DISCUSSION
TRD, treatment-resistant MDD, psychosis, psychotic disorders, behavioral and sensory experiences
ADVERSE EVENT
Dissociation is a pleomorphic clinical construct used to describe a relatively heterogenous set of behavioral and sensory experiences in different clinical contexts. In the treatment of TRD with glutamate receptor modulators, the aspects of dissociation most commonly described as associated with treatment are more limited; however, substantial variability remains between the cutoffs used on the CADSS and the aspects of dissociation most likely to be identified and/or evoke concern from clinicians.The results of our investigation of the characterization of dissociation in a group of patients with treatment-resistant MDD receiving their first treatment with esketamine nasal spray (in conjunction with recently started new oral antidepressant) echo this variability. We found that distinct dissociative experiences, as codified by the CADSS, did not cluster together but rather tended to move in the same direction in general as severity increased, consistent with the unifactorial nature of the CADSS items. Although the 4/5 threshold initially proposed by Some noteworthy differences exist between our study design and results compared with those reported by other groups investigating the factor structure of the CADSS among patients being treated with glutamatergic compounds. At the clinical level, both The modest correlation between investigator report and standardized assessment is not unique to this treatment setting (There was no single CADSS total score cutoff that could be viewed as a Item analysis across the range of reported adverse event severity suggests that there is no “universal” profile of dissociative symptoms associated with esketamine nasal spray. However, we found that, similar (but not identical) to the symptom clusters noted by In contrast, the relationship between dissociation and positive symptoms of psychosis is weak, unlike the pattern noted among clinical and nonclinical samples in a recent meta-analysis of studies that predominantly included participants suffering from psychotic disorders (