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50 Cards in this Set
- Front
- Back
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What are dissociative disorders?
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Loss of memory (amnesia), identity, or sense of self (the normal integration of thoughts, behaviors, perceptions, feelings, and memory into a unique identity)
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What are dissociative disorders thought to be often related to / caused by?
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Trauma or abuse during childhood or severe trauma as an adult
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What neurotransmitters are thought to be involved in dissociative disorders?
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- Glutamate
- Norepinephrine |
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Some argue that the more severe dissociative disorders are actually misdiagnosed from what?
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Personality disorders (borderline)
Or are volitional |
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What are the DSM-IV dissociative disorders?
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- Dissociative amnesia
- Dissociative fugue - Dissociative identity disorder (aka multiple personality disorder) - Depersonalization disorder - Dissociative disorder NOS |
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What are the features of dissociative disorders?
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- Amnesia
- Feelings of detachment - Gradual or sudden onset of symptoms - Temporary or sudden - Dissociative responses are common in stressful and traumatic events |
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Which is the most common dissociative disorder?
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Dissociative amnesia
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What are the characteristics of dissociative amnesia?
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- Amnesia is the only dissociative symptom present
- Very often retain new memory formation and can have large periods of time that are forgotten |
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What are the DSM-IV criteria for dissociative amnesia?
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- At least one episode of inability to recall important personal information, usually involving a traumatic or stressful event
- Amnesia cannot be explained by ordinary forgetfulness - Sx cause significant distress or impairment in daily functioning and cannot be explained by another disorder, including TBI, medical condition, or substance use |
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Dissociative amnesia is more common in what people?
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- Women > Men
- Younger > Older adults |
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Dissociative amnesia has increased incidence of what comorbid disorders?
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- Major depression
- Anxiety disorders |
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What is the course / prognosis for dissociative amnesia?
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Many acute cases abruptly return to normal after minutes to days
Recurrences are uncommon |
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How do you treat dissociative amnesia?
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- Establish patient's safety
- Psychotherapy is the mainstay - No specific pharmacology is approved for amnesia - Hypnosis or administration of sodium amobarbital or lorazepam (Ativan) during the interview have been used historically and may be useful to help some patients talk more freely |
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A patient with transient global amnesia will have difficulty remembering what sorts of things?
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Recalling recent events, while memory for more temporally distant events including his or her identity, remain intact
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A patient with dissociative amnesia will have difficulty remembering what sorts of things?
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- Common personal information, while memory for more obscure details, remains intact
- Report gaps in the recollection of a particular event; the memory forgotten is usually a traumatic one, such as being raped |
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Patients suffering from dissociative amnesia can experience what?
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Periods of flashbacks, nightmares, or behavioral reenactments
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Case: 22 yo Caucasian woman is found by a couple, walking alone at night. Concerned about her wandering around in an isolated part of town, the couple stops and asks her if she needs any help. She stares at them and says she is fine but is unable to provide her name or any contact information. She was found holding a bus ticket that suggested she has traveled from a nearby state. The couple calls an ambulance, and she is taken to a nearby ER where she is identified as Ms. Jane Doe.
