This document discusses the relationship between dissociation and other psychiatric disorders. It finds that temporal lobe epilepsy can produce dissociative symptoms similar to functional cases. High dissociation is also seen in detoxified substance abusers and around 60% of borderline personality disorder patients also meet criteria for a dissociative disorder. Dissociation may be a response to childhood trauma for these patients. Dissociation is also seen comorbidly in schizophrenia, eating disorders, and mood disorders where it correlates with trauma history and symptom severity. Treatment involves psychotherapy, pharmacotherapy, and management of individual disorders like dissociative amnesia, fugue, and conversion disorder.
Lesson about abnormal psychology which help to understand who are suffering from psychological problems and guide us to understand other peoples behavior, attitude. some of the type of abnormal behavior are the DID, somatoform, hypochondriasis and understanding psychosomatic behavior.
This slide contains information regarding Dissociative Disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Lesson about abnormal psychology which help to understand who are suffering from psychological problems and guide us to understand other peoples behavior, attitude. some of the type of abnormal behavior are the DID, somatoform, hypochondriasis and understanding psychosomatic behavior.
This slide contains information regarding Dissociative Disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
hii guys this is my ongoing presentation from my speciality class i hope u guys lije that please so i hope it is been useful for u in ur specialities by getting little help with that
The somatoform disorders are a group of psychological disorders in which a patient experiences physical symptoms that are inconsistent with or cannot be fully explained by any underlying general medical or neurologic condition. Medically unexplained physical symptoms account for as many as 50% of new medical outpatient visits. [1] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [2] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms.
Somatization in children consists of the persistent experience and complaints of somatic distress that cannot be fully explained by a medical diagnosis. They can be represented by a wide spectrum of severity, ranging from mild self-limited symptoms, such as stomachache and headache, to chronic disabling symptoms, such as seizures and paralysis. These psychological disorders are often difficult to approach and complex to understand. It is important to note that these symptoms are not intentionally produced or under voluntary control.
In somatoform disorders, somatic symptoms become the focus of children and their families. They generally interfere with school, home life, and peer relationships. These youngsters are more likely to be considered sickly or health impaired by parents and caretakers, to be absent from school, and to perform poorly in academics. Somatization is often associated temporarily with psychosocial stress and can persist even after the acute stressor has resolved, resulting in the belief by the child and his or her family that the correct medical diagnosis has not yet been found. Thus, patients and families may continue to seek repeated medical treatment after being informed that no acute physical illness has been found and that the symptoms cannot be fully explained by a general medical condition. When somatization occurs in the context of a physical illness, it is identified by symptoms that go beyond the expected pathophysiology of the physical illness.
Recurrent complaints often present as diagnostic and treatment dilemmas to the primary care practitioner (PCP) who is trying to make sense of these symptoms. The PCP may feel poorly prepared and/or may have little time to assess or treat the somatic concerns. While the more disabling somatic complaints are more likely to be referred to a mental health professional, these youngsters presenting with these disabling physical symptoms bridge both medical and psychological domains and present a puzzling quandary for professionals from either field if working with them alone. [3] The nature of these symptoms requires an integrated medical and psychiatric treatment approach to successfully decrease the impairment caused by these disorders.
'Non-pharmacological management in dementia' is really nice article published in British Journal of Psychiatry Advances. It gives basic idea about non pharmacological management in all forms of dementia for Behavioral and psychological symptoms of dementia.
Self-maintenance therapy in Alzheimer’s disease Barbara Romero1,.docxtcarolyn
Self-maintenance therapy in Alzheimer’s disease
Barbara Romero1,2 and Michael Wenz1
1Alzheimer Therapiezentrum der Neurologischen Klinik Bad Aibling, Germany
2Klinik und Poliklinik für Psychiatrie und Psychotherapie der Technischen Universität München, Germany
A short-term residential treatment programme designed to prepare patients with dementia and caregivers for life with a progressive disease was evaluated in a one group pretest–posttest design. The multicomponent programme included: (1) intensive rehabilitation for patients, based on the concept of Self-Maintenance Therapy, and (2) an intervention programme for caregivers. The results showed a consistent improvement in patients’ depression and in other psychopathologica l symptoms, which can be seen as directly beneficial for patients. Following treat- ment, caregivers also felt less depressed, less mentally fatigued and restless, and more relaxed. Controlled studies are needed to support the preliminary results presented and to address hypotheses about factors responsible for benefits as well as for treatment resistance. The concept of Self-Maintenance Therapy allowed the prediction that experiences that are in accordance with patients’ self-struc- tures and processes support patients’ well-being, reduce psychopathological symptoms, and facilitate social participation.
