Dissociative (Conversion disorders)

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Dissociative(Conversion disorders)
Meaning
It is a partial or complete loss of the normal interaction between memories of the past, awareness of identity and immediate sensations and control of bodily movements.
Classification(icd-10)
      F44.0 Dissociative amnesia
      F44.1 Dissociative fugue
      F44.2 Dissociative stupor
      F44.3 Trance and possession disorders
      F44.4 Dissociative motor disorders
      F44.5 Dissociative convulsions
      F44.6 Dissociative anesthesia and sensory loss
      F44.7 Mixed dissociative (conversion) disorders
      F44.8 Other dissociative (conversion) disorders
            .80 Ganser’s syndrome
            .81 Multiple personality disorder
            .82 Transient dissociative disorder occurring in childhood and adolescence
            .88 other specified dissociative (conversion) disorder
      F44.9 Dissociative (conversion) disorder, unspecified
 DISSOCIATIVE   AMNESIA
      Commonest type
      Occur in adolescent and young adults
      Sudden inability to recall important personal information usually concerning stressful or traumatic events
      Not as everyday forgetfulness
      No medical illness
Dissociative amnesia, Types
ü   Localized amnesia : inability to recall events related to a circumscribed period of time.
ü   Selective amnesia : ability to remember some but not all of the events occurring during a circumscribed period of time.
ü   Generalized amnesia : failure to recall one’s entire life
ü  Continuous amnesia : failure to recall successive events as they occur
ü   Systematized amnesia: amnesia for certain category of memory, such as all memories relating to one’s family or to a particular person
Differential diagnosis of dissociative amnesia
      Organic mental disorder
      Alcohol or drug abuse black outs
      Head injury
      Post ictal amnesia
DISSOCIATIVE FUGUE
      It is characterized by episodes of wandering away. During the episode, person adopts a new identity.
      Onset is sudden and end abruptly with amnesia about the episode.
      May last from less than an hour to a year or more, but generally last in the range of days to weeks
Differential diagnosis of dissociative fugue
      Post ictal fugue
      Alcoholic black-outs
DISSOCIATIVE STUPOR
      Patients are motionless and mute and do not respond to stimulation, but they are aware of their surroundings.
TRANCE   AND POSSESSION DISORDERS
      Disorders in which there is a temporary loss of both the sense of personal identity and full awareness of the surroundings;
      When associated with religious rituals the individual acts as if taken over by another personality, spirit, god or ‘force’
DISSOCIATIVE MOTOR DISORDER
      Loss of ability to move the whole or part of a limb or limbs
      Paralysis may be partial or complete
      Various forms and degrees of incordination may be evident, particularly in legs, resulting in bizarre gait or inability to stand
DISSOCIATIVE CONVULSIONS
      May mimic epileptic seizures very closely in terms of movements; but tongue biting, serious bruising due to falling and incontinence of urine are rare
       And loss of consciousness is absent or replaced with a state of stupor or trance
      Hemianesthesias, blindness or contracted visual fields and deafness are the common complaints
      Glove & stocking anesthesia
MIXED DISSOCIATIVE (conversion) DISORDERS (F44.0-F44.6)
      These are combination of any of the types
OTHER DISSOCIATIVE DISORDERS
      Ganser’s syndrome
v  Characterized by ‘approximate answers’
v  Suggest a psychogenic etiology
v  The answers are wrong , but show that the person understands the nature of question asked
      Multiple personality disorder/ Dissociative identity disorder
v  Rare
v  Essential feature is the apparent existence of two or more distinct personalities within an individual, with only one of them being evident at a time.
v  Each personality is complete, with its own memories, behavior and preferences
v  Change from one personality to another is usually sudden and closely associated with traumatic incident
v  In the common form with two personalities one personality is usually dominant, but neither has the access to the memories of the other and the two are almost always unaware of each other’s existence
Etiology
      Psychodynamic theory: Failure to repress the stressful event resulting in activation of secondary defense mechanism such as dissociation or conversion.
      Behavioral theory:  dissociative or conversion symptoms are learned responses to stress. Initially the symptom will be learned from environment.
      Biological :Conversion symptoms are seen in epilepsy, cerebral cortical lesions.
La-belle- indifference
      Lack of concern towards  the symptoms even if it causes severe disability.
Treatment
      Behavioural therapy
v  Hypnosis
v  Free association
v  IV amytal/thiopentone/diazepam
      Psychotherapy with abreaction
      Supportive psychotherapy
      Psycho analysis
      Benzodiazepines
Nursing management
      Monitor for organic pathology
      Identify primary and secondary gain
      Don’t focus on disability
      Don’t allow manipulation
      Withdraw attention when focusing on disability
      Encourage expression of feelings
      Positive reinforcement when using adaptive coping

      Identify unresolved conflicts and assist for resolution

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notes.nursium.com: Dissociative (Conversion disorders)
Dissociative (Conversion disorders)
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