Conversion disorder treatment in Dubai

Best psychiatrist in Dubai

Conversion disorders treatment in Dubai

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The syndrome currently known as conversion disorder was

originally combined with the syndrome known as somatization

disorder and was referred to as hysteria, conversion reaction, or

dissociative reaction. Now a days many people are facing

conversion disorder problems. We at psychiatrist in Dubai is

offering conversion disorder problem treatment, We are basically

Indian based psychiatrist in Dubai. Trained in UK so UK trained

psychiatrist in dubai. I am a professional psychiatrist in Dubai. Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




Conversion disorderConversion disorder is characterised by the presence of one or more symptoms suggesting the presence of a neurological disorder that cannot be explained by any known neurological or medical disorder. Patients are unaware of the psychological basis, and are thus not able to control their symptoms. Conversion disorders are formerly called as ‘hysteria’.

Definitions





Dissociative disorder

Dissociative Disorders is defined as a state of disrupted “consciousness, memory, identity, or perception of the environment. It will result in the significant impairment in general and social functioning”.Powered by

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Epidemiology• Hysteria (comprising of conversion,

dissociation and somatization disorder) constitutes about 6-15% of all outpatient diagnoses and 14-20% of all neurotic disorders.

• Females usually outnumber males, but in children the percentage tends to be similar in boys and girls.





Etiology of dissociative and conversion disorders

A) Psychological TheoriesPsychodynamic Theory

• According to Freud, important defence mechanisms involved in the formation of conversion symptoms are repression, dissociation, conversion, symbolization and identification.

• Repressed materials are sexual or aggressive conflicts arising during oedipal phase of development.





• Under the influence of a stressor, repression fails partly or completely, leading to the formation of a conversion or dissociation symptom.

• Thus an unpleasant repressed material is converted to somatic symptom leading to relief of anxiety, in conversion. But, in dissociation, a part of personality dissociated from the rest and presented with features of dissociative disorder.Powered by





B) Behavior theory• According to this theory, the symptoms are

learnt from surrounding environment (e.g. seeing a paralysed patient).

• These symptoms bring out psychological relief by avoidance of stress and are thus secondarily reinforced.

• Conversion disorder is more common in people with histrionic personality traits.Powered by





C) Biological theory(i)Neurophysiologic Theories.

• The observed sensory deficit seen in some conversion disorder patients can be explained by the elevated levels of corticofugal output, in turn, inhibits the patient’s awareness of body sensation.

(ii)Genetic Theories

• There is an increased likelihood of conversion disorder in the first-degree relatives of patients of conversion disorder. Increased risk of conversion disorder in monozygotic.





Common manifestations of Conversion disorder

1) Presence of symptoms or deficits affecting motor or sensory function, suggesting a medical or neurological disorder.

2) Sudden onset

3) Development of symptoms or deficits usually in the presence of significant psychosocial stressors.

4) A clear temporal relationship between stressors and development or exacerbation of symptoms.





5) Symptoms are not intentionally produced.

6) There is usually a secondary gain.

7) Detailed physical examination and investigation do

not reveal any medical disorder or substance use

disorder that can explain the symptoms adequately.

8) The symptoms may have a symbolic relationship

with stressor or conflict.Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




Common manifestations of dissociative disorders

1) Disturbance in the normally integrated functions of consciousness, identity, memory or perception of the environment.

2) Onset is usually sudden and disturbance is usually temporary. Recovery often is abrupt.

3) A precipitating stress is not uncommonly found before the onset of disorder. There is a clear temporal relationship between stressor and the onset of the illness.





4) Secondary gain resulting from the

development of symptoms may be found.

5) Detailed physical investigation and

examination do not reveal any evidence of

the physical disorder that can explain the

symptoms present.Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




ICD-10 ClassificationF44 - Dissociative Disorders

F44.0 Dissociative amnesiaF44.1 Dissociative fugueF44.2 Dissociative stuporF44.3 Trance and possession disordersF44.4-F44.7 Dissociative disorders of movement

and sensationF44.4 Dissociative motor disordersF44.5 Dissociative convulsionsF44.6 Dissociative anaesthesia and sensory lossF44.80 Ganser's syndromeF44.81 Multiple personality disorderPowered by





F44.0 Dissociative amnesia• It involves amnesia for personal identity but intact memory of

general information. • This clinical picture is exactly the reverse of the one seen in

dementia, in which patients may remember their names but forget general information.

• Its key symptom is the inability to recall information, usually about stressful or traumatic events in people’s lives.