Upon exam she shows no signs of trauma. Diagnostic tests including imaging, toxicology, and EEG, return normal. Although she is unable to provide any personal info, her purse contains a driver's license identifying her as Mary Clark and a cell phone is found showing multiple missed calls. With the intention of communicating with close family members, you call number identified as "mom" and you learn the family has been worried about her whereabouts for 2 days. Her mother reports she had contacted the local PD to file a missing person complaint. The mother reports her daughter has no prior psych history or medical conditions. When asked about recent stressors, she says her daughter has been concerned about being laid off. Her mom reports she will take the next flight to be at her daughter's side. What is the patient's diagnosis? |
Dissociative Fugue
- She presented with amnesia about personal identity after a sudden, unexpected travel away from home - This usually occurs after experiencing overwhelming stress or traumatic loss - Some patient assume a new identity, most do not - Important to consider medical conditions such as partial complex seizures, substance use, dissociative identity disorder, depersonalization disorder, acute stress disorder, and malingering |
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Case: 22 yo Caucasian woman is found by a couple, walking alone at night. Concerned about her wandering around in an isolated part of town, the couple stops and asks her if she needs any help. She stares at them and says she is fine but is unable to provide her name or any contact information. She was found holding a bus ticket that suggested she has traveled from a nearby state. The couple calls an ambulance, and she is taken to a nearby ER where she is identified as Ms. Jane Doe.Upon exam she shows no signs of trauma. Diagnostic tests including imaging, toxicology, and EEG, return normal. Although she is unable to provide any personal info, her purse contains a driver's license identifying her as Mary Clark and a cell phone is found showing multiple missed calls. With the intention of communicating with close family members, you call number identified as "mom" and you learn the family has been worried about her whereabouts for 2 days. Her mother reports she had contacted the local PD to file a missing person complaint.The mother reports her daughter has no prior psych history or medical conditions. When asked about recent stressors, she says her daughter has been concerned about being laid off. Her mom reports she will take the next flight to be at her daughter's side.
What differential diagnoses should be considered? |
- Dissociative Fugue
- Partial complex seizures - Substance use - Dissociative identity disorder - Depersonalization disorder - Acute stress disorder - Malingering |
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Case: 22 yo Caucasian woman is found by a couple, walking alone at night. Concerned about her wandering around in an isolated part of town, the couple stops and asks her if she needs any help. She stares at them and says she is fine but is unable to provide her name or any contact information. She was found holding a bus ticket that suggested she has traveled from a nearby state. The couple calls an ambulance, and she is taken to a nearby ER where she is identified as Ms. Jane Doe. Upon exam she shows no signs of trauma. Diagnostic tests including imaging, toxicology, and EEG, return normal. Although she is unable to provide any personal info, her purse contains a driver's license identifying her as Mary Clark and a cell phone is found showing multiple missed calls. With the intention of communicating with close family members, you call number identified as "mom" and you learn the family has been worried about her whereabouts for 2 days. Her mother reports she had contacted the local PD to file a missing person complaint. The mother reports her daughter has no prior psych history or medical conditions. When asked about recent stressors, she says her daughter has been concerned about being laid off. Her mom reports she will take the next flight to be at her daughter's side.
What is the recommended treatment? |
- Most dissociative fugue episodes resolve within a few hours to a few days
- She would benefit from a psychotherapeutic approach to help her cope with stressors and increase awareness of her reactions and feelings toward stressful situations - If dissociative state persists, hypnosis might be effective in retrieving memories and make these available to consciousness - IV benzos, sodium amobarbital, or other short-acting sedatives might be used to elicit memories |
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What is the word for the strong reaction patients get when retrieving traumatic memories?
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Abreaction
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What does the term "Abreaction" mean?
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Strong reaction patients often get when retrieving traumatic memories
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Case: A man is found 3 days after being reported missing. He was wandering around miles away from his home and when questioned could not remember how long he had been away from home or how he got there.
What is the likely diagnosis? |
Dissociative Fugue
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What is Dissociative Fugue characterized by?
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- Sudden, unexpected travel away from home, accompanied by the inability to recall one's identity or one's past
- May assume an entirely new identity and occupation after arriving in new location - Unaware of their amnesia and new identity, they never recall the period of fugue - Display low anxiety despite their confusion; affect is similar to "la belle indifference" of conversion responses |
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What mnemonic can be used to remember the characteristics of "fugue"?
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Fugue: think about a "FUG"itive who runs away and forms a new identity
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What are the DSM-IV criteria for Dissociative Fugue?
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- Sudden, unexpected travel away from home or work plus inability to recall one's past
- Confusion about personal identity or assumption of new identity - Not due to dissociative identity disorder or the physiological effects of a substance or medical disorder - Symptoms cause impairment in social or occupational functioning |
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What are the predisposing factors for Dissociative Fugue?
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- Heavy use of alcohol
- Major depression - History of head trauma - Epilepsy |
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Onset of Dissociative Fugue is associated with what?
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Stressful life event
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How is Dissociative Fugue different from Dissociative Amnesia?
