dissociative disorders

Question 1

dissociative disorders: general

Answer 1

• related to trauma or abuse?
• glu, NE?
• misdiagnosed personality dos?
• amnesia, fugue, identity do, depersonalization do

Question 2

dissociative amnesia: dx

Answer 2

• amnesia is ONLY dissoc symptom
• 1+ episode of inability to recall impt personal info
• cannot be explained by ordinary forgetfulness
• cause significant distress/impairment

Question 3

dissoc amnesia: epidem

Answer 3

• most common dissoc do
• women > men
• younger > older
• increased incidence of comorbid MDD or anxiety dos

Question 4

dissoc amnesia: prognosis

Answer 4

• many acute cases abruptly return to normal

- recurrences uncommon

Question 5

dissoc amnesia: tx

Answer 5

• psychotherapy
• can target specific sx
• hypnosis, sodium amobarbital, lorazepam during interview?

Question 6

dissoc fugue: dx

Answer 6

• sudden unexpected travel away from home or work PLUS inability to recall one’s past
• confusion about personal ID or assumption of new ID
• not due to dissoc ID do or substance/GMC
• sx cause impairment in social or occupational fn

Question 7

dissoc fugue: epidem

Answer 7

• rare
• risk factors: heavy alcohol use, MDD, head trauma, epilepsy
• onset assoc with stressful life event

Question 8

dissoc fugue: prognosis

Answer 8

• lasts few hours to several days (or longer)

- afterward return to normal w/o remembering event

Question 9

dissoc ID do

Answer 9

= multiple personality do

- can implicate memory, habits, skills, physical traits

Question 10

dissoc ID do: dx

Answer 10

• presence of 2+ distinct IDs
• at least two of IDs take control of person’s behavior
• inability to recall personal info of one ID while other is dominant

Question 11

dissoc ID do: epidem

Answer 11

• women = 90% of pts
• usually prior trauma
• avg age of onset 6 yo, avg age of dx 30yo
• high incidence of comorbid MDD, anxiety do, BPD, substance abuse
• up to 1/3 attempt suicide

Question 12

dissoc ID do: prognosis

Answer 12

• usually chronic, incomplete recovery

- earlier onset assoc with poorer prognosis

Question 13

dissoc ID do: tx

Answer 13

• hypnosis, drug-assisted interviewing, insight-oriented psychotherapy
• pharmacotherapy if comorbid do develops

Question 14

depersonalization do: dx

Answer 14

• persistent or recurrent experiences of being detached from one’s body/mental process
• reality testing remains intact during episode
• causes social/occupational impairment

(transient depersonalization common/normal in times of stress)

Question 15

depersonalization do: epidem

Answer 15

• women&raquo_space; men
• adolescents, young adults more common
• increased incidence of comorbid anxiety do and MDD
• severe stress is predisposing factor

Question 16

depersonalization do: prognosis/tx

Answer 16

• often chronic, but may remit w/o tx

- antianxiety or SSRIs possible

Question 17

ataque de nervios

Answer 17

• trance do common in PR
• convulsive movements
• fainting
• crying
• visual problems

Question 18

Ganser syndrome

Answer 18

• giving of approx answers to simple questions