INTRODUCTION
Patients with dementia of Alzheimer type (AD) gradually lose their cognitive competence in the course of the disease. The lost and preserved competencies of patients are traditionally described in terms of neuropsychologica l functions and daily activities, such as “spatial orientation” or “naming” abilities. Rehabilitation programmes grounded on this traditional approach aim at facilitation of basic functions, for example, facilitation of memory perfor- mance or attention. However, interventions designed to improve basic
Correspondence should be sent to Barbara Romero, Alzheimer Therapiezentrum der Neurologischen Klinik Bad Aibling, Kolbermoorerstr. 72, D-83043 Bad Aibling, Germany. Email: [email protected] .
The authors would like to thank L. Clare and R.T. Woods for providing helpful comments on a previous draft of this paper.
Ó 2001 Psychology Press Ltd http://www.tandf.co.uk/journals/pp/09602011.html DOI:10.1080/09602010143000040
334 ROMERO AND WENZ
neuropsychological functions have not really proved beneficial for patients with AD. Neuropsychological research has revealed that the relevance of func- tional training for dementia patients has been limited (Bäckman, 1992; Heiss, Kessler, & Mielke, 1994; McKittrick, Camp, & Black, 1992).
We proposed a systemic approach for evaluating patients’ psychosocial resources and for developing rehabilitation programmes (Romero, 1997; Romero & Eder, 1992; Romero & Wenz, 2000). There are two systems that should be stabilised and preserved in a rehabilitation programme for patients with dementia—the self as an intra-individual system, and the social networ.
Psychotherapy is a therapeutic interaction contracted between trained psychotherapists and the patient based upon verbal or nonverbal communication for treatment of emotional, behavioral, personality, and psychiatric disorders.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. Epilepsy and dissociation
• There is evidence that temporal lobe seizure activities can
produce dissociative syndrome, which is similar to that
observed in functional cases.
• From these findings, it may be inferred that temporal lobe
epileptic activity is important in the generation of the
dissociative symptoms without a neurological focal lesion
(Spiegel, 1991)
3. Substance use and dissociation
• Many studies conducted on populations with alcohol or other
substance dependence have led to significant data concerning
concurrent dissociative psychopathology.
• Ellason et al (1996) reported that alcohol and drug addiction
occurred in a large proportion of patients with dissociative
identity disorder and in many of these patients, drug abuse
was severe and began at an early age.
4. • High dissociation levels were found in detoxified male
veterans suggesting that dissociation might be due to the
chronic residual effect of long-term substance use, including
both alcohol and cocaine (Wenzel et al, 1996).
Borderline personality disorder and dissociation
• studies have shown a significant proportion (around 60%) of
borderline personality disorder patients had a diagnosis of
dissociative disorder
(Zittel & Westen, 2005; Yee et al, 2005)
5. • Patients with borderline personality disorder and a
dissociative disorder have high levels of reported childhood
trauma.
• Dissociation in response to childhood trauma may be at the
core of the pathogenic process that results in
symptomatology embodied in the diagnosis of both
borderline personality disorder and dissociative disorder.
6. • Chronic efforts to suppress (dissociate) unpleasant thoughts
may in some cases be a regulatory strategy underlying the
relationship between intense negative emotions and
symptoms of borderline personality disorder.
Schizophrenia and dissociation
• Patients of schizophrenia with a comorbid dissociative
disorder have more severe childhood trauma histories, more
comorbidity and higher scores for both positive and negative
symptoms (Ross & Keyes, 2004).
7. • Schneiderian first rank symptoms, have been found to be
more common in dissociative identity disorder in few studies.
• Schneiderian symptoms are highly related to other
dissociative symptom clusters and to childhood trauma (Ross
& Joshi, 1992).
8. Eating disorders and dissociation
• In a study done by Denitrak et al (1990), female patients with
anorexia and bulimia nervosa showed a significantly greater
incidence of dissociative phenomena than a group of age
matched normal female controls.
• Furthermore, the presence of severe dissociative experience
appeared to be specifically related to a propensity for self
mutilation and suicidal behaviour.
9. • The distortion of self and body image experienced by patients
with eating disorders might be related to the greater
propensity of these patients to undergo considerable
dissociative experiences.
10. Mood disorder and dissociation
• In studies of mood disorders, measures of dissociation might
correlate with childhood trauma, symptom severity and
response to medication.
• Among mood disorders, depression is more closely associated
with dissociation.
