Dissociative Conversion Disorders Research Articles

HISTRIONIC IMMATURE PERSONALITY DISORDER

Background: We aim at presenting a clinical case of a 37-year-old patient, who has been a nun for several years and at the moment can no longer adapt to the environment in which she lives and to the requirements of everyday life. The perspective of this analysis is both a psychiatric one, explaining the diagnosis of Axis II of Histrionic Immature Personality Disorder, but also the overlap with dissociative conversion disorder, and explanatory from a psychodynamic perspective, by addressing the regression issues and the presence of the Oedipus Complex.
 Histrionic Immature Personality Disorder and its overlap with Dissociative/Conversion Disorder are conditions with negative effects in terms of adaptation to the social environment and assuming professional responsibilities. Also, the particularities in the sphere of immaturity make it difficult to relate to those around.
 Method: Hospitalization, psychiatric interview, psychodynamic interview, psychological tests - CAQ Personality Questionnaire and the Szondi Test, psychodynamic interpretations.
 Results: The results highlight aspects of an immature premorbid personality, characterized by a high degree of sensitivity. Currently, the patient's ego is fragile and cannot adapt to the emotional meanings in the environment in which she lives, which leads to functional crises and manifestations such as dissociative fugue.
 Conclusions: Dissociative manifestations are associated with immaturity and reduced ability to adapt to professional requirements. On a personal level, the same immaturity leads to the denial of one's sexuality and projection.

Arousability, Personality, and Decision-Making Ability in Dissociative Disorder.

Background:There is a gap in understanding the pathogenesis of dissociative conversion disorder (DCD), despite the disorder having a strong historical root. The role of personality and neurocognitive factors are now highlighted; however, inconsistencies are reported. This study explores the personality disposition, arousability, and decision-making ability of patients with DCD, in reference to a healthy control group (HCG).Methods:In this cross-sectional study, the sample comprised ten adult psychiatric patients with DCD. Ten participants of the HCG were matched according to age, gender, education, economic status, domicile, religious background, and handedness. The study assessed personality disposition with Temperament and Character Inventory, arousability with reaction time task, and decision-making ability with the Iowa Gambling Task (IGT PEBL version).Results:The DCD group differed significantly on personality disposition related to both temperament and character. There was also evidence of easy arousability and frustration along with deficit in executive function related to decision-making ability.Conclusion:This study highlights the presence of both temperamental and characterological factors associated with DCD. Moreover, this study identifies the role of cognitive arousability and decision-making or feedback utilization ability in the psychopathology of DCD.

新疆维吾尔族分离转换性障碍(癔症) 87例临床现象分析

新疆维吾尔族分离转换性障碍(癔症) 87例临床现象分析

Psychiatric morbidity in children attending child guidance clinic in a tertiary care teaching hospital

Background: Mental health and its related problems are growing concerns over the world. The early onset of emotional and behavioral problem in the young children is related to a variety of health and behavior problems in adolescence and later life as well. Most of these children present to Pediatric outpatient clinics owing to the Stigma and lack of awareness. The aim of the study is to find out the pattern and prevalence of psychiatric morbidity in children presenting to pediatric outpatient clinics.Methods: It is a cross sectional, point prevalence study of children who have attended Child Guidance Clinic of Pediatric Department in a tertiary care teaching hospital October 2019 to January 2020. Clinical and demographic details was collected in a semi-structured proforma and the details were analyzed.Results: A total of 114 children were analyzed during the study period and this study comprised of 62 boys and 52 girls. Most of the children belonged to the age group of 11-15 years (51%) followed by the ages of 6-10(29.8%). Most common reason for consultation was change in behavior, school refusal and poor academic performance. The most common diagnosis made was Dissociative Conversion Disorder (17.6%), Nocturnal enuresis (15.7%), Mild Mental Retardation (10.5%) and Seizure Disorder with Behavioral Problems (10.5%).Conclusions: A significant number of children attending the Paediatric OPD of general hospitals have psychiatric disorders. The emotional and behavioral problems in children often present with physical symptoms. An effective liaison of services will help to identify and treat children with psychiatric morbidity.

