La importancia del cribado orgánico. A propósito de un caso clínico

Introducción: Antes de catalogar un proceso morboso como trastorno mental, es imprescindible tener presente la importancia del diagnóstico precoz de causas de origen no psiquiátrico para una posible presentación clínica. Por ello, trataremos de reflejar este hecho, que se antoja necesario recordar aunque sea bien sabido, ya que puede pasarse por alto en situaciones de urgencia en el ámbito hospitalario, con las consecuencias derivadas de un cribado incompleto y con el potencial riesgo vital para el paciente. Presentación del caso: Adolescente mujer, de 13 años, que presentó un cuadro clínico agudosugestivo de carácter disociativo. Se precisó su ingreso hospitalario para la aclaración diagnóstico-terapéutica, y mediante neuroimagen se diagnosticó inicialmente como lesión neoplásica en el tronco del encéfalo y, finalmente, como lesión isquémica de origen vasculítico en dicha localización. Discusión: Se planteó un diagnóstico diferencial a través de las diferentes etiologías tanto psíquicas como no psíquicas del cuadro clínico, pero fue necesaria la intervención del servicio de pediatría hospitalario para la orientación y filiación definitiva, ante la sospecha de enfermedad no psiquiátrica tras una evolución tórpida a pesar de intervenciones psicoterapéuticas y psicofarmacológicas. Conclusiones: A través de la presentación y revisión de un caso clínico que sucedió en nuestro hospital de trabajo, se debe insistir en un adecuado abordaje integral del paciente, especialmente con población infanto-juvenil, ante una presentación clínica aguda y sin previas evaluaciones físicas de relevancia.

Introduction: Before cataloguing a morbid process as a "mental disorder", it is essential to bear in mind the importance of early diagnosis of causes of non-psychiatric origin for a possible clinical presentation. For this reason, we will try to reflect this fact, which it seems necessary to remember even though it is well known, since it can be overlooked in emergency situations in the hospital setting, with the consequences derived from an incomplete diagnosis and with the potential life-threatening risk for the patient. Case presentation: A 13-year-old female adolescent, who presented an acute clinical picture suggestive of dissociative disorder. She required hospital admission for diagnostic-therapeutic clarification, and neuroimaging findings led to an initial diagnosis of a neoplastic lesion in the brain stem and, finally, as ischaemic lesion of vasculitic origin in said location. Discussion: A differential diagnosis was proposed through the different psychic and nonpsychic aetiologies of the clinical picture, being the intervention of the hospital's paediatric service necessary for orientation and definitive affiliation, given the suspicion of non-psychiatric illness after a torpid evolution in spite of psychotherapeutic and psychopharmacological interventions. Conclusions: Through the presentation and review of a clinical case that happened in our hospital, we must insist on an adequate comprehensive approach to the patient, especially with the child-adolescent population, when faced with an acute clinical presentation and without previous studies at a relevant physical level.

AVALIAÇÃO DE SINTOMAS DISSOCIATIVOS E PÓS-TRAUMÁTICAS EM CRIANÇAS INTERNADAS EM UNIDADES PEDIÁTRICAS / EVALUATION OF DISSOCIATIVE AND POST-TRAUMATIC SYMPTOMS IN INJURED CHILDREN IN PEDIATRIC UNITS

O objetivo foi investigar a presença de sintomas dissociativas pós-traumáticas infantis decorrentes de hospitalizações superiores a cinco dias. Investigação avaliativa descritiva. Abrangeu crianças de cinco a doze anos. Critérios de inclusão: crianças entre cinco e doze anos, internadas por mais de cinco dias, autorizadas por seus cuidadores e/ou responsáveis à participar da pesquisa. Critérios de exclusão: crianças menores de cinco anos e maiores de doze anos, que apresentaram patologias neurofisiológicas, crianças indígenas, surdas e mudas. Foi utilizada a Child Dissociative Checkist (CDC) e Children's Dissociative Experience Scale (CDES) para a coleta de dados. De acordo com Children Dissociative Checklist, as crianças sem transtornos dissociativos foram de 58% e sem transtorno foram de 42%, em ambos os hospitais, de acordo com a Children's Dissociative Experience Scale, na Santa Casa as crianças sem transtorno foram de 27%, com síndrome pós trauma foram de 26%, com transtorno dissociativo foram de 27% e falsa escala foram de 26%, no hospital Barros Barreto foram de 21% sem transtornos dissociativos, com síndrome pós trauma foram de 27%, com transtorno dissociativo foram de 13% e falsa escala foram de 33%. Concluiu se que os transtornos dissociativos afetaram a população infantil que estava hospitalizada, e a ideia da infância como um período puramente alegre e livre de sofrimentos, foi desmitificada.

