Transcript Dissociative Disorders

Dissociative Disorders
Unless otherwise indicated, answers
are from DSM-IV-TR or First and
Tasman
As of 1Sep07
Memory types
Q. What are the two basic memory types?
Memory types
Ans. There are different terms used.
declarative and procedural
explicit and implicit
episodic and semantic
We will use declarative and procedural in
these screens.
Memory – dissociative disorders
Q. Which type of memory is lost in
dissociative disorders?
Memory - dissociative
Ans. Declarative. The patient still has the
memory, for example, to drive a car even
though they may not remember their
name.
Classification
Q. Besides NOS category, what are the four
dissociative disorders?
Classification
Ans.
1. Dissociative amnesia
2. Dissociative fugue
3. Dissociative identity disorder
4. Depersonalization disorder
[also, dissociative trance disorder is in the
DSM appendix of disorders in need of
research.]
Dissociative amnesia - basic
Q. Basic features of dissociative amnesia?
Dissociative amnesia - basic
Ans. An inability to recall important personal
information, usually of a traumatic or
stressful nature, that is too extensive to be
explained by normal forgetfulness.
Dissociative amnesia prevalence
Q. There is a controversy as to the
prevalence of this disorder. State the
controversy.
Prevalence
Ans. The increase of reported cases is
attributed by some to greater clinician
awareness. Others claim that the increase
is the result of greater suggestibility.
Dissociative amnesia course
Q. What is the course?
Dissociative amnesia course
Ans. Some eventually get total recall, others
have none.
Treatment of dissociative amnesia
Q. What is the treatment of dissociative
amnesia?
Treatment of dissociative amnesia
Ans.
Place in safe environment
Hypnosis, e.g., age regression
Or
supportive psychotherapy of integrating
memories into consciousness
Dissociative fugue - basic
Q. What is the basic feature to this disorder?
Dissociative fugue - basic
Ans. A sudden, unexpected travel away
from one’s customary place of daily
activities, with inability to recall some or all
of one’s past.
Fugue’s prevalence
Q. What is fugue’s prevalence?
Fugue’s prevalence
Ans. 0.2% of the general population.
Fugue’s course
Q. What is the course?
Fugue’s course
Ans. May last for hours to months. Recovery
is rapid, but refractory amnesia may
persist.
Treatment of fugues
Q. What is the treatment of fugues?
Treatment of fugues
Ans.
First and Tasman prefer hypnosis.
Some examiners may also like to use
medication-facilitated [e.g., Amytal]
interviews.
Supportive psychotherapy is also used.
Dissociative identity disorder [DID]
- basic
Q. What is the basic findings in DID?
DID - basic
Ans. The pt has two or more distinct
identities or personality states that
recurrently take control of behavior.
DID - prevalence
Q. What is the prevalence?
DID - prevalence
Ans. Controversial as some believe the
increase is the result of clinician
suggestion.
DID - course
Q. What is the course?
DID - course
Ans. Average time between onset and dx is
6-7 years, and course is episodic or
continuous. Episodic is associated with
untoward events.
DID treatment
Q. What is the treatment of DID?
DID treatment
Ans. Supportive, extensive, psychotherapy
directed at integrating the personalities. In
doing so, addressing past traumas may
become key; but any suggestions as to
trauma is seen as iatrogenic by some.
Also used as adjuncts:
hypnosis
SSRIs when dysphoria is part of the
presentation
Depersonalization disorder - basic
Q. Basic feature of depersonalization
disorder?
Depersonalization - basic
Ans. Episodes of feeling detachment or
estrangement from one’s self.
“Laboratory” findings
Q. DSM-IV suggests what laboratory finding
in folks with depersonalization?
“Laboratory” findings
Ans. Display high hypnotizability.
Depersonalization – prevalence
Q. What is the prevalence?
Depersonalization - prevalence
Ans. About half of all adults have had such
an experience, usually precipitated by
severe stress.
Depersonalization - course
Q. What is the age of onset and subsequent
course?
Depersonalization - course
Ans. Mean age of onset is 16 and course is
usually chronic, exacerbating in
association with actual or perceived
stress.
Depersonalization - treatment
Q. What is the treatment?
Depersonalization - treatment
Ans. Medications for the co-morbid condition
may suffice. Anxiolytics may work, but
watch for side effect of depersonalization
that may actually increase with these
meds. Hypnosis is another option.
Dissociative trance disorder - basic
Q. Basic feature of this disorder?
BEING IN THE DSM APPENDIX MAKES
THIS A VERY UNLIKELY EXAM TOPIC.
Dissociative trance disorder - basic
Ans. Patient has an involuntary state of
trance causes significant distress and is
not part of the individual’s cultural practice.
Trance - treatment
Q. What is the treatment?
Trance treatment
Ans. First and Tasman suggest adhering to
the approach used in the pt’s cultural, e.g.,
“negotiating a change” in the pt’s “social
circumstances.”