USE OF AVERSION THERAPY IN DISSOCIATIVE PSEUDO-SEIZURE PATIENTS

Background: psychological methods are less commonly used in treatment of psychiatric illnesses in hospital setup. In some psychiatric illnesses drug use has limiting effect in full cure of illness due to psychosocial dynamics associated with those illnesses.
 Aim: In dissociative conversion disorder one theory states that primary gain is conversion of mental or emotional feeling into physical symptoms and secondary gain is any other external benefit from physical symptom occurred in primary gain. Like in a disturbed marital conflict wife develops episodic unresponsiveness (pseudo seizures) as primary gain and revived attention and care of husband due to this episodic unresponsiveness (pseudo seizures) as secondary gain. It is hypothesized that dissociative conversion reaction develops and become resistant by getting these two primary and secondary gains. Our study aim at providing unpleasant mild aversive electric current to the subjects along with standard pharmacotherapy to make patient condition to this painful stimulus and end their maladaptive behavior. 
 Material and Methods: Structured Clinical Interview for DSM-5 was used for making diagnosis and Dissociative Experiences Scale and Global Assessment of Functioning (GAF) for evaluating the response of treatment. Mild electric current (30 mili columb) was used in test group along with standard treatment group.
 Results: In test group improvement in terms of Dissociative Experiences Scale and Global Assessment of Functioning (GAF) and number of episodes of unresponsiveness was better.
 Conclusion: Use of mild electric current as aversive stimulus as compared to standard treatment group was found more affective mode of treatment
 Keywords: dissociative, conversion, aversion therapy, pseudo seizures, electric current

Prevalence of Mental Disorders in Nepal: Findings from the Pilot Study.

The global prevalence of mental disorders is high and has an increasing trend. In Nepal, there is dearth in literature on prevalence of mental disorders based on national representative sample. In this study, we aim to present the findings on the prevalence of mental disorders from the pilot study of National Mental Health Survey, Nepal. A cross-sectional study was conducted among 1647 participants aged 13 years and above in three districts of Nepal: Dhanusha, Bhaktapur and Dolakha each representing three ecological regions. Mini International Neuropsychiatric Interview (MINI) standard version 7.0.2 for DSM-5 was used for adults (aged 18 years and above), and kid version of the same tool was used for children (aged 13-17 years) in Nepali language. Separate sets of questions were added for epilepsy and dissociative conversion disorder that were not in the Mini International Neuropsychiatric Interview tool. Prevalence of assessed mental disorders was reported separately for adults and children. The current prevalence of mental disorders among adults and children were 13.2% and 11.2% respectively. Substance use disorder, dissociative conversion disorder, major depressive disorder, alcohol use disorder and psychotic disorder were common among adults. Similarly, psychotic disorder, agoraphobia, major depressive disorder, and anxiety disorders were common among children. Current suicidality was present among 10.9% adults and 8.7% children. Our findings from the pilot study have given insight into the prevalence of different mental disorders in the survey areas. These findings can be utilized for planning the National Mental Health Survey, Nepal.

A single case report of Body Oriented Psychological Therapy for a patient with Chronic Conversion Disorder

This case study describes an innovative experiential Body Oriented Psychological Therapy (BOPT) for a patient with mixed dissociative conversion disorder (ICD-10, F44.7) and co-morbid depression resulting in severe somatoform complaints and emotional distress. The therapy process is informed by the main theoretical hypotheses of BOPT and utilises non-verbal expressive behaviour, body awareness and movement interventions to facilitate a change process through linking the expression of a wider range of emotions to implicit memories on a somatic level. Hereby the patient is enabled to access and bring into consciousness determinants of psychological states including repressed anger and conflicting feelings and ideas. The playfulness in BOPT fosters creative capabilities and embodied symbolic enactments of responses to trauma help to explore alternative coping mechanisms. Over the course of fifty sessions of BOPT important positive changes in the patient’s presentation were noted. By the end of therapy the patient was much more able to cope with his disability and he felt empowered to move forward in his life. The positive outcome suggests that this BOPT approach offers a useful alternative intervention when working with patients with conversion disorders.