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In Dissociative Fugue, patients are not aware that they have forgotten anything
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What is the course / prognosis of Dissociative Fugue?
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- Usually lasts a few hours to several days but may last longer
- After the episode, the patient will assume his or her old identity without ever remembering the time of the fugue |
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How do you treat Dissociative Fugue?
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Similar to that of dissociative amnesia:
- Establish patient's safety- Psychotherapy is the mainstay- No specific pharmacology is approved for amnesia- Hypnosis or administration of sodium amobarbital or lorazepam (Ativan) during the interview have been used historically and may be useful to help some patients talk more freely |
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What are the characteristics of Dissociative Identity Disorder?
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- Two or more distinct personalities that alternately control their behaviors and thoughts
- Memories, habits, skills, and even physical traits (such as handedness or allergies) can be implicated - Rare studies show physiological differences (blood glucose, etc) among the personality states |
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What are the DSM-IV criteria for Dissociative Identity Disorder?
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- Presence of two or more distinct identities
- At least two of the identities recurrently take control of the person's behavior - Inability to recall personal information of one personality when the other is dominant - Not due to effects of substance or medical condition |
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Who is more likely to get Dissociative Identity Disorder?
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- Women account for up to 90% of patients
- Most patients have experienced prior trauma, especially childhood physical or sexual abuse |
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What is the average age of onset / diagnosis of Dissociative Identity Disorder?
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- Age of onset: 6y
- Age of diagnosis: 30y |
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What disorders are often comorbid with Dissociative Identity Disorder?
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- Major depression
- Anxiety disorders - Borderline personality disorder - Substance abuse |
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How common is suicide in patients with Dissociative Identity Disorder?
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1/3
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Symptoms of Dissociative Identity Disorder may be similar to what other disorders?
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- Borderline personality disorder
- Psychosis - Malingering |
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What is the course / prognosis of Dissociative Identity Disorder?
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- Usually chronic, with incomplete recovery
- Worst prognosis of all dissociative disorders - Patients with an earlier onset have a poorer prognosis |
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How do you treat Dissociative Identity Disorder?
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- Hypnosis, drug-assisted interviewing, and insight-oriented psychotherapy
- Pharmacotherapy, as needed if comorbid disorder develops (such as major depression) |
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What disorder is characterized by persistent or recurrent feelings of detachment from one's self, environment (derealization), or social situation?
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Depersonalization Disorder
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What are the characteristics of Depersonalization Disorder?
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Persistent or recurrent feelings of detachment from one's self, environment (derealization), or social situation
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What are the DSM-IV criteria of Depersonalization Disorder?
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- Persistent or recurrent experiences of being detached from one's body or mental processes
- Reality testing remains intact during episode - Causes social / occupational impairment, and cannot be accounted for by another mental or physical disorder |
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Who is more likely to get Depersonalization Disorder?
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- 2x more common in men than women
- More common among adolescents and young adults |
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What is a predisposing factor for Depersonalization Disorder?
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Severe stress
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There is increased incidence of what comorbid disorders with Depersonalization Disorder?
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- Anxiety disorders
- Major depression |
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How should you treat Depersonalization Disorder?
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Anti-anxiety agents or SSRIs to treat associated symptoms of anxiety or major depression
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What are the dissociative disorders not otherwise specified?
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- Dissociative disorder presentations without two or more states
- Primary derealization - Cultural-bound dissociative trance disorders - Loss of consciousness, stupor, or coma not due to medical condition - Ganser syndrome (the giving of approximate answers to simple questions as how man legs do you have?) |
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What is the definition of dissociative disorder not otherwise specified?
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Primary dissociative disorders that share the characteristics of disruption in consciousness, memory, identity, or perception but do not meet criteria of the other specific categories
Many of these disorders include cultural components and are very unlikely to be seen in the wards |
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What is "Ataque de nervous"?
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Culturally bound trance disorder common in Puerto Rico that consists of compulsive movements, fainting, crying, and visual problems
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What is the term for the culturally bound trance disorder common in Puerto Rico that consists of compulsive movements, fainting, crying, and visual problems?
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Ataque de nervios
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