title: From state dissociation to status dissociatus.
abstract: The states of being are conventionally defined by the simultaneous occurrence of behavioral, neurophysiological and autonomic descriptors. State dissociation disorders are due to the intrusion of features typical of a different state into an ongoing state. Disorders related to these conditions are classified according to the ongoing main state and comprise: 1) Dissociation from prevailing wakefulness as seen in hypnagogic or hypnopompic hallucinations, automatic behaviors, sleep drunkenness, cataplexy and sleep paralysis 2) Dissociation from rapid eye movement (REM) sleep as seen in REM sleep behavior disorder and lucid dreaming and 3) Dissociation from NREM sleep as seen in the disorders of arousal. The extreme expression of states dissociation is characterized by the asynchronous occurrence of the various components of the different states that prevents the recognition of any state of being. This condition has been named status dissociatus. According to the underlying disorders/diseases and to their severity, among status dissociatus we may recognize disorders in which such an extreme dissociation occurs only at night time or intermittently (i.e., autoimmune encephalopathies, narcolepsy type 1 and IgLON5 parasomnia), and others in which it occurs nearly continuously with complete loss of any conventionally defined state of being, and of the circadian pattern (agrypnia excitata). Here, we render a comprehensive review of all diseases/disorders associated with state dissociation and status dissociatus and propose a critical classification of this complex scenario.
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Antelmi
authors.affiliation: Sleep Research Centre, Department of Neurology, I.C., Oasi Institute (IRCCS), Troina, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Ferri
authors.affiliation: Neurology Service, Hospital Clinic de Barcelona, IDIBAPS, CIBERNED, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Iranzo
authors.affiliation: Sleep Disorder Unit, Pitié-Salpêtrière University Hospital, APHP, Paris, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Arnulf
authors.affiliation: Centre de Référence Nationale Maladies Rares, Narcolepsie et Hypersomnie Idiopathique, Service Neurologie, Hôpital Gui-de-Chauliac, INSERM U1061, Montpellier, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Dauvilliers
authors.affiliation: Sobell Department of Motor Neuroscience and Movement Disorders, University College London (UCL) Institute of Neurology, London, UK.
authors.forename: Kailash P
authors.initials: KP
authors.lastname: Bhatia
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy.
authors.forename: Rocco
authors.initials: R
authors.lastname: Liguori
authors.affiliation: Minnesota Regional Sleep Disorders Center, Department of Psychiatry, Hennepin County Medical Center, University of Minnesota Medical School, Minneapolis, MN, USA.
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Schenck
authors.affiliation: Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy. Electronic address: giuseppe.plazzi@unibo.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Plazzi
mesh_terms: D000818:Animals; D002385:Cataplexy / Q000503:physiopathology; D006801:Humans; D009290:Narcolepsy / Q000503:physiopathology; D020447:Parasomnias / Q000503:physiopathology; D020187:REM Sleep Behavior Disorder / Q000503:physiopathology; D012893:Sleep Wake Disorders / Q000503:physiopathology*; D012895:Sleep, REM
keywords: Agrypnia Excitata; Narcolepsy; Parasomnia; REM sleep behavior disorder; State dissociation; Status dissociatus