Application effect of targeted nursing intervention in patients with dissociative (conversion) disorders

Objective To explore the application effect of targeted nursing intervention in patients with dissociative (conversion) disorders. Methods A total of 60 cases of patients with dissociative and conversion were randomly divided into the observation group and the control group according to the random number method, 30 cases of each group.The control group received routine nursing care, while the observation group was given targeted nursing intervention.The Hamilton anxiety scale (HAMA) and Hamilton depression scale (HAMD) were assessed for two groups of patients in two weeks, four weeks and six weeks before and after nursing intervention.The clinical efficacy of the two groups of patients after 6 weeks of nursing intervention was compared. Results The HAMA and HAMD scores in 4 weeks and 6 weeks of the observation group after nursing intervention were significantly lower than those of the control group (P< 0.05). The symptoms of anxiety and depression of the observation group were significantly higher than in the control group (P< 0.05). Conclusions The nursing intervention on dissociative (conversion) has a good effect of disorders, encourage patients to take positive and effective coping styles, reduce the level of psychological stress reaction, to alleviate the emotional symptoms, reduce psychosocial consequences, and improve the quality of life of patients. Key words: Targeted nursing intervention; Dissociative and conversion disorders; Coping style; Quality of life

P-1040 - The dissociative foundation of hysterical psychosis: a clinical case illustrating janet's original concept

Hysterical psychosis has never been part of the standard nomenclature. Janet postulated that a psychosis could be considered hysterical if its dissociative nature could be established. Breuer and Freud emphasized the traumatic origins and oneiroid form of the disorder. Hollender and Hirsch focused mainly on descriptive features: the dramatic onset, the temporal relation to an upsetting event, the short duration and the preponderance of females with histrionic behavior. To demonstrate the traumatic origins and distinct features of hysterical psychosis. A clinical case was followed and reviewed. A 48-year-old female presented acutely with disorganized behavior, negativism, loosening of associations, delusions of demonic influence and a fluctuating level of consciousness. Symptom onset was temporally related to severe family stressors. A complete medical evaluation ruled out the presence of an underlying organic factor. Dissociative conversion disorder was chosen as our working diagnosis. Rapid clinical response was achieved on low dose paliperidone. After the abatement of symptoms, our patient provided a comprehensive history of her experience, describing an oneiroid state in which she transiently submerged in vivid fantasies based upon past traumatic life events. Pharmacotherapy was gradually withdrawn and psychodynamic psychotherapy was introduced as a means to help her abreact the past traumata and integrate them into a cohesive self. This case supports Janet's formulation of hysterical psychosis and demonstrates the usefulness of the dissociative component in forming a diagnostic impression and treatment approach. It also underlines the need of distinctly classifying this clinical entity among dissociative disorders.

Psychiatric Morbidity Profiles of Child and Adolescent Psychiatry Out-Patients in a Tertiary-Care Hospital

Background: Psychiatric morbidity is ubiquitous, affecting children, adolescents and adults. Age factorsplay a great role in pattern of morbidity profile. Psychiatric morbidity profile of children and adolescentsmay indicate different needs and priorities. Objective: This study aims to sort out referral pattern, attitudeabout psychiatric referral and morbidity profile among child and adolescent psychiatric out-patients in atertiary-care general hospital. Methodology: A total of 100 consecutive child and adolescent patientsin psychiatry OPD coming into contact with investigator psychiatrist were enrolled during the studyperiod. Diagnoses were made according to the ICD-10. Results: Fifty three of the subjects were female,majority of the cases (79) were of age between 13-18 years. Main ethnicity-caste groups seeking carewere Mongol, Brahmin, Chhetri and indigenous Terai tribes. People from semi-urban and urban settingspredominated in this study. Great majority (more than 80%) had reached this service in the 4th or in morethan the 4th step of their help seeking. Most of the subjects were comfortable and happy about psychiatricreferral. More than half had presented mainly with physical and somatic complaints. Major psychiatricdiagnoses encountered were mood (affective), anxiety, seizure, dissociative conversion disorders andmental retardation. Four percent of subjects had suicidal behaviours and 17% migraine headache.Conclusion: Common psychiatric diagnoses among these child and adolescent out-patients are mood,anxiety, seizure, dissociative conversion disorders and mental retardation.Key words: Attitude to psychiatric consultation; child and adolescent; out-patient; psychiatric morbidityDOI: 10.3126/jnps.v30i2.2604J. Nepal Paediatr. Soc. May-August, 2010 Vol 30(2) 79-84