.; Berrios G.
年份: 1998
DOI: 10.1016/S0006-3223(98)00015-8
原文链接: 无
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/S0006-3223(98)00015-8](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/S0006-3223(98)00015-8)

摘要（中文）: 本综述提出新模型：右侧背外侧前额叶激活导致警觉增强和前扣带回抑制，产生"意识空白"和"疼痛 indifference"体验；左侧前额叶机制抑制杏仁核，导致情绪低落和"非真实感"。

摘要（英文）: Reviews ideas and the clinical features of depersonalization, particularly of its emotional changes, suggesting that they are important for the neurobiological understanding of depersonalization. Attention is drawn to clinical similarities between the experiential narratives produced by patients suffering from depersonalization and those with corticolimbic disconnections. On the basis of this, a new model is proposed according to which the state of increased alertness observed in depersonalization results from an activation of prefrontal attentional systems (right dorsolateral prefrontal cortex) and reciprocal inhibition of the anterior cingulate, leading to experiences of "mind emptiness" and "indifference to pain" often seen in depersonalization. On the other hand, a left-sided prefrontal mechanism would inhibit the amygdala resulting in dampened autonomic output, hypoemotionality, and lack of emotional coloring that would, in turn, be reported as feelings of "unreality or detachment."

一句话概括: 左右前额叶不同机制导致DPD警觉增强和情绪钝化。

[14] Potential Targets for Noninvasive Brain Stimulation on Depersonalization-Derealization Disorder​

作者: Zheng S.; Song N.; Wang S.; Zhu H.; Song M.; Jia Y.; Jia H.
年份: 2022
DOI: 10.3390/brainsci12081112
原文链接: https://www.mdpi.com/2076-3425/12/8/1112
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.3390/brainsci12081112](https://pubmed.ncbi.nlm.nih.gov/?term = 10.3390/brainsci12081112)

摘要（中文）: 本研究通过三项分析流程识别DPD非侵入性脑刺激的潜在靶点：Meta分析、功能连接分析和ROI分析。识别出双侧内侧前额叶、背外侧前额叶、顶上小叶、颞上回和右侧腹外侧前额叶等多个潜在刺激靶点。

摘要（英文）: Introduction: Non-invasive brain stimulation seems to be beneficial for DPD patients. However, the sites used in previous studies were empirical. Exploring new stimulation locations via functional magnetic resonance imaging may improve the efficacy. Objectives: The objective was to find potential locations for non-invasive brain stimulation on the depersonalization-derealization disorder. Methods: We explored the potential brain surface regions from three pipelines: pipeline 1: activation likelihood estimation meta-analysis (five studies with 36 foci included); pipeline 2: functional connectivity analysis based on DPD-network (76 subjects included); and pipeline 3: functional connectivity analysis based on DPD regions of interest from the meta-analysis. Potential targets were the 10–20 system coordinates for brain surface regions. Results: We identified several potential brain surface regions, including the bilateral medial prefrontal cortex, dorsal lateral prefrontal cortex, superior parietal gyrus, superior temporal gyrus, and right ventrolateral prefrontal cortex as potential sites. Conclusion: Our findings of the potential stimulation targets might help clinicians optimize the application of non-invasive brain stimulation therapy in individuals with DPD.

一句话概括: 多分析流程识别多个DPD潜在刺激靶点，包括双侧mPFC、DLPFC等。

[15] Limbic and prefrontal responses to facial emotion expressions in depersonalization​

作者: Lemche E.; Surguladze S.; Giampietro V.; Anilkumar A.; Brammer M.; Sierra M.; Chitnis X.; Williams S.; Gasston D.; Joraschky P.; David A.; Phillips M.
年份: 2007
DOI: 10.1097/WNR.0b013e328057deb3
原文链接: https://journals.lww.com/10.1097/WNR.0b013e328057deb3
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1097/WNR.0b013e328057deb3](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1097/WNR.0b013e328057deb3)

摘要（中文）: 9名DPD患者和12名对照在fMRI下观看不同强度的快乐和悲伤面孔。DPD患者对强度递增的情绪面孔表现出皮下边缘区活动降低，且双侧背外侧前额叶与皮肤电导呈负相关，提示情绪唤醒时前额叶调控异常。

