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dissociative disorders

Terms in this set (57)

The DSM-IV-TR defines as disruption in the usually integrated functions of consciousness, memory, identity or perception of the environment
dissociative disorder
Dissociation is a defense against
trauma
Dissociation involves the segregation of
mental or behavioral processes form the rest of the person's psychic activity
Patient unable to recall an important personal memory, usually one that is STRESSFUL OR TRAUMATIC (It is NOT a cognitive issue)
Dissociative amnesia
patient does have the capacity to learn and remember
new information
forgotten memories in dissociative amnesia relate to
day-to-day info that is a routine part of conscious awareness (who a person is)
onset of dissociative amnesia is
abrupt
T/F patient with dissociative amnesia is aware they lost memory
T
Some report slight _______ __ ________during period immediately surrounding onset of amnesia
clouding of consciousness
MC predisposing factors for dissociative amnesia
depression and anxiety
Example where amnesia may show primary or secondary gain
woman amnestic about the birth of a dead infant
Types of dissociative amnesia
localized
generalized amnesia
selective or systematized amnesia
Memory loss for events over a short period of time
localized
Loss of memory for a whole lifetime of experiences
generalized amnesia
inability to recall some but not all events over a short time
selective or systematized amnesia
to fit the criteria amnesia cannot be
due to med condition or substance
The most common dissociative disorder
Seen in women more than men
More often in adolescents and young adults than in older adults
Incidence increases during times of war and natural disasters
Dissociative Amnesia
R/O these in dissociative amnesia
Dementia or delirium (see cognitive issues here)
Epilepsy (EEG)
What is transient global amnesia, this must be r/o with dissociative amnesia
Associated with anterograde amnesia during the episode
Patients more upset and concerned about the symptoms
Patients able to retain personal identity
Memory loss is generalized
Past remote events recalled better than recent events
Patients usually have cardiovascular disorders
Be familiar with Table 17-2 p 236
Kaplan and Sadock's Handbook
Differential diagnostic considerations in dissociative amnesia
Symptoms of dissociative amnesia terminate
abruptly
tx dissociative amnesia
pyschotherapy-> help incorporate memories into pts conscious state. Hypnosis can be used.
pharmacotherapy-> drug assisted interviews
Drug assisted interviews use
short-acting barbiturates, such as Pentothal (thiopental) and Amytal (sodium amobarbital) iv; and benzos may be used to help patients recover their forgotten memories
Impulsive, sudden travel away from customary home or work and failure to remember important aspects of previous identity (name, family, occupation) A new identity often is assumed
Dissociative Fugue
Dx of dissociative fugue
SUDDEN memory loss
Associated with purposeful, unconfused TRAVEL, often for extended periods of time
Patients lose part of complete memory of past life
Often unaware of the memory loss
They assume an apparently normal, non-bizarre new identity
Perplexed and disoriented some times.
When suddenly return to their former selves, they recall the time antedating the fugue
BUT are amnestic for the period of the fugue itself
Dissociative fugue occurs most when
times of WAR
natural disasters
result of personal crisis with internal conflict
EMOTIONAL TRAUMA
Predisposing factors for dissociative fugue
Personality disorders: borderline, histrionic, schizoid
Alcohol abuse
Mood disorders
Organic disorders (Esp epilepsy)
Head trauma
Rule out these for dissociative fugue
Cognitive disorder
Temporal lobe epilepsy
Dissociate amnesia
Malingering
Dissociative Identity Disorder
Bipolar disorder
Schizophrenia
See discussion of dif dx p 238 Kaplan and Sadock
Dissociative fugue is normally brief and most recover but this may persist
refractory dissociated amnesia
tx of dissociative fugue
pysch interviews
drug assisted interviews
hypnosis to reveal stressors
psychotherapy
A CHRONIC dissociative disorder usually involving a traumatic event, often childhood physical or sexual abuse
Patients have two or more distinct personalities or identities within themselves, each of which when present may dominate the person's attitudes, behavior, and self-view as though no other personality existed
DISSOCIATIVE IDENTITY DISORDER (MULTIPLE PERSONALITY DISORDER)
Dx
Must have TWO distinct personality states
Original personality is generally amnestic for and unaware of other personality/personalities
Number of personalities- median 5-10
Usually two or three identities evident at time of diagnosis
Remaining personalities recognized during treatment
MULTIPLE PERSONALITY DISORDER occurs in
Occurs in 5% of psychiatric patients
more common in
females
as many as ____ attempt suicide
2/3
how does it occur
severe psychological and physical abuse leads to need to distance the self from horror and pain
Each personality expresses the necessary _______ or state that the original personality does not express
emotion (rage, sexuality, flamboyance, competence)
During abuse, child protects self from trauma by _______ from the terrifying acts, becoming in essence another person/s who is/are not experiencing abuse.
dissociating
The dissociated selves become a ____ _____ ingrained method of self protection
long-term
DDx of multiple personality disorders
Schizophrenia
Malingering
Borderline personality disorder
Bipolar Disorder with rapid cycling
Neurologic disorders
Complex partial epilepsy
Most chronic and SEVERE of the dissociative disorders
Mulitple personality disorders
Individual personalities may have their own separate mental disorders, mood disorders, and personality disorders, with other ______ disorders being the MC
dissociative
Tx of multiple personality disorders
psychotherapy-> Insight-oriented, often with hypnotherapy or drug-assisted interviewing
Goal- reconciliation of disparate, split-off affects by helping patient understand original reasons for the dissociation no longer exists and one whole personality can express all the feeling without the self being destroyed.
med adjuvants used
antidepressant and anti-anxiety meds
anti-convulsant helpful in some -> Tegretol
Drug assisted interviewing also done
Persistent, recurrent episodes of feeling DETACHED from one's self or body
Pt reports seems like watching herself in a movie, feeling mechanical, or as if in a dream (dreaming)
Episodes are ego-dystonic (unwelcomed and uncomfortable)
Patients recognize the unreality of the symptoms
Depersonalization Disorder
Dx of depersonalization disorder
Persistent or RECURRENT EPISODES of depersonalization resulting in significant
DISTRESS to patients or in impairment in their social, occupational, or interpersonal relationships
Reality testing is intact
Patient's inner mental processes and external events remain unchanged, yet they no longer appear to have any relation or significance to the person
**Central characteristic of depersonalization disorder
sense of unreality and estrangement.
feeling that extremities are either too large or too small
depersonalization disorder
Sense of strangeness- lack of realness- about external world is a common finding in depersonalization disorder, this is known as
derealization
Occasional isolated depersonalization
episodes are common and occur in _____% of a given population
70%
Rarely found in persons over
40
Occurs more often in men or women
women
Predisposing factors for depersonalization disorder
anxiety
depression
severe stress
Associated with substances: alcohol, barbituates, benzos, scopolamine, B-adnergic antags, pot, PCP, hallucinogens
Neurological causes of depersonalization disorder
Migraines
Epilepsy
Toxic and Metabolic Disorders that can cause depersonalization disoder
hypoparathyroidism
hypothyrodism
Depersonalization disorder seen in normal individuals who are
bored, shocked, sensory deprived, exhausted
Tx of depersonalization disorder
Benzo's, SSRI's, Lamictal
Cognitive behavioral-> re-learn feelings and attitudes
Disorders is LONG LASTING in more than 50%
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