EXPEDIE: Phenomenological Explorations of the Esketamine-Induced Transient Dissociative State
Study Details
Study Description
Brief Summary
Ketamine is an anaesthetic used in low doses to treat depressive disorders. A related molecule, Esketamine, has recently been launched on the market for the treatment of resistant depression. One of the side effects of ketamine, like Esketamine, is induction of transient dissociative state. Dissociation has been described as disruption in continuity of conscious thought and emotion, cognitive processes disorganisation and an alteration in self-perception and environment perception. A study of healthy volunteers receiving ketamine showed that this state was manifested by altered sensory perceptions, with increased noise sensitivity, visual distortions and altered time perception. Few studies have looked at this phenomenon in the Esketamine context. However, it is a frequent side effect. With ketamine, it has been shown that anxiety associated with dissociative experience reduces the antidepressant effect. Benzodiazepines use for anxiolytic purposes is also thought to limit the antidepressant effect.
It is necessary to explore the Esketamine induced transient dissociative state in order to clarify this state and develop therapeutic strategies. The investigators have chosen a phenomenological approach, which is the only way to evaluate consciousness contents and structures, in order to explore this state using the experiential phenomenological interview.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed Description
Patients will be identified when they come for an Esketamine session performed as part of routine practice in the Psychiatry Department of Hôpital Sainte Musse. The clinician, who is also the study investigator, will then select patients who meet the protocol's inclusion criteria and inform them of the research before administering the Esketamine. He will explain the study in detail and give them the information letter.
Patients will then be seen again in consultation outside the Esketamine sessions, as part of routine practice, within a minimum of 48 hours. During this consultation, the investigating physician will obtain their oral consent to their participation in the research, resulting in a research consultation lasting around 45 minutes and including :
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an audio recording of an Experiential Phenomenological Interview;
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completion of the EQFC "Trait" questionnaire.
Study Design
Arms and Interventions
Arm | Intervention/Treatment |
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Experimental: Depressive patients Patients suffering from depressive disorder and treated with Esketamine between 2 days and 3 months prior to the study. |
Behavioral: Experiential Phenomenological Interview
Consciousness fluidity of patients suffering from depressive disorder and treated with Esketamine will be evaluated thanks to Experiential Phenomenological Interview and EQFC "Trait" questionnaire
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Outcome Measures
Primary Outcome Measures
- Consciousness fluidity evaluation by Experiential phenomenological interviews [1 day]
Qualitative assessment by Experiential phenomenological interviews.
Secondary Outcome Measures
- Consciousness fluidity evaluation by EQFC "Trait" questionnaire [1 day]
Qualitative assessment by EQFC "Trait" questionnaire.
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patient followed in the Psychiatry Department of Hôpital Sainte Musse, with depressive state characterized by the DSM-V criteria and treated with Esketamine between 2 days and 3 months prior to the study;
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Patient over the age of 18;
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Patient presented transient dissociative state during Esketamine treatment;
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Patient able to express his/her consent prior to participation in the study;
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Patient who understands and speaks French.
Exclusion Criteria:
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Patient with major anxiety and panic attack during an Esketamine-induced dissociative state, regardless of Esketamine effect;
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Patient under judicial protection (guardianship, curatorship...) or safeguard of justice;
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Pregnant, parturient or breast-feeding women;
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Any other reason that, in the opinion of the investigator, would interfere with the evaluation of the study objectives.
Contacts and Locations
Locations
No locations specified.Sponsors and Collaborators
- Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
Investigators
- Study Director: Manuel DIAS ALVES, MD PhD, Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
Study Documents (Full-Text)
None provided.More Information
Additional Information:
Publications
- Aust S, Gartner M, Basso L, Otte C, Wingenfeld K, Chae WR, Heuser-Collier I, Regen F, Cosma NC, van Hall F, Grimm S, Bajbouj M. Anxiety during ketamine infusions is associated with negative treatment responses in major depressive disorder. Eur Neuropsychopharmacol. 2019 Apr;29(4):529-538. doi: 10.1016/j.euroneuro.2019.02.005. Epub 2019 Feb 13.
- Holmes EA, Brown RJ, Mansell W, Fearon RP, Hunter EC, Frasquilho F, Oakley DA. Are there two qualitatively distinct forms of dissociation? A review and some clinical implications. Clin Psychol Rev. 2005 Jan;25(1):1-23. doi: 10.1016/j.cpr.2004.08.006.
- McIntyre RS, Rosenblat JD, Nemeroff CB, Sanacora G, Murrough JW, Berk M, Brietzke E, Dodd S, Gorwood P, Ho R, Iosifescu DV, Lopez Jaramillo C, Kasper S, Kratiuk K, Lee JG, Lee Y, Lui LMW, Mansur RB, Papakostas GI, Subramaniapillai M, Thase M, Vieta E, Young AH, Zarate CA Jr, Stahl S. Synthesizing the Evidence for Ketamine and Esketamine in Treatment-Resistant Depression: An International Expert Opinion on the Available Evidence and Implementation. Am J Psychiatry. 2021 May 1;178(5):383-399. doi: 10.1176/appi.ajp.2020.20081251. Epub 2021 Mar 17.
- Pereira S, Brennan E, Patel A, Moran M, Wallier J, Liebowitz MR. Managing dissociative symptoms following the use of esketamine nasal spray: a case report. Int Clin Psychopharmacol. 2021 Jan;36(1):54-57. doi: 10.1097/YIC.0000000000000327.
- 2023-CHITS-008
- 2023-A01528-37