摘要（英文）: Depersonalization disorder, characterized by emotional detachment, has been associated with increased prefrontal cortical and decreased autonomic activity to emotional stimuli. Event-related fMRI with simultaneous measurements of skin conductance levels occurred in nine depersonalization disorder patients and 12 normal controls to neutral, mild and intense happy and sad facial expressions. Patients, but not controls, showed decreases in subcortical limbic activity to increasingly intense happy and sad facial expressions, respectively. For both happy and sad expressions, negative correlations between skin conductance measures in bilateral dorsal prefrontal cortices occurred only in depersonalization disorder patients. Abnormal decreases in limbic activity to increasingly intense emotional expressions, and increases in dorsal prefrontal cortical activity to emotionally arousing stimuli may underlie the emotional detachment of depersonalization disorder.

一句话概括: DPD患者边缘区激活降低而背外侧前额叶激活增强，导致情绪 detachment。

[16] Emotional Experience and Awareness of Self: Functional MRI Studies of Depersonalization Disorder​

作者: Medford N.; Sierra M.; Stringaris A.; Giampietro V.; Brammer M.; David A.
年份: 2016
DOI: 10.3389/fpsyg.2016.00432
原文链接: [http://ovidsp.ovid.com/ovidweb.cgi?T = JS&PAGE = reference&D = psyc13&NEWS = N&AN = 2016-40453-001](http://ovidsp.ovid.com/ovidweb.cgi?T = JS&PAGE = reference&D = psyc13&NEWS = N&AN = 2016-40453-001)
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.3389/fpsyg.2016.00432](https://pubmed.ncbi.nlm.nih.gov/?term = 10.3389/fpsyg.2016.00432)

摘要（中文）: 本fMRI研究探讨DPD情绪加工的神经解剖学基础及治疗后的改变。DPD情绪体验减弱与岛叶活动减弱相关，症状改善与岛叶活动增加相关。右侧腹外侧前额叶可能是"自上而下"情绪抑制的关键脑区。

摘要（英文）: This paper presents functional MRI work on emotional processing in depersonalization disorder (DPD). This relatively neglected disorder is hallmarked by a disturbing change in the quality of first-person experience, almost invariably encompassing a diminished sense of self and an alteration in emotional experience such that the sufferer feels less emotionally reactive, with emotions experienced as decreased or "damped down," so that emotional life seems to lack spontaneity and subjective validity. Here we explored responses to emotive visual stimuli to examine the functional neuroanatomy of emotional processing in DPD before and after pharmacological treatment. We also employed concurrent skin conductance measurement as an index of autonomic arousal. In common with previous studies we demonstrated that in DPD, there is attenuated psychophysiological response to emotional material, reflected in altered patterns of (i) regional brain response, (ii) autonomic responses. By scanning participants before and after treatment we were able to build on previous findings by examining the changes in functional MRI response in patients whose symptoms had improved at time 2. The attenuation of emotional experience was associated with reduced activity of the insula, whereas clinical improvement in DPD symptoms was associated with increased insula activity. The insula is known to be implicated in interoceptive awareness and the generation of feeling states. In addition an area of right ventrolateral prefrontal cortex emerged as particularly implicated in what may be "top-down" inhibition of emotional responses. The relevance of these findings to the wider study of emotion, self-related processes, and interoception is discussed.

一句话概括: 岛叶活动减弱导致DPD情绪体验减弱，症状改善与岛叶活动增加相关。

[17] Emotional memory in depersonalization disorder: A functional MRI study​

作者: Medford N.; Brierley B.; Brammer M.; Bullmore E.; David A.; Phillips M.
年份: 12/2
DOI: 10.1016/j.pscychresns.2006.05.007
原文链接: https://linkinghub.elsevier.com/retrieve/pii/S0925492706000941
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/j.pscychresns.2006.05.007](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/j.pscychresns.2006.05.007)

摘要（中文）: 10名DPD患者和对照在fMRI下完成情绪词语记忆任务。DPD患者对情绪词语的识别增强，但中性词的情绪增强记忆缺失。编码和识别期间情绪加工区未激活，提示情绪材料加工异常。