• The women with childhood sexual abuse, who also became
depressed earlier in life, were more likely to have high
dissociation score.
(Ellason et al, 1996)
11. • In clinical practice, chronic depression and suicidality in
patients with dissociative disorder are usually resistant to
standard biologic treatment modalities but respond positively
to the successful treatment of the dissociative disorder
(Parker et al, 2005)
14. PSYCHOTHERAPY
• Psychotherapy remains the mainstay for management of
dissociative disorder.
• Following are the general techniques of psychotherapy for
dissociative disorders-
• Psychoeducation: Education is an invaluable tool for treating
dissociative disorder. It helps to undo the stigmatization and
shame associated with being ill.
15. • Education appeals to intellectual strengths and the practice of
coping skills improve function and resilience.
• Psychoeducation can be accomplished in focused skill-building
groups, which also have the advantage of increasing
interpersonal connection (Harris, 1998).
16. Pacing and containment
• Pacing and containment are critical in building a foundation
and framework for therapy.
• One of the essential goals of therapy is to maintain function
while doing the work.
• The first stage of therapy is the establishment of safety and
stabilization and the building of the therapeutic alliance.
17. • The second is of trauma processing; the integration of
traumatic recollection and intense affect.
• The third is postintegration of self and relational development
• Containment skills can be taught through psychoeducation
and imagery.
18. • Therapists must start by normalizing feelings as an integral
part of human being.
• Affect modulation involves the identification of feelings,
followed by the contextual relationship, and then modulation.
• Learning to identify a specific feeling and giving it context is
the beginning of control and understanding.
19. • Modulation also involves teaching self-soothing, mindfulness,
or distracting strategies.
• The therapist and patient can collaboratively create a list of
strategies to keep at hand for difficult moments or days
• Grounding skills: Dissociative processes adaptively modulate
intolerable anxiety and stress resulting from trauma at the
same time that these processes exact the price of destroying
the context and meaning of experience.
20. • Grounding is the process of being psychologically present and
particularly effective in dealing with depersonalization
experiences. Grounding skills can be divided into two areas
1. sensory awareness
2. cognitive awareness
21. • Sensory awareness encourage patients focus in the present by
using all five senses in awareness of their body position; e.g.,
patients often find it helpful to hold a ball, small stone or
other palm-sized objects to enhance their sense of touch.
• Similarly, sensory cues are used for other sensations like
vision, hearing, smell and taste.
• Cognitive awareness grounding skills involve orienting the
patient to day, date, age and location (Turkus, 2006).
22. • Traumatic reenactment
• For patients who can stabilize and form a reasonable working
alliance in treatment, longer-term treatment goals involve
detailed, affectively intense, psychotherapeutic processing of
life experiences for the individual.
• Authorities emphasize that, in most cases, intensive, detailed
psychotherapeutic work with traumatic memories should only
be initiated after the patient has demonstrated the ability to
use symptom management skills independently
23. • The patient should be able to give informal consent and
should have a realistic understanding of the potential risks
and benefits of intensive focus on traumatic material.
• Furthermore, patient shouldn’t be in the midst of an acute life
crisis or major life change, comorbid medical and psychiatric
disorders should be stabilized, the patient must have ego-
strength and psychological resources to withstand the rigors
of the process, and there must be adequate resources, such
as support by significant others, to support the patient for
additional sessions.
24. Safety planning
• Establishing a written safety should take if in crisis can be very
useful early in the treatment process when the therapist is
developing a rapport with the patient.
• The basic intent of such a plan is an agreement between
patient and therapist that if the patient has attempted to
manage the crisis independently using skills such as
relaxation, grounding or containment, then the patient will
contact the therapist before acting on any self harming
impulses and wait for the therapist to call back so that
impulses can be discussed.
25. Healing place
• Clinical practice in the field of trauma and dissociation is
replete with the creation of “safe place” imagery to manage
fear and anxiety.
• The installation of a healing place is a valuable therapeutic
intervention.
26. • After installation of healing place, the therapist should invite
the patient to describe and share the experience for
affirmation and reinforcement or to discuss any problems
encountered.
• The place may need to be modified if there is intrusion of
resistance or traumatic material (Turkus, 2006).
28. DISSOCIATIVE AMNESIA
PSYCHOTHERAPY
1.Free recall-
• Patients with acute and chronic forms of amnesia may
respond well to free recall strategies in which they allow
memory material to enter into consciousness.
2.Cognitive therapy-
• It may have specific benefit for individuals with trauma
disorders.