The objective was to investigate the presence of dissociative children's post-traumatic symptoms resulting from hospitalizations of more than five days. Descriptive evaluative research. It covered children from five to twelve years. Inclusion criteria: children between five and twelve years old, hospitalized for more than five days, authorized by their caregivers and / or caregivers to participate in the research. Exclusion criteria: children younger than five years and older than twelve years, who presented neurophysiological pathologies, indigenous children, deaf and dumb. The Child Dissociative Checker (CDC) and Children's Dissociative Experience Scale (CDES) were used for data collection. According to the Children Dissociative Checklist, children without dissociative disorders were 58% and no disorder were 42%, in both hospitals, according to the Children's Dissociative Experience Scale, at Santa Casa children without disorder were 27%, With post-trauma syndrome were 26%, dissociative disorders were 27% and false-scale were 26%, Barros Barreto hospital were 21% without dissociative disorders, with post-trauma syndrome were 27%, with dissociative disorder were 13% and false scale were 33%. It was concluded that dissociative disorders affected the hospitalized infant population, and the idea of childhood as a purely joyous and suffering-free period was demystified.

Dissociative Experience in Unipolar and Bipolar Depression: Exploring the Great Divide

OBJECTIVE: Unipolar and bipolar depression (UD and BD) differ strikingly in respect to neurobiology, course and management, but their apparent clinical similarity often leads to misdiagnosis resulting in chronicity of course and treatment failure. In this study we have tried to assess whether UD and BD can be differentiated on the basis of their dissociative symptoms. METHODS: Thrty-six UD patients and 35 BD patients in active episodes, without any psychiatric comorbidity were selected from outpatient department and compared for depressive and dissociative symptoms using Hamilton Depression Rating Scale and Dissociative Experience Scale-II (DES-II). RESULTS: We found that thought the two groups didn’t differ in terms of the socio-demographic or clinical variables, BD group had significantly higher dissociative experience (U=343, p=0.001) than UD and the difference remained significant even after adjusting for the confounding factors. CONCLUSION: Our study shows that dissociative symptoms are significantly more prevalent in the depressive episodes of bipolar affective disorder as compared to the UD and can be an important tool in differentiating between the two disorders with very similar clinical profile. The difference can be measured using a simple self-report questionnaire like DES-II.

Dissociative Identity Disorders in Korea: Two Recent Cases

Although dissociative identity disorder (DID), the most severe of the dissociative disorders, has retained its own diagnostic entity since its introduction in the DSM-III, cases of DID are rarely seen in South and East Asia, likely due to the higher prevalence of possession disorder. We report two patients with DID who were recently admitted to our inpatient psychiatric unit and demonstrated distinct transitions to several identities. Their diagnoses were confirmed through a structured interview for dissociative disorders and possible differential diagnoses were ruled out by psychological, neuroimaging, and laboratory tests. The rapid transition to a Westernized, individualized society along with an increase in child abuse, might contribute to an increase in DID, previously under-diagnosed in this region.

Dissociative disorder in children and adolescents and their personality profile: a comparative study.

Background: Studies demonstrate the change in nature of dissociation in accordance with increasing age but there is dearth of literature studying the differential influence of personality factors in childhood and adolescent dissociation respectively. Personality attributes putatively determine the overt expression of nature of dissociative symptoms in childhood and adolescent dissociative symptoms differentially. Objective: Aim of this study was to compare the personality profiles of children and adolescents onset dissociative disorder. Methods: 60 subjects with diagnosis of dissociative disorders were included in this study with 30 subjects with 8-12 years of age and 30 adolescents with 13-16 years of age. Children in the age group of 8-12 years were given children personality questionnaire (CPQ) and adolescents were given 16 PF (form B) which are a paper-pencil self-administered questionnaires. Results: Both the groups were comparable for various socio-demographic and clinical variables except habitat and education. Children in younger age group were found to be more serious, taciturn, internally restrained, depressed and apprehensive. Adolescents on other hand were more aggressive, stubborn and aggressive. Conclusions: Dissociation in childhood and adolescents is a malleable developmental phenomenon determined by core personality attributes.

