Paucity of Derealization and Depersonalization Signs in Chronic Schizophrenia

Introduction: Derealization (subjective experience of unreality of the surrounding world) and depersonalization (feeling detached from one’s mental or bodily processes) have been been considered as pathological symptoms. We examined the presence and stability of depersonalization-derealization over time in chronic schizophrenia.

Method: Patients with chronic schizophrenia (N=41, 28 men, 13 women, mean age 38.5 years, SD=12.4) were rated at baseline, week 2, week 5, and week 8 with the Hamilton Depression Rating Scale (HAM-D) and with other psychiatric scales, i.e., 4 times. The Item 19 of the 31 item version of the Hamilton Depression Rating Scale (HAM-D) measures the depersonalization-derealization (DD): we evaluated the changes in DD scores over the 4 time points.

Results: Most patients (68.3%) consistently reported absence of symptoms of DD over the 4 timepoints. Five patients (12.2%) described a “mild” symptom of DD at least once at the 4 time points, 7 patients (17.1%) reported DD at a “moderate” level at least once,and only one patient (2.4%) reported “severe” DD, however, only once over the 4 time points.

The DD measures were not significantly correlated (p>.05, one tailed) with the Scale for the Assessment of Negative Symptoms(SANS) and its subscales, the Brief Psychiatric Rating Scale (BPRS), the HAM-D version that includes only the first 17 items (i.e., without Item 19), and the Positive and Negative Syndrome Scale (PANSS). An exception was the PANSS subscale of positive symptoms (r=.40, p=.005, 1-tailed): those with DD signs experienced more intense positive symptoms of psychosis.

Conclusions: Only minimal variation in the level of DD was observed over 8 weeks. DD symptoms were completely absent in about two-thirds of these patients. The DD scores were not significantly correlated to various measures of psychopathology (SANS, PANSS, BPRS) except for the PANSS subscale of positive symptoms.

Keywords: Depersonalization, Derealisation, Schizophrenia, Positive Symptoms.