• Dissociative amnesia may take one of several forms:• Localized amnesia, (or circumscribed)• Generalized amnesia• Selective (systematized)• Continuous amnesia





• Localized amnesia, (or circumscribed) the most common type, is the loss of memory for the events of a short time (a few hours to a few days)

• Generalized amnesia is the loss of memory for a whole lifetime of experience.

• Selective (systematized) amnesia is the failure to recall some but not all events that occurred during a short time.

• Continuous amnesia:-in which the individual can not recall events subsequent to a specific time up to and including the present.





F44.1 Dissociative fugue• It is a sudden, unexpected travel away from home or workplace,

with the assumption of a new identity and an inability to recall the past.

• The onset is sudden, often in the presence of severe stress.

• Following recovery, there is no recollection of events that took place during the fugue.

• The course is typically a few hours to days and sometimes

months.





F44.2 Dissociative stupor

• The individual's behaviour fulfils the

criteria for stupor.

• But examination and investigation reveal

no evidence of a physical cause.





F44.3 Trance and possession disorders• This disorder is very common in India.

• It is characterized by temporary loss of both the sense of personal identity and full awareness of the person’s surroundings.

• When the condition is induced by religious rituals, the person may feel taken over by a deity or spirit.

• The focus of attention is narrowed to few aspects of immediate environment, and there is often limited but repeated set of movements, postures and utterances.

F44.4-F44.7 Dissociative disorders of movement and sensation

In ICD-10, conversion disorder is included under “Dissociative disorders of movement and sensation”

– F44.4 Dissociative motor disorders

– F44.5 Dissociative convulsions

– F44.6 Dissociative anaesthesia and sensory loss





F44.4 Dissociative motor disorders• The commonest varieties of dissociative motor

disorder are loss of ability to move the whole or a part of a limb or limbs.

• Paralysis may be a monoplegia, paraplegia, or quadriplegia.

• Various forms and variable degrees of incoordination (ataxia) may be evident, particularly in the legs, resulting in bizarre gait or inability to stand unaided (astasia abasia).

• These abnormal movements increase in

severity when attention is directed

towards them.

• There may be close resemblance to almost

any variety of ataxia, apraxia, akinesia,

aphonia, dysarthria, dyskinesia, or

paralysis.





F44.5 Dissociative convulsions

• Dissociative convulsions (pseudo seizures) may mimic epileptic seizures very closely in terms of movements, but tongue-biting, serious bruising due to falling, and incontinence of urine are rare in dissociative convulsion, and loss of consciousness is absent or replaced by a state of stupor or trance.





F44.6 Dissociative anaesthesia and sensory loss

• It is characterized by sensory disturbances like

hemianaesthesia, blindness, deafness and glove and

stocking anaesthesia (absence of sensations at wrists and

ankles).

• The disturbance is usually based on patient’s knowledge

of that particular illness whose symptoms are produced.

• A detailed examination does not reveal any abnormalities.

• Dissociative deafness and anosmia are far less common

than loss of sensation or vision.

Other dissociative [conversion] disorders

F44.80 Ganser's syndrome

F44.81 Multiple personality disorder

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F44.80 Ganser's syndrome

• The complex disorder described by Ganser.

• This condition occurs in prisoners awaiting trial.

• It is characterized by “vorbeireden” or "approximate answers", (for example, when asked to multiply 4 times 5, the patient answers 21) usually accompanied by several other dissociative symptoms, often in circumstances that suggest a psychogenic etiology.

F44.81 Multiple personality disorder• The essential feature is the apparent

existence of two or more distinct personalities within an individual, with only one of them being evident at a time.

• Each personality is complete, with its own memories, behaviour, and preferences; these may be in marked contrast to the single premorbid personality.





• In the common form with two personalities, one personality is usually dominant but neither has access to the memories of the other and the two are almost always unaware of each other's existence.

• Change from one personality to another in the first instance is usually sudden and closely associated with traumatic events. Powered by





ManagementThe treatment usually consists of two parts:

• Early treatment directed towards symptom

removal.

• Long- term treatment directed towards

resolution of conflicts and prevention of

further episodes.Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




(i) Psychotherapy• Establishment of rapport and therapeutic

alliance is often useful to communicate to the patient that he is responding to the stresses in life.

• The therapist tries to help the patient be aware of his tendency to use dissociation and amnesia to deal with painful conflicts, and understand and accept his individual conflicts so they can be integrated in to the primary personality.