Discriminating Power of Dissociation in Patients with Psychological Trauma / 정신간호학회지

PURPOSE: The purpose of the study was to identify the discriminating power of dissociation as defined by depression, obsession, and Minnesota Multiphasic Personality Inventory(MMPI; psychopathology) in patients with psychological trauma. METHODS: Participants were patients (N=114) from "S" clinic for psychological trauma. Data were collected from April to June 2014 through semi-structured interviews and self-reports using a modified Lifetime Incidence of Traumatic Events, Dissociative Experience Scale (DES), Beck Depression Inventory-2, Maudsley Obsessional Compulsive Inventory, and MMPI-2. RESULTS: Participants were grouped in to two groups depending on DES scores; dissociative (n=15) and non-dissociative (n=99). Depression, F-scale (infrequency), Ma (Hypomania), and Hs (Hypochondriasis) scale of MMPI correctly discriminated 86.8% of the sample. There were also significant differences in Obsession, K-scale (korrection), D (Depression), Hy (Hysteria), Pd (Psychopathic Deviate), Pa (Paranoia), Pt (Psychasthenia), Sc (Schizophrenia), Si (Social Introversion) scales of MMPI between two groups, but they were not significant discriminant factors. CONCLUSION: Future interventions for patients with high levels of dissociation and psychological trauma should focus on the prevention of suicide and chronic dissociation by assessing depression-related factors; suicidal behavior, impulsivity, aggression, and alexithymia. Therapists should also interpret patients' MMPI profiles carefully, especially in the presence of an extremely elevated F-scale.

Despersonalización: más que síntoma, un síndrome / Depersonalization: more than a symptom, a syndrome

La despersonalización es un fenómeno psicopatológico consuetudinariamente soslayado, considerado un simpleelemento sintomático unidimensional formando parte de otros síndromes de mayor complejidad. En los últimosaños la investigación psicopatológica y neurobiológica ha permitido identificar diversos componentes de ladespersonalización que permitirían caracterizarla más propiamente como un síndrome con correlatos funcionalesde desconexión córtico-subcortical. Sobre la base de cuatro casos de despersonalización primaria o comórbidos con cuadros de ansiedad, depresión y consumo de sustancias psicoactivas, se procede a una razonable revisión de la literatura y se enfatiza la necesidad de su detección clínica sistemática, abordaje pertinente y manejo combinado, al tiempo que se plantea la necesidad de investigación transcultural de este trastorno en nuestro medio.

Depersonalization is a psychopathological phenomenon customarily ignored, treated as a mere companion of other syndromes and understood in a one-dimensional fashion. In recent years, psychopathological and neurobiological research has discriminated various components of depersonalization, with which it would properly constitute a syndrome, and has found a functional correlate of cortex-subcortex disconnection. From selected cases of primary depersonalization or comorbid depersonalization with anxiety, depression and psychoactive substance use, we review the literature and emphasize the need for screening, a convenient approach to this phenomenon and cross cultural research of depersonalization in our context.

Gravidade psicopatológica em mulheres vítimas de violência doméstica / Psychopathology severity in women victims of violence

