mental health

1. Dissociative/ conversion disorder
• Conversion: Conversion is an unconscious
mechanism by which the anxiety that stems
from intra-psychic conflicts is converted and
expressed in somatic symptoms
• Dissociation: it is a defense mechanism in
which person separates oneself from a feeling
through unconscious detachment

2. Conversion disorder
Conversion disorder:
Conversion disorder is a psychoneurotic disorder
in which repressed inner conflicts are
unconsciously converted or transformed into
physical symptoms that have no organic basis for
example paralysis, blindness, loss of sensation or
seizures etc.
Dissociative disorder:
Dissociation disorders are defined by a disruption
of consciousness, memory, identity or
perception. (APA, 2000)

3. Epidemiology
• Hysteria (comprising of conversion,
dissociation and somatization disorders)
constitutes about 6-15% of all outpatient
diagnoses and 14-20% of all neurotic
disorders.
• Females usually outnumber males, but in
children, the percentage tends to be similar in
boys and girls.

4. Causes
• Psychodynamic Theory
• Behavioral Theory
• Biological Theory

5. Clinical Features
• Conversion is characterized by following
clinical features:
• Presence of symptoms or deficits affecting
motor or sensory function, suggesting medical
or neurological disorders (esp. in conversion)
or disturbance in the normally integrated
functions of consciousness, identity or
memory (esp. in dissociation)

6. • Sudden onset
• Development of symptoms usually in the
presence of a significant psychological stresses
• A clear temporal relationship between
stressor and development or exacerbation of
symptoms
• Patient doesn’t intentionally produce the
symptoms

7. Clinical Features…
• There is usually a secondary gain (drawing
attention of significant others and relieving
anxieties or stresses e.g. through sympathy,
care etc assuming sick role). Other prominent
features of conversion disorder being primary
gain (the direct external benefits that being
sick provides such as relief of anxiety, conflict
or distress) and la Belle indifference (lack of
patients’ concern towards the symptoms or
diseases)

8. Clinical Features…
• Detailed physical examination and
investigations do not reveal any abnormality
that can explain the symptoms adequately
• The symptom may have a symbolic
relationship with the stressor or conflict
• The symptoms or deficit cause clinically
significant distress or impairment in social,
occupational or other important areas of
functioning or warrants medical evaluation

9. Diagnosis
• PHT
• MSE
• DSM/ ICD criteria

10. Management
• Drug treatment: no specific drug treatment:
symptomatic treatment includes - antidepressant,
benzodiazepines and beta blockers
• Supportive psychotherapy
• Physical therapy
• Stress management
• Trans-cranial magnetic stimulation: Transcranial
magnetic stimulation (TMS) is a noninvasive
method to
cause depolarization or hyperpolarization in
the neurons of the brain

11. Management…
• Behavior therapy
- Strong suggestion
- Aversion therapy: liquor ammonia, aversive
electric stimulation, pressure just above
eyeballs or tragus of the ear: closing the nose
and mouth in resistant cases
- Amplification of suggestion with hypnosis,
free association, iv amytal or theopentone or
iv diazepam

12. Management…
• Abreaction therapy: abreaction is bringing to
the conscious awareness, thoughts, affects
and memories for the first time done through:
- Hypnosis
- Free association
- IV thiopentone or diazepam
• Psychoanalysis

13. Nursing interventions
Assessment:
• Laboratory reports and other data to rule out
organic pathologies
• Primary and secondary gains
• Self care activities
• Stressors and precipitating factors

14. Nursing diagnosis
• Manipulative behavior related to inability to
express feelings appropriately
• Attention seeking behavior related to
unsatisfactory social and interpersonal
relationship
• Potential for self inflicted injury related to low
self esteem
• Disturbance in interpersonal relationship
related to shallow emotions

15. Nursing interventions
Interventions:
• Assess physician’s ongoing assessments,
laboratory reports and other data to rule out
organic pathology
• Identify primary and secondary gains and
encouraging normal behavior (i.e. reducing
primary and secondary gain)

16. • Encourage patient to perform self care
activities as independently as possible.
Intervene only when patient requires
assistance
• Withdraw attention if the patient continues to
focus on physical limitations
• Encourage patient to verbalize fears and
anxieties. Encourage to talk during therapy

17. Nursing interventions…
• Positive reinforcement for identification or
demonstration of alternative adaptive coping
strategies
• Identify specific conflicts that remain
unresolved and assist patient to identify
possible solutions
• Assist the patent to set realistic goals for the
future

18. Nursing interventions…
• Allow the patient to express her feelings and
emotional conflicts, verbal expression of
emotional pain speeds up recovery, so patient
should be encouraged to talk during therapy
• Establish trusting relationship with the patient
• Patient's comfort and safety are nursing priorities
• Essential information for patient and family.
Physical symptoms have not serious physical
impacts, symptoms can be brought about by
stress, give positive reinforcement for
improvement