めまいの症状を持つ集団、OBE率が高い。(Cortex, 2018.7)

Lopez, C., & Elzière, M. (2018). Out-of-body experience in vestibular disorders – A prospective study of 210 patients with dizziness. Cortex, 104, 193–206. https://doi.org/10.1016/J.CORTEX.2017.05.026

Abstract
Out-of-body experiences (OBEs) are states during which people experience their centre of awareness as located outside of their physical body, along with the sensation of seeing the environment from an elevated viewpoint. OBE is encountered in epilepsy, migraine and depersonalization, and it is not an uncommon experience in the general population. Current neuroscientific models of bodily self-consciousness consider that OBE are related to a failure to integrate visual, somatosensory and vestibular signals. These models have highlighted the importance of visual-vestibular mismatch in OBE. Case reports from older clinical literature suggest that vestibular disorders may precipitate OBE, but we were lacking population-based evidence that OBE is related to vestibular disorders. The present observational, prospective study describes otoneurological, neuropsychological and phenomenological correlates of OBE in the largest sample of patients with dizziness to date (n = 210) compared to a group of age- and gender-matched controls with no history of dizziness (n = 210). We show a significantly higher occurrence of OBE in patients with dizziness (14%) than in healthy participants (5%). Most of the patients experienced OBE only after they started having dizziness for the first time. OBE in patients with dizziness were mainly related to peripheral vestibular disorders. We also identify depersonalization-derealization, depression and anxiety as the main predictors of OBE in patients with dizziness, as well as a contribution of migraine. Depersonalization-derealization was the only significant predictor of OBE in healthy controls. Altogether, our data indicate that OBE in patients with dizziness may arise from a combination of perceptual incoherence evoked by the vestibular dysfunction with psychological factors (depersonalization-derealization, depression and anxiety) and neurological factors (migraine).

幽体離脱(OBE)は、てんかん(epilepsy)・偏頭痛(migraine)・離人症(depersonalization)において生じることがわかっている。現在の神経科学のモデルでは、OBEは視覚・体性感覚・前庭系の信号の統合の失敗と関連づけられており、また症例報告でも前庭系の失調がOBEを引き起こすことを示唆しているが、集団ベースの証拠は少ない。

めまい(dizziness)の症例のある集団と無い集団におけるOBEの経験を、それぞれ年齢・性のバランスを統制したうえで調べたところ、「めまいあり集団」(14%)は、「めまい無し集団」(5%)と比較して、有意にOBEの発生率が高かった。多くの患者がOBEを経験したのは、目眩を感じ始めてすぐのことであった。さらに、めまいあり集団の中では、depersonalization-derealization(離人感、非現実感)、depression(抑うつ)、anxiety(不安)がOBE発生の主要因であった一方、コントロール集団で主要因となった要素は、depersonalization-derealizationのみであった。

これらの結果は、めまいの患者におけるOBEは、前庭系の機能障害、心理的要因(離人感、抑鬱、不安)、神経系要因(偏頭痛)の組み合わせによって生じていることを示唆する。

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