摘要（英文）: This study examines emotional memory effects in primary depersonalization disorder (DPD). A core complaint of DPD sufferers is the dulling of emotional responses, and previous work has shown that, in response to aversive stimuli, DPD patients do not show activation of brain regions involved in normal emotional processing. We hypothesized that DPD sufferers would not show the normal emotional enhancement of memory, and that they would not show activation of brain regions concerned with emotional processing during encoding and recognition of emotional verbal material. Using fMRI, 10 DPD patients were compared with an age-matched healthy control group while performing a test of emotional verbal memory, comprising one encoding and two recognition memory tasks. DPD patients showed significantly enhanced recognition for overtly emotive words, but did not show enhancement of memory for neutral words encoded in an emotive context. In addition, patients did not show activation of emotional processing areas during encoding, and exhibited no substantial difference in their neural responses to emotional and neutral material in the encoding and emotional word recognition tasks. This study provides further evidence that patients with DPD do not process emotionally salient material in the same way as healthy controls, in accordance with their subjective descriptions of reduced or absent emotional responses.

一句话概括: DPD患者情绪记忆加工异常，不显示正常情绪增强效应。

[18] Cognitive load and autonomic response patterns under negative priming demand in depersonalization-derealization disorder.​

作者: Lemche E.; Sierra-Siegert M.; David A.; Phillips M.; Gasston D.; Williams S.; Giampietro V.
年份: 2016
DOI: 10.1111/ejn.13183
原文链接: https://api.wiley.com/onlinelibrary/tdm/v1/articles/10.1111%2Fejn.13183
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1111/ejn.13183](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1111/ejn.13183)

摘要（中文）: 16名DPRD患者和对照完成Stroop/负启动联合任务。DPRD患者在认知负荷期间自主神经模式逆转：对照显示认知负荷与自主反应负相关，而患者显示正相关。DPRD仅显示轻度执行认知特异，但支持自主功能异常。

摘要（英文）: Previous studies have yielded evidence for cognitive processing abnormalities and alterations of autonomic functioning in depersonalization-derealization disorder (DPRD). However, multimodal neuroimaging and psychophysiology studies have not yet been conducted to test for functional and effective connectivity under cognitive stress in patients with DPRD. DPRD and non-referred control subjects underwent a combined Stroop/negative priming task, and the neural correlates of Stroop interference effect, negative priming effect, error rates, cognitive load span and average amplitude of skin conductance responses were ascertained for both groups. Evoked haemodynamic responses for basic Stroop/negative priming activations were compared. For basic Stroop to neutral contrast, patients with DPRD differed in the location (inferior vs. superior lobule) of the parietal region involved, but showed similar activations in the left frontal region. In addition, patients with DPRD also co-activated the dorsomedial prefrontal cortex (BA9) and posterior cingulate cortex (BA31), which were also found to be the main between-group difference regions. These regions furthermore showed connectivity with frequency of depersonalization states. Evoked haemodynamic responses drawn from regions of interest indicated significant between-group differences in 30-40% of time points. Brain-behaviour correlations differed mainly in laterality, yet only slightly in regions. A reversal of autonomic patterning became evident in patients with DPRD for cognitive load spans, indicating less effective arousal suppression under cognitive stress - patients with DPRD showed positive associations of cognitive load with autonomic responses, whereas controls exhibit respective inverse association. Overall, the results of the present study show only minor executive cognitive peculiarities, but further support the notion of abnormalities in autonomic functioning in patients ...

一句话概括: DPRD患者认知负荷下自主神经模式逆转，提示自主调节受损。

[19] How do you feel when you can't feel your body? Interoception, functional connectivity and emotional processing in depersonalization-derealization disorder.​

作者: Sedeno L.; Couto B.; Melloni M.; Canales-Johnson A.; Yoris A.; Baez S.; Esteves S.; Velasquez M.; Barttfeld P.; Sigman M.; Kichic R.; Chialvo D.; Manes F.; Bekinschtein T.; Ibanez A.
年份: 2014
DOI: 10.1371/journal.pone.0098769
原文链接: 10/gc8x9v
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1371/journal.pone.0098769](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1371/journal.pone.0098769)

