| ID | 128 |
|---|---|
| Name | DISSOCIATIVE & CONVERSION DISORDER |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | |
| Management | |
| Introduction | Dissociative disorder’ is a neurotic disorder in which a wide variety of somatic and mental symptoms of illness develop and usually results from dissociation for some real or imaginary gain without being fully aware of the underlying motive.42 In this, there are symptoms & signs of disease with three characteristics: 1. They occur in the absence of physical pathology 2. They are produced unconciously. 3. They are not caused by overactivity of the sympathetic nervous system |
| History | |
| Etiology | Etiology: 1. Family history 2. Characteristic hysteric type of personality. 3. Mental stress and 4. Constitutional factors are also very important. 5. Childhood Trauma |
| Clinical Features | Clinical features: Common characteristics of hysteria: 1. Age- common in teen age group. 2. Sex- females dominate. 3. Education- commonly seen among the less educated group. 4. Culture- the hysterics are usually culturally backward. 5. Conflict- an obvious or hidden conflict usually come into surface. Common presentations: Gait disturbances, loss of function in limbs, aphonia, pseudoseizures, sensory loss, blindness. Other presentations: Neurological: Motor symptoms- there may be motor weakness with flacidity, rarely hysterical rigidity may be seen. Tremor may be present, jerks may be dull or brisk, planter reflex is flexor. Sensory symptoms- many of the special senses, such as blindness and deafness. Cutaneous and deep sensibility in their various forms are lost. The sensory loss does not obey anatomical or physiological laws, may have a sharp horizontal upper margin on the limb. There may be subjective sensory symptoms such as headache, pain, tinnitus etc. Gastrointestinal: There may be vomiting but no weight loss. There may be a sensation of lump in the throat called globus hystericus. Rarely there may be anorexia nervosa with loss of appetite and abstinence from food for a long time. Respiratory: There may be breathlessness, series of recurrent cough, aphonia etc. Cardiovascular: Palpitation and precordial pain are present. Ocular: Blepharospasm may be seen. Mental symptoms: Patient may be delirious or may talk monosense. Stupor or twilight state may develop. Amnesias may be present. Psendoseizuras are also seen. There may be causeless laughing or crying. |
| Preventions | |
| Treatment | Treatment: 1. Relief of local symptoms- by reassurance & suggestion, persuation or by re-education. 2. Underlying cause should also be treated. 3. Supportive, interpretative or other methods of psychotherapy may be employed. 4. Environmental factors should be readjusted as far as possible. 5. Gradually patient is to be rehabilitated into normal activities. 6. Hypnotics and antidepressants are helpful. |
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