Hysterical disorders

A presentation for Family Physicians, Pediatricians and Neurologists. They will see these disorders more than any Psychiatrist will

1. HYSTERICAL DISORDERS Presented By Dr Vani Kulhalli , MD Psychiatrist

2. SCOPE OF PRESENTATION Overview of: Epidemiology Definition Clinical features and diagnosis Treatment Prognosis and outcome

3. EPIDEMIOLOGY Not common disorder- but epidemics are known Age and gender- certain symptoms seen in certain groups Risk factors- personality issues, history of trauma or abuse, genetic factors unknown- but familial cases Co- morbities - depression/ anxiety/ personality/ stress reactions Mechanism of occurrence- essentially psychological reaction to unbearable situation 3 factors Personality Disease Environment

4. DEFINITION Origin from word ‘ hysteros ’ related to uterus No longer called hysterical- but dissociative and conversion Defence mechanisms- dissociation and conversion ……partial or complete loss of the normal integration between memories of past, awareness of identity and immediate sensations, and control of bodily movements…..

5. CLINICAL FEATURES Specific constellation of symptoms No evidence of physical disorder to explain symptoms Evidence of psychological causation TO BE NOTED: Onset, duration, test reports, good mood, recurrence or past history are not diagnostic

6. DIAGNOSIS History- note organic and psychosocial factors General examination- level of consciousness Focused systemic examination- what type? Relevant investigation Diagnostic formulation

7. PHARMACOLOGICAL MANAGEMENT No evidence for use of any pharmacological agent Benzodiazepine in small doses- anti- anxiety or placebo effect Treat the co-morbid psychiatric disorder

8. NON PHARMACOLOGICAL MANAGEMENT Immediately Confidence building measures Removal of stressor Normalisation of behavior Differential reinforcement Short-term Individual and family counseling- supportive Long term Specific individual or family therapy social intervention

9. PROGNOSIS AND COMPLICATIONS Good prognostic factors Short duration of history Acute and circumscribed stress Minimal personality dysfunction Presence of co-morbidity Adequate support system Complications Chronicity Disruption of family Deliberate self harm

10. CONCLUSIONS Psychological aspects more important Symptoms as well as treatment-wise Psychiatrists rarely able to treat this disorder Empathic approach essential No medicine proved to be useful

11. DR VANI KULHALLI, Psychiatrist MD (NIMHANS, 2003) Clinics: Vile Parle East and West Hospitals: Four Care Hospital, VPEast Jewel Hospital, VPWest For Appointments Contact: 9819269628 Between 5 PM to 8 PM