摘要（中文）: 首项结合行为和神经生物学测量探讨内感受与DD关系的研究。DD患者心跳检测任务表现受损，内感受状态下全脑连接性降低，且表现出情感共情特定模式损害，提示内感受和脑-体相互作用异常与DD现象相关。

摘要（英文）: Depersonalization-Derealization Disorder (DD) typically manifests as a disruption of body self-awareness. Interoception -defined as the cognitive processing of body signals- has been extensively considered as a key processing for body self-awareness. In consequence, the purpose of this study was to investigate whether there are systematic differences in interoception between a patient with DD and controls that might explain the disembodiment symptoms suffered in this disease. To assess interoception, we utilized a heartbeat detection task and measures of functional connectivity derived from fMRI networks in interoceptive/exteroceptivo/mind-wandering states. Additionally, we evaluated empathic abilities to test the association between interoception and emotional experience. The results showed patient's impaired performance in the heartbeat detection task when compared to controls. Furthermore, regarding functional connectivity, we found a lower global brain connectivity of the patient relative to controls only in the interoceptive state. He also presented a particular pattern of impairments in affective empathy. To our knowledge, this is the first experimental research that assesses the relationship between interoception and DD combining behavioral and neurobiological measures. Our results suggest that altered neural mechanisms and cognitive processes regarding body signaling might be engaged in DD phenomenology. Moreover, our study contributes experimental data to the comprehension of brain-body interactions and the emergence of self-awareness and emotional feelings.

一句话概括: DD患者内感受加工和全脑连接性受损，情感共情也受损。

[20] White matter network alterations in patients with depersonalization/derealization disorder.​

作者: Sierk A.; Daniels J.; Manthey A.; Kok J.; Leemans A.; Gaebler M.; Lamke J.; Kruschwitz J.; Walter H.
年份: 2018
DOI: 10.1503/jpn.170110
原文链接: 无
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1503/jpn.170110](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1503/jpn.170110)

摘要（摘要）: DPD患者白质网络改变，左侧颞区和右侧颞顶区FA值显著低于对照，且与解离症状严重程度相关。提示多模态整合和情绪调节相关脑区间的结构连接可能异常。

摘要（英文）: BACKGROUND: Depersonalization/derealization disorder (DPD) is a chronic and distressing condition characterized by detachment from oneself and/or the external world. Neuroimaging studies have associated DPD with structural and functional alterations in a variety of distinct brain regions. Such local neuronal changes might be mediated by altered interregional white matter connections. However, to our knowledge, no research on network characteristics in this patient population exists to date. METHODS: We explored the structural connectome in 23 individuals with DPD and 23 matched, healthy controls by applying graph theory to diffusion tensor imaging data. Mean interregional fractional anisotropy (FA) was used to define the network weights. Group differences were assessed using network-based statistics and a link-based controlling procedure. RESULTS: Our main finding refers to lower FA values within left temporal and right temporoparietal regions in individuals with DPD than in healthy controls when using a link-based controlling procedure. These links were also associated with dissociative symptom severity and could not be explained by anxiety or depression scores. Using network-based statistics, no significant results emerged. However, we found a trend for 1 subnetwork that may support the model of frontolimbic dysbalance suggested to underlie DPD symptomatology. LIMITATIONS: To ensure ecological validity, patients with certain comorbidities or psychotropic medication were included in the study. Confirmatory replications are necessary to corroborate the results of this explorative investigation. CONCLUSION: In patients with DPD, the structural connectivity between brain regions crucial for multimodal integration and emotion regulation may be altered. Aberrations in fibre tract communication seem to be not solely a secondary effect of local grey matter volume loss, but may present a primary pathophysiology in patients with...