• Identifying the specific cognitive distortions that are based in
the trauma may also provide an entry into autobiographical
memory for which the patient experiences amnesia.
29. 3.Hypnosis
• Hypnosis is not treatment itself; rather, it is a set of adjunctive
techniques that facilitate certain psychotherapeutic goals.
• It can be used in a number of different ways.
• In particular, hypnotic intervention can be used to contain,
modulate, and titrate the intensity of symptoms
30. • To facilitate controlled recall of dissociated memories, to
provide support and ego strengthening for the patient; and,
finally, to promote working through and integration of
dissociated material (Loweinstein & Putnam, 2005).
31. PHARMACOTHERAPY
• There is no known pharmacotherapy for dissociative amnesia
other than pharmacologically facilitated interview.
• A variety of agents have been used for this purpose, including
sodium amobarbital, thiopental, oral benzodiazepines and
amphetamines.
• At present, no adequately controlled studies have been
conducted that assess the efficacy of any of these agents in
comparison with one another or with other treatment
methods.
32. DISSOCIATIVE FUGUE
• Dissociative fugue is usually treated with an eclectic,
psychodynamically informed psychotherapy that focuses on
helping the patient recover memory for identity and recent
experience.
• Hypnotherapy and pharmacologically facilitated interviews
are frequently necessary adjunctive techniques to assist with
memory recovery.
• The initial phase is centered on establishing clinical
stabilization, safety, and a therapeutic alliance using
supportive and educative interventions.
33. • Once stabilization is achieved, subsequent therapy is focused
on helping the patient regain memory for identity, life
circumstances and personal history.
• During this process, extreme emotions related to trauma or
severe psychological conflict, or both, may emerge that
require working through.
34. • In general, the therapist should take a supportive and
nonjudgmental stance, especially if the fugue has been
precipitated by intense guilt or shame over an indiscretion.
• At the same time, it is important for the therapist to balance
this with being a spokesperson for the patient, taking realistic
responsibility for misbehaviour.
Loweinstein & Putnam, 2005
35. DISSOCIATIVE IDENTITY DISORDER
PSYCHOTHERAPY
• A vast majority of clinicians consider psychotherapy as the
primary and most efficacious treatment modality.
• The initial phase of psychotherapy consists of
psychoeducation and setting up treatment frame and
boundaries, development of skills to manage symptoms and
cognitive therapy.
• The second phase deals with the traumatic memories.
• The third phase consists of fusion, integration, resolution and
recovery of personality.
36. PHARMACOTHERAPY
Available treatment methods are given below-
Affective symptoms
• Affective symptoms are only infrequently responsive to mood
stabilizing medications.
• They often have only partial, response to antidepressant
medications, usually SSRIs or TCAs.
• Refractory patients may need a series of antidepressant trials
or combination therapy with two antidepressants.
37. Pseudopsychotic symptoms-
• pseudopsychotic symptoms rarely are ameliorated by
antipsychotic medications, even in higher doses.
• On the other hand, in many patients with dissociative identity
disorder and severe, intrusive PTSD, anxiety, confusion and
cognitive dysfunction , low doses of atypical neuroleptics
(risperidone, quetiapine, ziprasidone, olanzepine) may
ameliorate these symptoms.
38. Anxiety symptoms
• Many patients with dissociative identity disorder may require
long-term treatment with benzodiazepines for persistent
anxiety symptoms.
• Obsessive-compulsive symptoms in dissociative identity
disorder preferentially respond to medication like fluvoxamine
and clomipramine.
39. PTSD symptoms
• A variety of uncontrolled studies have shown efficacy of mood
stabilizers (carbamazepine, valproate , lamotrigine) for PTSD
symptoms in dissociative identity disorder.
• A subgroup of patients of dissociative identity disorder with
PTSD symptoms responds to beta-blockers for severe
hyperarousal symptoms, such as pronounced startle response.
40. • Long-acting forms of propranolol are used most frequently for
this indication.
• Similarly, the α-agonist clonidine may be effective in a few
patients for the same indication (Loweistein, 2005)
41. ELECTROCONVULSIVE THERAPY
• A clinical picture of major depression with persistent,
refractory melancholic features across all alters may predict a
positive response to ECT.
• However, this response is usually only partial
42. DEPERSONALIZATION DISORDER
PHARMACOTHERAPY
• Patients with depersonalization disorder are usually clinically
refractory group.
• Over the past decade there have been anecdotal reports of
improvement in this condition with SSRIs (e.g., fluoxetine) or
clomipramine.
