Aetiology,Diagnosis and Treatment of Dissociative Disorders.pptx

Psychiatry

1. Aetiology, Diagnosis and Treatment of Dissociative and Conversion Disorders RISHI KANNAN G S ROLL NUMBER 106

2. AETIOLOGY

3. Psychodynamic Theory

4. Behavioural Theory Dissociative symptoms are learned responses in the phase of stress. First time,it might be learned from the surrounding environment. The development of symptoms brings the psychological relief by avoidance of stress and thus secondarily reinforced.

5. Biological Theory This theory suggests the association of dissociative behaviour with the underlying illnesses. 80 percent of the people who have diagnosed with hysteria later found to have physical illnesses. Conversion symptoms are more in patients with epilepsy and sometimes it is hard to differentiate between true and pseudo seizures. Conversion release symptoms are found in some cerebral cor lesions.

6. DIAGNOSIS

7. Diagnosis Diagnosis includes the absence of absence of objective signs of physical illness,also excluding the existence of unde physical illnesses. Dissociative symptoms appearing in a male who is more than 50 years,for the first time, strongly suspected with underlying physical or psychiatric illnesses. All dissociative disorders are not associated with physical illnesses. Other clinical features include lack of concern towards the symptoms despite apparent severity of the disability produced.(la belle indifference) Premorbid histrionic personality traits are often present.

8. TREATMENT

9. BEHAVIORAL THERAPY The symptoms may worsen with more attention,they should not be unduly focused on. Improve in symptoms could be actively encouraged. Firm and Empathetic attitude should be shown towards the patient. Sudden,acute symptoms are treated by strong suggestions to return to normality,Aversion therapy(liqour ammonia or electric stimulus,closing nose and mouth) Aversion therapy is contraindicated if it may harm patient,violates the basic human rights,Tends to get over used,can lend a wrong picture of the patient in physicians mind.

10. PSYCHOTHERAPY WITH ABREACTION Abreaction is bringing to the conscious awareness, thoughts, affects and memories for the first time.This may be achieved by: Hypnosis,Free association,Intravenous Thiopentone or diazepam. The aim of abreaction with IV thiopentone is, both,to make the confl icts conscious and to make the patient more suggestible to therapist’s advice.

11. SUPPORTIVE PSYCHOTHERAPY It’s required when the conflicts have become conscious and their affects have been released. The symptom disappears.

12. PSYCHOANALYSIS This mode of treatment is chosen not on the basis of conversion/dissociative symptoms but on the total personality structure of the patient. The total length of therapy in classical psycho analysis is usually five years or more.

13. Drug Therapy Limited role in dissociative disorders,apart from the use of iv thiopentone sodium,amytal or diazepam in abreaction. A few patients having disabling anxiety may require short term benzodiazepines.