OBJETIVO: Avaliar a presença de sintomas psicopatológicos em mulheres vítimas de violência doméstica (VD) que procuraram uma delegacia de defesa da mulher. MÉTODO: Foram avaliadas mulheres com idade entre 20 e 50 anos que deram entrada em uma delegacia da mulher com queixa de VD. Durante a entrevista, todas foram submetidas ao Relatório de Indicadores Sociais e preencheram os seguintes instrumentos de autoaplicação: Inventário de Depressão de Beck, Inventário de Ansiedade de Beck, Post-Traumatic Stress Disorder Checklist - Civilian Version e o Questionário de Experiências Dissociativas Peritraumáticas (todos em língua portuguesa). Foram usadas notas de corte a partir dos estudos de validação desses instrumentos para categorizar indivíduos com alta probabilidade de apresentar transtorno depressivo maior, transtorno de ansiedade, transtorno de estresse pós-traumático, ou alta/baixa dissociação peritraumática. RESULTADOS: Foram avaliadas 17 mulheres com idade média de 34,7±7,7 anos. O tempo médio de duração da violência foi de 9,1±8,7 anos. Do total de mulheres, 53 por cento eram vítimas de agressão excessiva e 84 por cento eram ameaçadas de morte pelo companheiro; em 71 por cento dos casos, os companheiros eram usuários de drogas. Além disso, 53 por cento das mulheres afirmaram ter sofrido VD na infância. Do total da amostra, 89 por cento tiveram grande probabilidade de apresentar transtorno depressivo maior, 94 por cento transtorno de ansiedade, 76 por cento transtorno de estresse pós-traumático e 88 por cento apresentaram elevados níveis de experiências dissociativas peritraumáticas. CONCLUSÃO: As vítimas de VD que dão entrada em delegacias de defesa da mulher têm alta probabilidade de apresentar morbidade psiquiátrica, assim como alterações cognitivas que as impossibilitam de sair do ciclo da violência.

OBJECTIVE: To assess the presence of psychopathological symptoms in women victims of domestic violence who seek help at police units offering women's protective services. METHODS: Women aged between 20 and 50 years who sought help at women's protective services complaining of domestic violence were assessed. During the interview, all participants were submitted to assessment using a Social Indicator Report and filled in the following self-report instruments: Beck Depression Inventory, Beck Anxiety Inventory, Post-Traumatic Stress Disorder Checklist - Civilian Version, and the Peritraumatic Dissociative Experiences Questionnaire (all in Brazilian Portuguese). Cut-off points were established based on instrument validation studies and were used to identify subjects with a high probability of having major depressive disorder, anxiety disorder, post-traumatic stress disorder, or high/low peritraumatic dissociation. RESULTS: Seventeen women with a mean age of 34.7±7.7 years were assessed. Average duration of exposure to domestic violence was 9.1±8.7 years. Of the total sample, 53 percent were exposed to excessive violence and 84 percent received death threats from their partners; 71 percent of the partners were drug abusers. In addition, 53 percent of the women reported exposure to domestic violence during childhood. From the total sample, 89 percent presented a high probability of having major depressive disorder, 94 percent anxiety disorder, 76 percent post-traumatic stress disorder, and 88 percent showed high scores of peritraumatic dissociative experiences. CONCLUSION: Victims of violence seeking help at women's protective services showed a high probability of having psychiatric morbidities cognitive dysfunction that prevent these women from interrupting exposure to this specific type of violence.

Marcadores neurobiológicos e psicométricos da eficácia da terapia cognitivo-comportamental no transtorno de estresse pós-traumático associado a sintomas dissociativos: relato de caso / Neurobiological and psychometric markers of the efficacy of cognitive behavioral therapy in post-traumatic stress disorder with dissociative symptoms: a case report

INTRODUÇÃO: O transtorno de estresse pós-traumático (TEPT) tem sido associado à desregulação de diversos parâmetros psicofisiológicos e pode apresentar comorbidade com diversas psicopatologias, inclusive a dissociação, podendo dificultar o tratamento. O objetivo do presente trabalho foi investigar os efeitos da terapia cognitivo-comportamental em um paciente com TEPT e sintomas dissociativos com base em medidas psicofisiológicas e psicométricas em diferentes momentos do tratamento. DESCRIÇÃO DO CASO: O paciente é um homem de 38 anos, com diagnósticos de TEPT e transtorno depressivo maior recorrente com sintomas dissociativos e resistência ao tratamento farmacológico. O tratamento psicoterápico teve duração de 4 meses, sendo composto por uma sessão semanal de terapia e três sessões semanais de coterapia. Os parâmetros fisiológicos (frequência cardíaca, tônus vagal, balanço simpático e cortisol) e psicométricos (afeto negativo e positivo, resiliência e sintomas de estresse pós-traumático, depressão, ansiedade e dissociação) foram medidos antes, durante (uma vez ao mês) e após o tratamento. COMENTÁRIOS: Os resultados mostraram diminuição do balanço simpático e aumento do tônus vagal, da frequência cardíaca e dos níveis de cortisol ao longo do tratamento. O tratamento também promoveu redução no afeto negativo e nos sintomas de estresse pós-traumático, depressão, ansiedade e dissociação, além de um aumento nos escores de resiliência, apoio social e afeto positivo. Esses resultados sugerem que a terapia cognitivo-comportamental é um tratamento eficaz para o TEPT com sintomas dissociativos. Além disso, parece promover a normalização das alterações fisiológicas do sistema nervoso autônomo e neuroendócrino relacionadas ao TEPT.

