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DR.M IMRAN AFZALMBBS,DPM(DIPLOMAT PSYCHOLOGICAL MEDICINE)C.PSYCH (MISSOURI) USADAYTOP GRADUATE (USA)CONSULTANT PSYCHIATRISTPUNJAB INSTITUTE OF MENTAL HEALTH,SHADMAN, LAHORE.
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DISSOCIATION (CONVERSION) DISORDERFORMERLY HYSTERIA
Disorder of sudden dramatic symptomsInconsistent with known diseasesUnconscious process---not malingeringSymptoms may present singly or en masse
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EPIDEMIOLOGYIncidence reported as 22 per 100,0005 to 15 % of psychiatric consultations in a general hospital Ratio of men to women is 1 to 2Men mostly involved in occupational and military accidentsCommon age is adolescents and young adults
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Common among rural populations, little educated persons, those with low IQ, low socioeconomic groups and military personnel exposed to combat situations
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CO MORBIDITY Commonly associated with major depressive disorder , anxiety disorders and schizophrenia
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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
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Neuropsychological tests reveal cerebral impairments in verbal communication, memory , vigilance , affective incongruity and attention
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Psychological
Amnesia Identity confusion Trance Possession states
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CLINICAL FEATURES ParalysisBlindnessMutism SENSORY SYMPTOMS Anaesthesia Paresthesia Stocking and glove anaesthesia of the hands and feet Hemi anaesthesia of the body along the midline
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MOTOR SYMPTOMS Abnormal movements (choreiform,tics,jerks) Gait disturbance WeaknessParalysis
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SEIZURE SYMPTOMS Pseudo seizures are common Pupillary and gag reflexes are retained after pseudo seizures No post seizure increase in prolactin levelsCo existing epileptic disorder
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ASSOCIATIVE FEATURES Primary gains Secondary gains Avoiding difficult life situations Receiving support and assistance Controlling others behaviour La belle indifference
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DIFFERENTIAL DIAGNOSIS Epileptic fit Physical conditions causing similar symptoms Neurological illnesses esp. multiple sclerosis,myopathies guillain-barre syndrome,early neurological symptoms of AIDS Atypical depression Unexplained somatic complaints Anxiety disorders
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MANAGEMENT Good history taking Advice and support to the patient and family
Symptoms have no clear physical cause Can be brought about by stress Symptoms usually resolve rapidly leaving no permanent damage
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PSYCHOLOGICAL HELP Encourage the patient to acknowledge recent stresses Give positive reinforcement Take brief rest from stress before returning to usual activities Advise against prolonged rest or withdrawal from activities
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MEDICATION Anxiolytics Use of ammonia ?? Anti depressants Referral to psychiatric facility
