Today’s post is going to be a little different from the standard of this site. No, I’m not writing about Firefly, but I’ll get to that connection in a bit. I would like to take the opportunity to give the readers of Nothing in Biology Makes Sense a brief glance into an aspect of medicine that few get the opportunity to experience.
I am talking about surgery, specifically, Cardiothoracic surgery, or surgery that takes place by opening up the chest of a patient and putting them on cardiopulmonary bypass in order to operate on the heart (doing coronary bypass, valve replacement, or placement of assist devices). The reason I feel the need to post about this is because I know I have been given the opportunity that few people (physicians and medical students included) get the chance to experience first hand. For the last 6 weeks I have been on my surgical rotation, and was lucky enough to be able to spend two of those weeks working with the Cardiothoracic surgeons observing and assisting with open heart surgeries.
As a third year medical student, I am required to prepare various evidence-based medicine projects related to patients that I see during a given rotation. Rotations are where I get the opportunity to see patients in the hospital in various specialty settings and apply the knowledge that I have acquired during the first two years of my medical education. My first rotation was psychiatry, where I met an adolescent girl with a very interesting diagnosis. The diagnosis was depersonalization disorder (DPD). This diagnosis and its potential treatment are the focus of my post this week. I investigated the current pathophysiologic theories along with current pharmacologic ideas for treatment.
DPD is characterized by an altered perception of self in which an individual experiences detachment from his or her body and personal memories, emotional and physical numbing, and a sense of living in a dream-like state. DPD patients often feel as though they are watching things happen to them. They do, however, remain aware of this unreality and feel like something is wrong with them (1). They can have a tendency to resort to extreme measures, such as cutting, in an attempt to “feel” and overcome the sensation of numbness.
There are currently no definitive treatments that have been developed regarding DPD. This is due largely to the fact that there is no well-defined pathology regarding its onset. Given its estimated prevalence of 0.8-2.0% in the general population, it is about as widespread as schizophrenia. Yet little research has been done to understand its root cause and treatment (1). Despite the epidemiologic studies that have shown this prevalence rate, it is still assumed to be rare and associated with other anxiety or psychotic disorders instead of being a primary condition on its own.