INTRODUCTION: Post-traumatic stress disorder (PTSD) has been associated with dysregulation of many psychophysiological parameters and may present comorbidity with different psychopathologies, including dissociation, potentially affecting treatment outcome. The aim of this study was to evaluate the effects of cognitive behavioral therapy in a patient with PTSD and dissociative symptoms based on psychophysiological and psychometric measures at different time points throughout the course of treatment. CASE DESCRIPTION: Our patient is a 38-year old man diagnosed with PTSD, major depression, and dissociative symptoms, resistant to pharmacotherapy. Psychological treatment lasted for 4 months and consisted of one weekly therapy session and three weekly coaching sessions. Physiological (heart rate, vagal tone, sympathovagal balance, and cortisol) and psychometric measures (negative and positive affect, resilience, and post-traumatic stress, depression, anxiety, and dissociative symptoms) were obtained before, during (once a month) and after treatment. COMMENTS: Results showed a decrease in sympathovagal balance and an increase in heart rate, vagal tone and cortisol levels during the course of treatment. Treatment also lead to a decrease in negative affect and in post-traumatic stress, depression, anxiety, and dissociation symptoms, as well as to an increase in resilience, social support and positive affect scores. These results suggest that cognitive behavioral therapy is an effective treatment for PTSD patients with dissociative symptoms. Moreover, the treatment seems to be able to normalize PTSD-related physiological parameters in the neuroendocrine and autonomic nervous systems.

Dissociative disorders and other psychopathological groups: exploring the differences through the Somatoform Dissociation Questionnaire (SDQ-20)

OBJECTIVE: The Somatoform Dissociation Questionnaire is a self-report questionnaire that has proven to be a reliable and valid instrument. The objectives of this study were to validate the Portuguese version and to determine its capability to distinguish patients with dissociative disorders from others with psychopathological disorders. METHOD: 234 patients answered the translated version of Somatoform Dissociation Questionnaire. The Portuguese Dissociative Disorders Interview Schedule was used to validate clinical diagnosis. Patients with dissociative disorder (n = 113) were compared to a control group of 121 patients with various anxiety and depression disorders. RESULTS: Reliability measured by Cronbach's a was 0.88. The best performance of the Portuguese form was at a cut-off point of 35, which distinguishes between dissociative disorder and neurotic disorders with a good diagnostic efficacy (sensitivity = 0.73). The somatoform dissociation was significantly more frequent in dissociative disorder patients, conversion disorder patients and post-traumatic stress disorder patients. CONCLUSIONS: These findings suggest that dissociative disorders can be differentiated from other psychiatric disorders through somatoform dissociation. The Portuguese version of the Somatoform Dissociation Questionnaire has fine psychometric features that sustain its cross-cultural validity.

OBJETIVO: O objetivo deste estudo foi adaptar, validar e determinar a confiabilidade da versão portuguesa do Somatoform Dissociation Questionnaire e determinar a sua capacidade de discriminar doentes que dissociam de outros doentes. Método: O Somatoform Dissociation Questionnaire foi traduzido para o português e retrovertido para o inglês de forma a garantir a sua base conceitual. Os sujeitos responderam também à versão portuguesa do Dissociative Disorders Interview Schedule de forma a validar o seu diagnóstico clínico. O estudo incluiu 234 sujeitos divididos entre 113 doentes com patologias dissociativas e 121 doentes com outras patologias do foro ansioso e depressivo. RESULTADOS: O Somatoform Dissociation Questionnaire versão portuguesa mostrou o seu melhor desempenho no ponto de corte 35, apresentando uma sensibilidade de 0,73. O alfa de Cronbach revelou uma consistência interna de 0,88. A dissociação somatoforme foi significativamente mais freqüente nos doentes com patologias dissociativas, patologias conversivas e distúrbio de stress pós-traumático. CONCLUSÕES: A versão portuguesa do Somatoform Dissociation Questionnaire mostrou-se um instrumento útil para discriminar doentes com patologia de foro dissociativo de outros doentes.

