From state dissociation to status dissociatus.
Elena Antelmi, Raffaele Ferri, Alex Iranzo, Isabelle Arnulf, Yves Dauvilliers, Kailash P Bhatia, Rocco Liguori, Carlos H. Schenck, Giuseppe Plazzi
Sleep Medicine Reviews August 1, 2016 DOI: 10.1016/j.smrv.2015.07.003 (opens in new tab) via PubMed
Summary
AI-generated from the abstractState dissociation disorders occur when features of one state of being—wakefulness, REM sleep, or NREM sleep—intrude into another. Examples include cataplexy, sleep paralysis, REM sleep behavior disorder, and disorders of arousal. The most extreme form, status dissociatus, involves a breakdown of all recognizable states; it can occur intermittently in conditions like narcolepsy type 1 or continuously in agrypnia excitata. This review classifies the full range of diseases and disorders associated with state dissociation and status dissociatus.
Study at a glance
| Characteristics | Review Peer reviewed |
|---|---|
| Keywords | Agrypnia excitata Narcolepsy Parasomnia State dissociation Status dissociatus |
| Key finding | State dissociation disorders range from mild intrusions between wakefulness, REM, and NREM sleep to complete loss of distinct states in status dissociatus, with agrypnia excitata representing the most severe form. |
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.