Transcript Prevalence of Dissociative Disorders in General Population Samples

Dissociative Disorders
Maha S Younis
Definition

(DSM-IV-TR)- “the essential feature of the
dissociative disorders is a disruption in the
usually
integrated
functions
of
consciousness,
memory,
identity,
or
perception of the environment. The
disturbance may be sudden or gradual,
transient or chronic.”
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(ICD-10) classifies the dissociative disorders
among
the
neurotic,
stress-related,
and somatoform disorders. The ICD-10
explicitly states that the term hysteria should
be avoided because of its lack of precision.
DSM IV Dissociative disorders
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dissociative identity disorder
depersonalization disorder
dissociative amnesia
dissociative fugue
dissociative disorder not otherwise specified
(NOS)
ICD 10
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dissociative
amnesia,
dissociative
fugue,
dissociative stupor, trance and possession disorder,
and dissociative disorders of movement and
sensation (roughly equivalent to the DSM-IV-TR
conversion disorder diagnosis). The latter includes
dissociative
motor
disorders,
dissociative
convulsions, and dissociative anesthesia and
sensory loss. Ganser syndrome and multiple
personality
disorder
are
classified
under
other
dissociative
disorders.
Depersonalization disorder is classified separately.
Terminology
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Conversions applies to somatic symptoms
and dissociative applies to psychological
symptoms.
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Several authors, most recently E.A. Holmes
and R.J. Brown, have suggested a heuristic
dichotomy between
dissociative
detachment
(e.g.,
depersonalization)
and
dissociative
compartmentalization (e.g., amnesia and
dissociative identity disorder self-states),
each with their own empirically or
hypothesized, underlying neurobiological and
neurocognitive correlates.
Conscious vs Unconscious
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Model proposed by Spence invokes a
consciousness that acts upon the body and
the world as opposed to the psychodynamic
model (conversion) which invokes an
unconscious mechanism.
Do medically unexplained symptoms matter? A prospective cohort study of 300
new referrals to neurology outpatient clinics
Alan J Carsona,
Brigitte Ringbauera,
Jon Stoneb,
Lesley McKenzieb,
Charles Warlowc,
Michael Sharpea
2000;68:207-210 doi:10.1136/jnnp.68.2.207
Prevalence of Dissociative Disorders in General
Population Samples (CTP)
Table 17-2. Prevalence of Dissociative Disorders in General Population Samples
Study
Ross (1997)
Johnson et al. (2006)
Sar et al. (2007)
Measures
DES and DDIS
Adapted from DES,
SCID, SCID-II, and
GAFS
DDIS, SCID-PTSD, and SCID-II
Number of subjects
502
658
628 (female)
Diagnosis
Subjects (%)
Subjects (%)
Subjects (%)
Dissociative amnesia
6.0
1.8
7.3
Dissociative fugue
0
0
.2
Dissociative identity disorder
1.3
1.5
1.1
Depersonalization disorder
2.8
.8
1.4
Dissociative disorder not otherwise specified (NOS)
.2
4.3
8.3
Dissociative disorder NOS with multiple personality
states
4.1
Dissociative disorder NOS with indirect cues for
personality states
2.4
Derealization without depersonalization
1.1
Dissociative trance disorder
.6
All dissociative disorders
12.2
9.1
18.3
Clinical features
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Conversion disorder- motor symptoms
Paralysis, functional weakness, gait
disturbance, fits resembling epilepsy, and
abnormal movements.
Sensory symptoms – sensory loss,visual
loss
Disability and prognosis
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Often poor.
Short history and young age is good
prognosis.
Management
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No/ very few RCT
Cochrane review –all studies were of poor
methodological quality.
Cochrane Database Syst Rev. 2005 Oct 19;(4):CD005331.
Psychosocial interventions for conversion disorder.
Ruddy R, House A.
University of Leeds,Academic Unit of Psychiatry & Behavioural Sciences,15 Hyde
Terrace,Leeds,UK LS2 9LT. [email protected]
Management-Team work( liaison services)
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Needs collaboration from psychologists,
nurses, physiorherapists, and occupational
therapists.
IP care may be needed.
Management
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Exclude organic conditions.
To explain the there is no underlying serious
organic disorder.
Explanation of symptoms that is
comprehensible to the patient.
Better to use the word functional rather than
psychological.
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Long term – behavioral techniques.
Psychological- CBT,IPT
Hypnosis
Pharmacological- SSRI and TCA benefit
medically unexplained symptoms( such as
poor sleep and pain) whether or not
depression is present.
CNS Spectr. 2006;11(3)212-222
Antidepressants and Cognitive-Behavioral Therapy for Symptom Syndromes
Jeffrey L. Jackson, MD, MPH, Patrick G. O’Malley, MD, MPH, and Kurt Kroenke, MD
A Randomized Controlled Clinical Trial of a Hypnosis-Based Treatment for Patients
with Conversion Disorder, Motor Type
Authors: Moene F.C.; Spinhoven P.; Hoogduin K.A.L.; Dyck R.V.
Source: International Journal of Clinical and Experimental Hypnosis, Volume
51, Number 1, January 2003 , pp. 29-50(22)
Publisher: Routledge, part of the Taylor & Francis Group
Imaging studies
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Functional neuro omaging studies suggest
that some amount of disruption in the neural
circuits linking volition, movement, and
perception.
Pre frontal cortex.
Summary.
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Lot of debate regarding definition,
classification.
Course and prognosis can frequently be bad.
Liaison with multiple service providers may
be need.
Studies not much about effectiveness of
interventions.
Generates of interest because of inter
disciplinary nature of the disorder.