title: The neurobiology and clinical significance of depersonalization in mood and anxiety disorders: a critical reappraisal.
abstract: Depersonalization and derealization occur on a continuum of situations, from healthy individuals to a severely debilitating disorder where the symptoms can persist chronically. Since 1960s, different neurobiological models have been hypothesized and they have been associated with the temporal lobes. Recent advances in the functioning of the limbic system and the application of Geschwind's concept of disconnection in the cortico-limbic networks, pointed the role of the amygdala and its connections with medial prefrontal cortex and anterior cingulate cortex, the same structures that are strictly interlinked with the neurobiology of emotions and affective disorders. In this paper, we hypothesize that depersonalization may represent a clinical index of disease severity, poorer response to treatment and high level of comorbidity, in mood and anxiety disorders, discussing the neurobiology of depersonalization and the available clinical evidence.
authors.affiliation: Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Section of Psychiatry, University of Pisa, Via Roma, 67-56100 Pisa, Italy. marcomula@yahoo.it
authors.forename: Marco
authors.initials: M
authors.lastname: Mula
authors.forename: Stefano
authors.initials: S
authors.lastname: Pini
authors.forename: Giovanni B
authors.initials: GB
authors.lastname: Cassano
mesh_terms: D000679:Amygdala / Q000503:physiopathology; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D001714:Bipolar Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D001921:Brain / Q000503:physiopathology*; D002540:Cerebral Cortex / Q000503:physiopathology; D002908:Chronic Disease; D003861:Depersonalization / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000503:physiopathology* / Q000523:psychology; D004292:Dominance, Cerebral / Q000502:physiology; D006801:Humans; D008032:Limbic System / Q000503:physiopathology; D009415:Nerve Net / Q000503:physiopathology; D016584:Panic Disorder / Q000175:diagnosis / Q000503:physiopathology / Q000523:psychology; D011379:Prognosis; D013702:Temporal Lobe / Q000503:physiopathology