As crises não-epilépticas psicogênicas como manifestações clínicas do transtorno de estresse pós-traumático / Psychogenic nonepileptic seizures as clinical manifestations of posttraumatic stress disorder

As crises não epilépticas psicogênicas (CNEP) ainda são pouco entendidas. Como não existem critérios clínicos positivos para as CNEP, não há consenso sobre sua definição, assim como não se tem clareza em relação à nosologia de base, à fisiopatologia e ao tratamento apropriado. As CNEP manifestam-se principalmente por sintomas conversivos e dissociativos, os quais estão ligados historicamente a uma doença considerada de origem traumática, a histeria. Recentemente, observou-se que pacientes com CNEP apresentam taxas elevadas de experiências traumáticas, em particular abuso na infância, e de transtorno de estresse pós-traumático (TEPT). Estes achados sugerem que a CNEP pode ocorrer como expressão clínica de um padrão de TEPT cuja característica central é a predominância de fenômenos dissociativos e conversivos. Algumas evidências levantam a possibilidade de que este subtipo de TEPT dissociativo/conversivo seja resultante de maus cuidados parentais e disfunção familiar na infância, os quais estão associados a - e, portanto podem causar - sintomas somatoformes, incluindo as CNEP. Limitações metodológicas impedem a confirmação destas hipóteses, sendo necessários desenhos de pesquisa mais fortes, tais como prospectivos e de caso-controle.

Psychogenic nonepileptic seizures (PNES) are still poorly understood. Because there are no positive clinical criteria for PNES, there is no consensus about its definition, nor clarity about the underlying nosology, pathophysiology, or the suitable treatment. PNES most commonly occur in the form of conversion and dissociative symptoms, which are historically linked to a trauma-related disease called hysteria. Recently, it has been observed that PNES patients show high rates of traumatic experiences, in particular childhood abuse, and posttraumatic stress disorder (PTSD). This suggests that PNES may arise as a clinical expression of a PTSD pattern whose cardinal feature is the predominance of dissociative and conversion phenomena. Emerging evidence also raise the possibility that the dissociative/conversion subtype of PTSD may occur as a result of poor parental care and family dysfunction, which are associated with - and may therefore cause - somatoform symptoms, including PNES. Methodological limitations do not permit the confirmation of these hypotheses. Stronger research designs are needed, such as prospective and case-control studies.

Evaluación de trastornos disociativos en población psiquiátrica mexicana: prevalencia, comorbilidad y características psicométricas de la Escala de Experiencias Disociativas

