![DISSOCIATIVE MOTOR DISORDER
Characterize by motor disturbances like paralysis [
monoplegia , paraplegia or abnormal movements] or
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Conversion and dissoociative disorder.pptx
- 1. F44 CONVERSION DISORDER Conversion disorder is define as a psychiatric condition in which emotional distress or unconscious conflicts are expressed through physical symptoms. Thus emotional conflicts is converted into physical symptoms.
- 2. F44 CONVERSION DISORDER Conversion disorder is a loss of or change in body function resulting from a psychological conflict. The physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. Conversion symptoms affect voluntary motor or sensory functioning suggestive of neurological disease such as blindness or paralysis. Are therefore sometimes called “pseudo neurological”
- 3. F44 CONVERSION DISORDER Examples include paralysis, Aphonia(loss of voice) seizures, coordination disturbance, difficulty swallowing, blindness, deafness, double vision, Anosmia(inability to perceive smell/odor) loss of pain sensation. Pseudocyesis (false pregnancy) is a conversion symptom and may represent a strong desire to be pregnant.
- 4. F44 CONVERSION DISORDER Psychological factors like stress and conflicts are associated with onset or exacerbation of the symptoms Emotional conflicts is converted into physical problems. Patients are unaware of the psychological basis and are thus not able to control their symptoms.
- 5. F44 CONVERSION DISORDER Some features of the disorder include: • symptom occurs after a situation that produces extreme psychological stress for the individual. • Patient does not produce the symptoms intentionally . • Patient shows less distress or lack of concern about the symptoms - gives clue to the physician that the problem may be psychological rather than physical. • Physical examination and investigations do not reveal any medical or neurological abnormalities.
- 6. May present symptoms in a dramatic fashion Conversion disorders were formerly called as 'hysteria.’ The term is now changed to conversion Disorder.
- 7. EPIDEMIOLOGY More common in: rural populations lower SES women than men Onset: late childhood through early adulthood;
- 8. CAUSES: Biochemical influence Disturbance in norepinephrine, serotonin level etc. Psychodynamic Theory In conversion disorder, the defense mechanisms involved are repression. Repression(Subconsciously blocking ideas or impulses that are undesirable) e.g. A child, who faced abuse by a parent, later has no memory of the events but has trouble forming relationships Conversion symptoms allow a hidden wish or urge to be partly expressed. The symptoms are symbolically related to the conflict.
- 9. CAUSES: Behavior Theory According to this theory the symptoms are learnt from the surrounding environment. These symptoms bring about psychological relief by avoidance of stress. Conversion disorder is more common in people with hystrionic personality traits.
- 10. CAUSES: Others factors: Repeated trauma Stressful life events Gains associated with sick role: decreased responsibility and increased attention Stimulant drug abuse. Common in lower socioeconomic groups, rural population and less educated clients.
- 11. CLINICAL FEATURES Symptoms : very sudden and follows a stressful experience. Unintentionally produce symptoms. Physical examination and investigation do not revel any medical or neurological condition.
- 12. CLINICAL FEATURES Symptoms include: loss of one or more bodily function Paralysis Inability to speak seizures, coordination disturbance, difficulty swallowing, urinary retention, blindness, deafness, double vision, anosmia Pseudocyesis (false pregnancy) The loss of physical function is involuntary and does not show any physical cause for dysfunction.
- 13. CLINICAL FEATURES Patient are motionless and mute and do not respond to stimulation but they are aware of the surroundings. Pseudo seizures( Dissociative convulsion) : Characterized by convulsive movements and partial loss of consciousness.
- 14. F44 Conversion Disorder Diagnostic Criteria A. One or more Sign or deficits affecting voluntary motor or sensory functioning and indicative of a neurological or other medical condition. B. Psychological factors are associated with the deficit the initiation or exacerbation is preceded by conflicts or stressors. C. The Sign is not intentionally produced.
- 15. Diagnostic Criteria A. The Sign cannot be fully explained by a general medical condition, the effects of a substance, or a culturally sanctioned behavior or experience B. Sign cause significant distress or impairment in functioning or warrant medical attention C. The Sign is not better accounted for by another mental disorder
- 16. Diagnosis History collection Physical Examination Mental status examination Complete Medical workup to rule out medical problems. ICD 10 criteria
- 17. MANAGEMENT Psychological Intervention Verbalization of feelings Individual psychotherapy: Free Association : refers to the verbalization of thoughts as they occur, without any conscious screening. The psychoanalyst searches for patterns in the material that is verbalized and in the areas that are unconsciously avoided (such areas are identified as resistances).
