Download DISSOCIATION (CONVERSION) DISORDER FORMERLY HYSTERIA

DR.M IMRAN AFZAL
MBBS,DPM
(DIPLOMAT PSYCHOLOGICAL
MEDICINE)
C.PSYCH (MISSOURI) USA
DAYTOP GRADUATE (USA)
CONSULTANT PSYCHIATRIST
PUNJAB INSTITUTE OF MENTAL
HEALTH,
SHADMAN, LAHORE.
DISSOCIATION (CONVERSION) DISORDER
FORMERLY 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
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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 levels
Co existing epileptic disorder
ASSOCIATIVE FEATURES
 Primary gains
 Secondary gains
Avoiding difficult life situations
Receiving support and assistance
Controlling others’ behaviour
 La belle indifference
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
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
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
MEDICATION
 Anxiolytics
 Use of ammonia ??
 Anti depressants
 Referral to psychiatric facility