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Abstract: Introduction: Dissociative disorders are characterized by impaired conscious integration functions, personal identity, memory and environment perception. Their frequent psychopathological manifestations are amnesia, depersonalization, fugue states, extra sensorial experiences, trance states and total personality changes. They usually appear under different life stressors, and their clinical course is highly variable. Prevalence estimates give figures ranging from 5 to 10% among general population, and reach 10.2 to 41.4% among psychiatric populations. This wide variation is one of the indicators of the complexity of this diagnostic entities and of its difficulty to be studied. Culture is a key factor in functionality of subjects with a dissociative disorder, because the acceptance of many of its clinical features varies. It is accepted that these diagnostic categories are barely-recognized, not only by general physicians, but by experienced mental health specialists. The original Structured Diagnostic Interviews (SCID, CIDI, SADS, SCAN), did not include them in their widely distributed packages, and many of them decided to create a separate appendix to address them. Unfortunately, structured interviews face an important limitation as there is a lack of trained, and some times, experienced psychopathologist, a fact that difficults to use them in large samples. Self-report instruments, when they show good reliability and validity, are of great value in terms of time, costs and feasibility. Their major limitation is the low reliability that they show in psychiatric conditions in which lack of insight is present (psychotic disorders). To evaluate the psychometric properties of translated versions of instruments is highly desirable. This is specially important when elusive disorders are being evaluated. Given that the cultural environment of Mexico is surrounded by several factors that influence this kind of disorders, the availability of reproducible research instruments is of outmost relevance. Therefore, the Dissociative Experiences Scale (DES) -the most widely used measure in this field- in contrast with the Dissociative Disorders Interview Schedule (DDIS), was evaluated, with the purpose to give a first approach to a 12 month prevalence of some Dissociative disorders in Mexican psychiatric patients. Methods: Subjects: A non-random, consecutive sample of male and female patients, between 18 and 63 years old were included. They were receiving treatment, regardless of the diagnosis, at the Institute of Mental Health of Jalisco, from the State's Ministry of the Health in Mexico. The ethics committee authorized the study, and they all gave informed consent. Translation: The Spanish version of the DES, has a Spanish translation, and a Mexican Spanish idiomatic adaptation was performed by consensus. The DDIS was translated by one bilingual psychiatrist, and independently reviewed by another. Consensus was reached in controverted items. Once a final translated version was obtained, it was given to 10 subjects (mainly with primary school level), to assess item understanding. A second review was performed to reach a culturally compatible version, concentrating in respecting item content validity. Back translation was not considered, because this method does not capture common language of low school population, which is the case of most Mexicans. Measures: Dissociative Experiences Scale (DES): This is a 28 items, self-report scale, designed to evaluate different kinds and severity of Dissociative conditions, in a 0 to 100 range. Most populations without a psychiatric condition or with a non-Dissociative disorder, scored under 20. A cut-off point of 30, usually indicates the possibility of a Dissociative disorder diagnosis. Given that a Spanish version of the DES is available from Spain, only an idiomatic adaptation to Mexican Spanish was performed (changes in slang or word content differences between countries). Dissociative Disorder Interview Scale (DDIS): This is a structured diagnostic interview, of 132 yes/no items, designed to assess the presence of DSM-IV Dissociative disorders entities. It is to be applied by mental health professionals, properly trained on its use. It does not give a total score, it assesses each disorder independently. As previous studies performed in different languages, it has adequate psychometric properties, and is the usual golden standard for Dissociative categories. Previous reports on DDIS correlation with DES have shown variations between disorders, with Kappa values for Identity Dissociative Disorder ranging 0.68 to 0.95. Procedures: A 4th year general psychiatry residency doctor was trained in the DDIS, and, after obtaining the patient's consent, applied the DDIS interview, and then gave the patient the DES to be completed. Demographic and clinical variables were obtained, as well as the diagnosis assigned in the patient chart. To analyze results two procedures were planned: 1) compare DES total score punctuation between positive and negative presence of Dissociative disorders according with the DDIS and 2)compare between patients with a Dissociative disorder with or without concomitant major depression. Results: A total of 100 subjects were included, 63% female, with a mean age of 32.4±12.5 (range 18 - 63) years old. The DES internal consistency index was 0.96. Patients with a Dissociative Disorder (according to the DDIS), showed clinically and significantly higher DES values than non-Dissociative patients (34.7±24.8 n= 38 vs. 10.7±9.6 n=62; T -6.8, d.f. 98, p< 0.001). Frequency of Dissociative disorders and symptoms: Mean DES total score was 19.8±20.6. According to DDIS criteria, 38 subjects fulfilled DSM IV diagnostic criteria for a Dissociative disorder: Dissociative identity disorder 24, Depersonalization Disorder 6, psychogenic fugue 3. The most common concomitant diagnosis as assessed in the patient chart was unipolar major depression (17 44.7%. When a Dissociative disorder was comorbid with major depression, comparing it with Dissociative disorders only, the difference was greater (34.7±24.2 n= 38, 9.3±8.55, T 6.3, d.f. 80, p<000.1. Discussion: Dissociative disorder measurements evaluated, seem to work adequately in Mexican population. Prevalence of dissociative disorders found in this psychiatric population, is consistent with other studies. Further research in the field is needed, to evaluate the influence of cultural factors, including rural and indigenous samples.