- 18. MANAGEMENT Psychological Intervention Hypnosis: is an artificially induced state person is relaxed can be induced in many ways, using a fixed point for attention, rhythmic monotonous instructions, etc. person highly suggestible to the commands of the hypnotist. ability to produce or remove symptoms or perceptions. Dissociation(disconnection) of a emotions. Amnesia for the events that occurred during the hypnotic state
- 19. MANAGEMENT Psychological Intervention Abreaction therapy process by which a painful experience or conflict is brought back to consciousness. not only recalls but also relives the material, accompanied by the appropriate emotional response. useful in acute neurotic conditions caused by extreme stress procedure is begun with neutral topics at first, and gradually approaches areas of conflict. can be done with or without the use of medication
- 20. MANAGEMENT Psychological Intervention Abreaction therapy can be facilitated by giving a sedative drug intravenously. Safe method is the use of thiopentone sodium i.e. 500 mg dissolved in 10 cc of normal saline. It is infused at a rate no faster than 1 cc/minute to prevent sleep as well as respiratory depression.
- 21. MANAGEMENT Psychological Intervention Group therapy Family therapy Supportive psychotherapy Ventilation Environmental modification/manipulation Reeducation Reassurance Meditation and yoga may reduce stress or emotional reaction to the events.
- 22. MANAGEMENT Pharmacological Intervention Drug therapy: Drugs have a very limited role. A few patients have anxiety and may need short-term treatment with benzodiazepines Antidepressant drug appear to be more effective
- 23. Nursing Assessment Presence of physical symptoms with no pathophysiology Level of concern regarding physical symptoms Degree of impairment Level of anxiety
- 24. Nursing Diagnosis Disturbed Thought Processes RELATED TO: Severe psychological stress and repression of anxiety Ineffective Coping RELATED TO: Severe psychosocial stressor or severe anxiety Disturbed Personal Identity RELATED TO: Childhood trauma/abuse
- 25. Nursing Intervention Monitor physician's ongoing assessments, laboratory reports and other data to rule out organic pathology. Do not focus on the disability; encourage patient to perform self-care activities as independently as possible. Intervene only when patient requires assistance. Positive reinforcement for identification or demonstration of alternative adaptive coping strategies.
- 26. Nursing Intervention Identify specific conflicts that remain unresolved and assist patient to identify possible solutions. Assist the patient to set realistic goals for the future. Help the patient to identify areas of life situation that are not within his ability to control. Encourage verbalization of feelings.
- 27. Nursing Intervention Do not allow the patient to use the disability as a manipulative tool to avoid participation in the therapeutic activities. Withdraw attention if the patient continues to focus on physical limitations. Encourage patient to verbalize fears and anxieties
- 28. Nursing Intervention Provide information to patient ad family that physical symptoms can be because of stress and internal conflict and can be managed if stress is resolved. Reassure family that she is not seriously physically ill. Provide health teaching to family. Daily healthy routine Adequate rest and exercise Proper Nutrition Relationship of stress and physical symptoms Educate about relaxaion technique Decrease attention while patient is on sick role.
- 29. DISSOCTIAVE DISORDER Dissociative disorder is the stress related disorder characterized by disturbance in normally integrated functions of consciousness, identity or memory. Example include motor disturbances, loss of memory, loss of personal identity etc. Results due to lack of ability to cope with realities of traumatic event Often interfere with personal ability to function in daily life.
- 30. DISSOCTIAVE DISORDER Rare in general population but prevalent among person with history of childhood physical and sexual abuse. Sudden onset and usually temporary Relationship between stress and onset of illness. Physical examination and investigation do not reveal any abnormalities.
- 31. ETIOLOGY Genetics more common in first-degree relatives of people with the disorder than in the general population. Neurobiological a possible correlation between neurological alterations and dissociative disorder. Areas of the brain that have been associated with memory include the hippocampus, amygdala, fornix, mammillary bodies, thalamus, and frontal cortex.
- 32. ETIOLOGY Psychodynamic Theory Freud (1962) believed that dissociative behaviors occurred when individuals repressed distressing mental contents from conscious awareness Psychological Trauma traumatic experiences like severe physical, sexual, or psychological abuse by a parent or significant other in the child’s life.
- 33. ETIOLOGY Others: Stress of war or natural disaster Long term physical, sexual or emotional abuse during childhood are at greatest risk.