• A double-blind placebo-controlled study comparing 25
patients receiving fluoxetine with 25 patients receiving
placebo for 10 weeks found that fluoxetine was no better than
placebo for this condition .
Simeon et al, 2004
43. • Sierra et al (2003), in another double-blind placebo-controlled
study, found lamotrigine no better than placebo for
depersonalization disorder.
• Many patients who respond to SSRIs or mood stabilizers have
comorbid psychiatric conditions like depression or anxiety and
that might the reason for improvement.
• Nevertheless, SSRIs remain the most frequently prescribed
medication for this condition
44. PSYCHOTHERAPY
Many different types of psychotherapy have been used with
depersonalization disorder patients including
• psychodynamic
• Cognitive
• cognitive-behavioural,
• hypnotherapeutic and supportive.
45. • Stress management strategies, distraction techniques,
reduction of sensory stimulation, relaxation training and
physical exercise may be somewhat helpful in some patients.
• Hunter et al (2005), in an open study, involving 21 patients
with depersonalization disorder, found cognitive behaviour
therapy (for a period of 2 years), significantly effective for
depersonalization- derealization symptoms, as well as for
anxiety and depressive symptoms.
46. • All the patients were symptomatic despite getting
psychopharmacologic intervention before CBT was started
and 29% of them no longer met the diagnostic criteria for
depersonalization disorder at the end of the trial.
47. CONVERSION DISORDER WITH MOTOR AND SENSORY
SYMPTOMS
• In acute cases without a prior history of conversion, accurate
reassurance coupled with reasonable rehabilitation to fit the
symptoms is warranted.
• Confrontation of the patient about the so-called false nature
of the symptoms is contraindicated.
• Chronic cases are more difficult to treat. Comorbid psychiatric
illness need to be treated aggressively.
48. • Treatment needs open explanation to the patient about the
findings, and education aimed at helping the patient
understand that, although the symptoms are real and causing
impairment, there is a hope for full recovery.
49. Three specific treatments must then be considered.
• First, psychomotor and sensory rehabilitation.
• Anxiolytic and antidepressant medication may decrease some
of the symptoms to allow the patient to engage in physical
rehabilitation or psychotherapy.
• Finally, psychotherapy may be useful but also may be
contraindicated in a patient who remains highly resistant to it
or who gets worse when it is initiated.
50. • Therapy is directed at increasing function and having the
patient demonstrate to himself or herself that the symptom
or deficit is alterable and that it is related to psychological or
social phenomena (Hollifield, 2005)
51. CONVERSION SEIZURE (PSEUDOSEIZURE)
Explaining conversion and pseudoseizure
• It is important to explain the diagnosis in a way that educates
the patient, provides a cognitive framework of understanding,
reduces shame and motivates willingness to undertake
treatment.
• Including the family in the discussion is recommended.
• Conversion symptoms are generated unconsciously and
express unconscious emotions and conflicts. Simple
metaphors are helpful in explaining these abstract concepts to
the patient.
52. Exploring the causes
• The second step is explanation of the causes of conversion in
an individual patient.
• Adequate evaluation of the causes requires open-ended,
nonleading questions about trauma or abuse.
• Treatment focuses on identifying the emotions that these
events raise and exploring the trauma.
53. • Conversion seizures usually decrease sharply after the conflict
is verbalized in individual psychotherapy and the patient is
assisted in discussing it in family therapy
Treatment proper
• Antidepressants should be used if there is comorbid PTSD,
panic or major depression. Some patients with overwhelming
anxiety may require initial treatment with anxiolytics until
their anxiety or trauma is resolved in psychotherapy.
54. • The primary principles of psychotherapy are a nonjudgmental,
supportive and educative approach that addresses
alexithymia and encourages verbal expression, problem
solving skills and resolution of trauma.
• Patients should focus on their symptoms, their dissociative
defenses, and the stress or emotions that trigger conversion
seizures.
• Clinician should emphasize hope,ability to gain control over
symptom and need to identify and verbalize emotion.
55. REFERENCES
• Kaplan & sadock’s comprehensive textbook of psychiatry,ninth edition
• Kaplan & sadock's synopsis of psychiatry: behavioral sciences/clinical psychiatry,
10th edition
• Glutamate and post-traumatic stress disorder: toward a psychobiology of
dissociation. semin clin neuropsychiatry. 1999
• Lanius ra, brain activation during script-driven imagery induced dissociative
responses in ptsd: a functional magnetic resonance imaging investigation. biol
psychiatry. 2002
• Epidemiology of dissociative disorders: an overview,epidemiology research
international volume 2011)