Abstract

Peritraumatic Dissociation and PTSD: a Shortcut to Neurodegeneration?

Author(s): Patricia Ferreira Mattos, Adriana Mozzambani, Joao Alencar Pedrini, Jose Paulo Fiks, Mario Francisco Juruena, Marcelo Feijo de Mello

Background: Peritraumatic dissociation has become increasingly important for both the diagnosis and the prognosis of Post-traumatic Stress Disorder (PTSD) and Acute Stress Disorder (ASD). Changes in inflammatory mediators, immune-related genes and alterations of the hypothalamic-pituitary adrenal axis are suggestive findings that support the role of stress and neurodegeneration that might result in negative cognitive outcomes, such as dementia and other comorbidities. This study aims to describe an ASD case with persistent peritraumatic dissociation, its evolution to PTSD and the concomitant early onset demential syndrome.

Methods and Findings: The patient, a woman, victim of urban violence, experienced peritraumatic dissociation; she was diagnosed with ASD and later developed PTSD and concomitant EOD, the latter being an unexpected and devastating outcome. Dissociative symptoms and cognitive impairment persisted throughout the patient’s clinical status evolution. Moreover, the patient underwent a full psychiatric interview and was assessed through a battery of neuropsychological tests, neuroimage studies and a complementary examination. Over two years, no proposed treatment was satisfactory for improving her symptoms of PSTD and the neuropsychological evaluation confirmed EOD.

Conclusion: This case illustrates that peritraumatic and persistent dissociation can be a possible psychopathological marker of neurodegeneration and an important factor for causing irreversible functional impairment.