一句话概括: DPD患者颞顶区白质连接降低，与解离症状严重程度相关。

[21] White matter abnormalities in first-episode patients with depersonalization/derealization disorder: A tract-based spatial statistics study.​

作者: Ning Y.; Song N.; Zhu H.; Zheng S.; Jia Y.; Yin D.; Li K.; Jia H.
年份: 2022
DOI: 10.1016/j.jad.2022.04.127
原文链接: https://linkinghub.elsevier.com/retrieve/pii/S0165032722004712
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1016/j.jad.2022.04.127](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1016/j.jad.2022.04.127)

摘要（中文）: 25名首发未用药DPD患者和23名对照的DTI扫描显示，患者右侧胼胝体和后冠状辐射FA值升高，且与CDS总分、麻木、自我非真实感、感知觉改变和时间解体正相关，提示白质微结构和认知损害与症状相关。

摘要（英文）: BACKGROUND: Neuroimaging studies on depersonalization / derealization disorder (DPD) have revealed that there are structural and functional alterations across numerous brain regions. However, to date, the exact white matter abnormalities that are associated with different clinical symptoms and cognitive impairments in first-episode, drug-naive patients with DPD remain unclear. METHODS: Overall, 25 first-episode, drug-naive patients with DPD and 23 healthy controls were recruited and underwent DTI scans. The tract-based spatial statistics analysis was conducted in order to determine white matter microstructural changes between the two groups. Correlation analysis was conducted between the fractional anisotropy (FA) of abnormal WM fibers and the total score of the 30-item Cambridge Depersonalization Scale (CDS-30), cognitive assessments. RESULTS: Patients with DPD demonstrated higher FA in the right corpus callosum (CC), and posterior corona radiate (CR), compared to healthy controls. The FA in the right CC demonstrated a positive correlation with total score of CDS-30, numbing, unreality of self, perceptual alterations, and temporal disintegration, respectively. FA in the right CR region indicated a positive correlation with the total score of CDS-30, unreality of self, perceptual alterations, and temporal disintegration, respectively. Furthermore, FA in the right CR region was found to be negatively correlated with the Continuous Performance Test and the Stroop color-word test. CONCLUSION: The altered white matter microstructure and cognitive impairments of medication naive DPD patients were observed. Abnormalities in the integrity of CC and CR were associated with severity of symptoms and cognitive impairments, which may provide a potential biomarker for clinical studies on DPD.

一句话概括: 首发DPD患者白质微结构异常，胼胝体和后冠状辐射与症状和认知损害相关。

[22] Grey matter alterations in patients with depersonalization disorder: a voxel-based morphometry study​

作者: Daniels J.; Gaebler M.; Lamke J.; Walter H.
年份: 2015
DOI: 10.1503/jpn.130284
原文链接: https://europepmc.org/articles/PMC4275327
PubMed: [https://pubmed.ncbi.nlm.nih.gov/?term=10.1503/jpn.130284](https://pubmed.ncbi.nlm.nih.gov/?term = 10.1503/jpn.130284)

摘要（中文）: 首个探索解离障碍全脑形态学异常的VBM研究。25名DPD患者和23名对照显示，患者右侧尾状核、右侧丘脑和右侧楔叶灰质体积减小，左侧背内侧前额叶和右侧感觉区体积增大，这些改变与焦虑抑郁无关。

摘要（英文）: BackgroundTo our knowledge, no whole brain investigation of morphological aberrations in dissociative disorder is available to date. Previous region-of-interest studies focused exclusively on amygdalar, hippocampal and parahippocampal grey matter volumes and did not include patients with depersonalization disorder (DPD). We therefore carried out an explorative whole brain study on structural brain aberrations in patients with DPD. MethodsWe acquired whole brain, structural MRI data for patients with DPD and healthy controls. Voxel-based morphometry was carried out to test for group differences, and correlations with symptom severity scores were computed for grey matter volume. ResultsOur study included 25 patients with DPD and 23 controls. Patients exhibited volume reductions in the right caudate, right thalamus and right cuneus as well as volume increases in the left dorsomedial prefrontal cortex and right somatosensory region that are not a direct function of anxiety or depression symptoms. LimitationsTo ensure ecological validity, we included patients with comorbid disorders and patients taking psychotropic medication. ConclusionThe results of this first whole brain investigation of grey matter volume in patients with a dissociative disorder identified structural alterations in regions subserving the emergence of conscious perception. It remains unknown if these alterations are best understood as risk factors for or results of the disorder.

一句话概括: DPD患者多个脑区灰质体积改变，涉及意识知觉相关脑区。

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