Python Notes for mca i year students osmania university.docx
Dissociative disorder
1. By Group 5
NURZAWANI SHAMSUDIN
AHMAD HAFIZZUDIN
NURLIYANA SAMSUDIN
MOHD SYAFEEQ IZZAMUDDIN
2.
1) Dissociative amnesia
2) Depersonalization disorder
3) Dissociative fugue
4) Dissociative identity disorder
5) Dissociative disorder not otherwise specified
DISSOCIATIVE
DISORDER
Definition: disruption in the usually integrated functions of
consciousness, memory, identity, or perception
of the environment
4.
• inability to recall important personal information, usually
of a traumatic or stressful nature, that is too extensive to
be explained by normal forgetfulness.
• approximately 6% of the general population.
• reported in late adolescence and adulthood
• no known difference is seen in incidence between men and
women
• increase incidence during times of war and natural disasters
Definition
Epidemiology
5.
Amnesia and
Extreme
Intrapsychic
Conflict
•Patient experiencing intolerable emotions of shame, guilt,
despair, rage, and desperation.
•Result from conflicts over unacceptable urges or
impulses, such as intense sexual, suicidal, or violent
compulsions
Betrayal
Trauma
•Betrayal trauma attempts to explain amnesia by the
intensity of trauma and by the extent that a negative event
represents a betrayal by a trusted, needed other.
•This betrayal is thought to influence the way in which the
event is processed and remembered.
Aetiology
6.
• overt, florid, dramatic clinical disturbance → brought quickly to
medical attention
• experienced extreme acute trauma
• depression and suicidal ideation
• histories of prior adult or childhood abuse or trauma
• in the context of profound intrapsychic conflict or emotional
stress
present with intercurrent somatoform or conversion symptoms,
alterations in consciousness, depersonalization, derealization,
trance states, spontaneous age regression, and even ongoing
anterograde dissociative amnesia
• no single personality profile or antecedent history is
consistently reported
Clinical Features
7.
• come to treatment for a variety of symptoms, such as
depression or mood swings, substance abuse, sleep
disturbances, somatoform symptoms, anxiety and
panic, suicidal or self-mutilating impulses and acts,
violent outbursts, eating problems, and interpersonal
problems
• self-mutilation and violent behavior in these patients
may also be accompanied by amnesia
• amnesia may also occur for flashbacks or behavioral
reexperiencing episodes related to trauma.
Nonclassic Presentation
8.
A. The predominant disturbance is one or more episodes of
inability to recall important personal information,
usually of a traumatic or stressful nature, that is too extensive to
be explained by ordinary forgetfulness.
B. The disturbance does not occur exclusively during the
course of dissociative identity disorder, dissociative fugue,
posttraumatic stress disorder, acute stress disorder, or
somatization disorder and is not due to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication) or a
neurological or other general medical condition (e.g., amnestic
disorder due to head trauma).
C. The symptoms cause clinically significant distress or
impairment in social, occupational, or other important areas of
functioning.
DSM-IV-TR Diagnostic Criteria
for Dissociative Amnesia
9.
Types of Dissociative Amnesia
Localized amnesia
Inability to recall events related to a limited period of time
Selective amnesia
Ability to remember some, but not all, of the events
occurring during a circumscribed period of time
Generalized amnesia
Failure to recall one's entire life
Continuous amnesia
Failure to recall successive events as they occur
Systematized amnesia
Amnesia for certain categories of memory, such as all
memories relating to one's family or to a particular person
10. 1. Ordinary Forgetfulness and Non pathological Amnesia
• described, such as infantile and childhood amnesia, amnesia for sleep and
dreaming, and hypnotic amnesia whereas dissociative amnesia specify that the
disturbance must be too extensive to be explained by normal forgetfulness
2. Dementia, Delirium, and Organic Amnestic Disorders
• memory loss for personal information is embedded in a far more extensive set of
cognitive, language, attentional, behavioral, and memory problems
• no loss memory of personal identity
• causes of organic amnestic disorders include Korsakoff's psychosis, cerebral
vascular accident (CVA), postoperative amnesia, postinfectious amnesia, anoxic
amnesia, and transient global amnesia
• memory loss for autobiographical experience is unrelated to traumatic or
overwhelming experiences
3. Posttraumatic Amnesia
• history of a clear-cut physical trauma, a period of unconsciousness or amnesia, or
both, and objective clinical evidence of brain injury
Differential Diagnosis
11. 4. Seizure Disorders
• clear-cut ictal events and sequelae
• pseudoepileptic seizures may also have dissociative
symptoms, such as amnesia and an antecedent history of
psychological trauma
• can be clarified by telemetry or ambulatory
electroencephalographic (EEG) monitoring
5. Substance-Related Amnesia
• hx of substance abuse
6. Transient Global Amnesia
• sudden onset of complete anterograde amnesia and learning
abilities; pronounced retrograde amnesia; preservation of
memory for personal identity; anxious awareness of memory
loss with repeated, often perseverative, questioning; overall
normal behavior; lack of gross neurological abnormalities in
most cases; and rapid return of baseline cognitive function,
with a persistent short retrograde amnesia
• older than 50 years of age and shows risk factors for
cerebrovascular disease
12. 7. Acute Stress Disorder, Posttraumatic Stress Disorder, and
Somatoform Disorders
• dissociative amnesia must be distinct from the course of acute
stress disorder, PTSD, or somatization disorder
• clinical judgment usually determines whether the extent of the
amnesia warrants a separate dissociative diagnosis
8. Malingering and Factitious Amnesia
• continue their deception even during hypnotically or
barbiturate-facilitated interviews
• asking to recover repressed memories as a chief complaint most
likely has a factitious disorder or has been subject to suggestive
influences
13.
• Acute dissociative amnesia frequently spontaneously
resolves once the person is removed to safety from
traumatic or overwhelming circumstances
• some patients do develop chronic forms of
generalized, continuous, or severe localized amnesia
and are profoundly disabled and require high levels
of social support, such as nursing home placement or
intensive family caretaking
Course and Prognosis
14. 1. Cognitive Therapy
• Identifying the specific cognitive distortions that are based in the
trauma
2. Hypnosis
• contain, modulate, and titrate the intensity of symptoms
• 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
• self-hypnosis: apply containment and calming techniques in his or
her everyday life
3. Somatic Therapies
• pharmacologically facilitated interviews use sodium amobarbital,
thiopental (Pentothal), oral benzodiazepines, and amphetamines.
4. Group Psychotherapy
• Time-limited and longer-term group psychotherapies
Treatment