- 35. Dissociative Amnesia Amnesia: loss of memory or the inability to recall. one or more episodes of the inability to recall important personal information that is beyond ordinary forgetfulness. Patients are sometimes found by the police wandering aimlessly and are confused and disoriented. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- 36. Dissociative Fugue Sudden, unexpected travel away from home or some other location with the assumption of a new identity (partial or complete) or a confusion about one’s identity. The travel and behavior appears normal to casual observers; thus, the person does not seem to be wandering in a confused state. May last from a few hours to several days.
- 37. Rare usually follows severe psychosocial stress, such as marital quarrels, personal rejections, military conflict, natural disaster, financial difficulty. Major depression often present prior to dissociative fugue and there might be a history of childhood trauma.
- 38. DISSOCIATIVE MOTOR DISORDER Characterize by motor disturbances like paralysis [ monoplegia , paraplegia or abnormal movements] or other difficulty with walking.
- 39. DISSOCIATIVE STUPOR Patient are motionless and mute and do not respond to stimulation but they are aware of the surroundings.
- 40. DISSOCIATIVE CONVULSION characterized by convulsive movements and partial loss of consciousness
- 41. TRANCE AND POSSESSION DISORDER characterized by temporary loss of both the sense of personal identity and awareness of the person’s surrounding. When the condition is induced by religious rituals, the person may feel taken away by spirit.
- 42. Dissociative Identity Disorder (Multiple Personality Disorder) Existence of two or more identities or personalities that take control of the person’s behavior. Person or host, is unaware of the other personalities (alters), but the other alters might be aware of each other to varying degrees. May experience memory problems, depersonalization, identity confusion.
- 43. DIAGNOSIS History talking Physical examination Investigation to rue out medical problems Mental status examination ICD 10 criteria
- 44. TREATMENT 1. Psychotherapy Behavioural therapy Ignoring: Patient have attention seeking behaviors so less focus should be provided by ignoring. Abreaction Supportive psychotherapy Ventilation Environmental modification Reeducation Reassurance family therapy Marital therapy Psychoanalysis
- 45. 2. Drug treatment: The symptoms of anxiety and/or depression usually respond to short-term use of benzodiazepines and antidepressants.
- 46. NURSING MANAGEMENT NURSING ASSESSMENT History of trauma or abuse Nightmare and flashback of traumatic event Low self esteem Difficult in sleeping Suicidal tendency
- 47. NURSING MANAGEMENT NURSING DIAGNOSIS Disturbed Thought Processes RELATED TO: Severe psychological stress and repression of anxiety Ineffective Coping RELATED TO: Severe psychosocial stressor or severe anxiety Disturbed Personal Identity RELATED TO: Childhood trauma/abuse Disturbed in interpersonal relationship related to low self-esteem and difficulty expressing feelings. Decrease ability to deal with stress related to feelings of helplessness.
- 48. NURSING MANAGEMENT NURSING INTERVENTION Obtain as much information as possible about the client from family and significant others. Consider likes, dislikes, important people, activities, music, and pets. Do not ask client with data regarding his or her past life. Expose client to stimuli that represent pleasant experiences from the past such as music known to have been pleasurable to the client. Encourage client to discuss situations that have been especially stressful and to explore the feelings associated with those times. Identify specific conflicts that remain unresolved, and assist client to identify possible solutions. More adaptive ways to respond to anxiety
- 49. NURSING INTERVENTION Reassure client of safety and security through your presence. Dissociative behaviors may be frightening to the client. Identify stressor that precipitated severe anxiety. Help client understand that the disequilibrium felt is acceptable in times of severe stress. As anxiety level decreases and memory returns, an accepting, nonthreatening environment to encourage client to identify traumatic experiences.
- 50. NURSING INTERVENTION Help client define more adaptive coping strategies. Examine benefits and consequences of each alternative. Provide positive reinforcement for client’s attempts to change. The nurse must develop a trusting relationship with the original personality and with each of the subpersonalities. Help client understand the existence of the subpersonalities and the need for each personal identity of the individual. Help client identify stressful situations that precipitate transition from one personality to another. Carefully observe and record these transitions.
- 51. NURSING INTERVENTION Provide support and encouragement during times of depersonalization. Explain the depersonalization behaviors and the purpose they usually serve for the client. Explain the relationship between severe anxiety and depersonalization behaviors. Help relate these behaviors to times of severe psychological stress that client has experienced. Explore past experiences and possibly repressed painful situations, such as trauma or abuse
- 52. NURSING INTERVENTION Discuss ways the client may more adaptively respond to stress, and use role-play to practice using these new methods