• Regularity of follow-up visits after discharge is important so that the patient does not need to 'produce’ a symptom to visit the therapist.

• Problem-solving techniques and stress management techniques are important adjuncts of long-term successful therapy.Powered by





(ii) Behavior Therapy:• When there is a sudden, acute symptom, its prompt

removal may prevent habituation and future disability. This may be achieved by one of the following methods:

• a) Aversion therapy for unwanted behaviour has been employed in resistant cases, using liquor ammonia, aversive faradic stimulation, pressures just above eyeballs, tragus of ear or over sternum, and closing the nose and mouth.





• b) Morrison’s behaviour modification technique involves

selective attention (or inattention) and verbal rewards.

• c) The other behavioural techniques employed in the

treatment include modelling, shaping, relaxation

methods, systematic desensitization.





(iii)AbreactionAbreaction is bringing to conscious awareness,

thoughts, affects and memories for the first time, with or without the use of drugs. This may be achieved by:

• Hypnosis

• Free association

• Drugs {thiopentone (Pentothal), amobarbital (Amytal), ketamine, diazepam, methylphenidate, or methamphetamine (methedrine)}





• The aim of abreaction with IV amobarbital or

thiopentone is, both, to make the conflicts

conscious and to make the patient more

suggestible to therapist’s advice. It is best to

begin with neutral topics and to approach affect

laden or traumatic material gradually.





(iv) Drug Therapy

• Very limited role .

• IV thiopentone, amytal or diazepam used for

abreaction and suggestion.

• Patients with disabling symptoms need

short-term benzodiazepines.Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




(v) Hospitalization• If the symptoms are disabling or alarming to the

family.

• Helps to remove the patient from the stressful situation.

• Demonstrate to the patient and significant others that the matter is important but will not elicit the kind of attention patient wants, and lead to the resolution of the trauma.

• Secondary gains must be minimized.

(vi) Family and Marital Therapy

• Direct communication with the family

members will also reduce the opportunities

for manipulation and misunderstanding.

(vii) Supportive psychotherapy

• It is needed especially when the conflicts

have become conscious and have to be faced

in routine life. Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




(viii) Group Therapy

• Participation in a group setting may diminish the

patient’s sense of loneliness, make available a

secure place to discuss traumatic matter that

patients without dissociative disorder may not

be able to tolerate, to study interpersonal

relationships, to develop more functional

interactions, and learn more about coping

mechanisms. Powered bywww.saiwebtech.co.inWeb Design Hyderabadwww.psychiatryservices4u.com




NURSING MANAGEMENTNursing diagnosis 1Risk for violence self-directed or other

directed violence related to low self esteemGoal: Client demonstrates non violent

behaviourInterventions• Intervene immediately when violence to

client or others is imminent.• Examine the client behaviour closely for

abrupt changes that may signal a risk for suicide.

• Provide a safe environment for patients.

• Provide a consistent, structured environment. Let the client know what is expected from him.

• Assist the client to identify alternatives to aggression or violence.

• Engage the client in appropriate insight oriented therapy.

• Praise the client for attempts to control anger and rage and for participation in ongoing therapeutic regimen.

• Encourage supervised physical activity.

Nursing diagnosis 2Ineffective coping related to overwhelming

stressors that exceeds the ability to cope repressed anxiety and inadequate coping methods as evidenced by client demonstrates inappropriate use of defence mechanisms like amnesia, presence of alternate personalities etc.

Goal: Client identifies ineffective coping behaviours and their negative effects on life functions, relationships and activities.





Interventions

• Protect the patient from harm or injury during dissociative episodes (amnesia).

• Demonstrate to the client the importance of discussing stress situations and exploring associated feeling.

• Structure the environment to reduce stimulation, such as loud noises, bright lights, or extraneous movement.

• Praise the client for using effective coping strategies.

• Engage the client in appropriate therapies.





Nursing diagnosis 3

Impaired social interaction related to depletion of effective coping

mechanisms as evidenced by unsatisfactory or inadequate interpersonal

relationships.

Goal: Client maintains active relationship with the immediate

surroundings.

Interventions:

• Approach the client in a calm, direct, non-authoritarian manner, using a

soft tone of voice.

• Assist the client to gain control of overwhelming feelings through

verbal interactions.





• Teach the client social skills, and encourage him or her to practice

these skills with staff members and other client.

• Give the client feedback regarding social interaction.

• Encourage the client to pursue personal interests, hobbies, and

recreational activities.

• Encourage the client to identify supportive people outside the

hospital and to develop these relationships.

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