DISSOCIATION DISORDR FORMERLY …解离障碍以前….pptVIP

DR.M IMRAN AFZALMBBS,DPM(DIPLOMAT PSYCHOLOGICAL MEDICINE)C.PSYCH (MISSOURI) USADAYTOP GRADUATE (USA)CONSULTANT PSYCHIATRISTPUNJAB INSTITUTE OF MENTAL HEALTH,SHADMAN, LAHORE. DISSOCIATION (CONVERSION) DISORDERFORMERLY HYSTERIA Disorder of sudden dramatic symptoms Inconsistent with known diseases “Unconscious” process---not malingering Symptoms may present singly or en masse EPIDEMIOLOGY Incidence reported as 22 per 100,000 5 to 15 % of psychiatric consultations in a general hospital Ratio of men to women is 1 to 2 Men mostly involved in occupational and military accidents Common age is adolescents and young adults Common among rural populations, little educated persons, those with low IQ, low socioeconomic groups and military personnel exposed to combat situations CO MORBIDITY Commonly associated with major depressive disorder , anxiety disorders and schizophrenia ETIOLOGY Psychoanalytic factors Conflict is between an instinctual impulse an the prohibitions against its expressions Biological factors Brain imaging shows hypo metabolism of the dominant hemisphere and hyper metabolism of the non dominant hemisphere Excessive cortical arousal Neuropsychological tests reveal cerebral impairments in verbal communication, memory , vigilance , affective incongruity and attention Psychological Amnesia Identity confusion Trance “Possession” states CLINICAL FEATURES Paralysis Blindness Mutism SENSORY SYMPTOMS Anaesthesia Paresthesia Stocking and glove anaesthesia of the hands and feet Hemi anaesthesia of the body along the midline MOTOR SYMPTOMS Abnormal movements (choreiform,tics,jerks) Gait disturbance Weakness Paralysis SEIZURE SYMPTOMS Pseudo seizures are common Pupillary and gag reflexes are retained after pseudo seizures No post seizure increase in prolactin leve