DISSOCIATIVE DISORDER

Ans:A i.e. Conversion reaction

La belle indifference is a condition in which the person is unconcerned with symptoms caused by a conversion disorder.

A naive, inappropriate lack of emotion or concern for the perceptions by others of one’s disability, usually seen in persons with conversion disorder.

Ans:D i.e. Dissociative disorder

• Dissociative disorders involve problems with memory, identity, emotion, perception, behavior and sense of self.
• Dissociative symptoms can potentially disrupt every area of mental functioning.
• Examples of dissociative symptoms include the experience of detachment or feeling as if one is outside one’s body, and loss of memory or amnesia.
• Dissociative disorders are frequently associated with previous experience of trauma
• Types of dissociative disorders-
  • Dissociative amnesia
  • Dissociative fugue
  • Trance disorder
  • Possession trnce disorder
  • Dissociative identity disorder(Mulitple personality disorder)
  • Dissociative neurological symptom disorder
  • Depersonalization/Derealization disorder
  • Others-Ganser’s syndrome

Ans: B i.e. Dissociative disorder

• Amnesia is seen in dissociative disorders and Conversion disorder presents with anesthesia (sensory dysfunction) voluntary motor dysfunction or hysterical fits.

Autonomic system is characteristically not involved in conversion disorder

Dissociative disorder

• The essential feature of the dissociative disorder is a disruption in the usually integrated functions of consciousness, memory, identity or perception of the environment. Dissociative disorder are :-

1. Dissociative (psychogenic) amnesia :- It is the most common type of dissociative disorder. Dissociative amnesia is characterized by retrograde amnesia (inability to retrieve stored memories and events leading up to onset of amnesia) and absence of antegrade amnesia (inability to form new long term memories).
2. Dissociative fugue :- A dissociative fugue may be present when a person impulsively wanders or travels away from home and upon arrival in the new location is unable to remember his/her past (i.e., amnesia for early life). There is loss of personal identity and the person assumes a new identity. There is absence of awareness of amnesia during fugue episode, i.e., Patient denies any memory loss during fugue state. On recovery there is amnesia for fugue episodes and recovery of memory of earlier life (i.e., before the episode of fugue).
3. Dissociative identity disorder (multiple personality disorder) :- More than one personality appears to possess the individuals, Showing their characteristic behavior. At any instance behavior and memories of one personality is exhibited, patient then is unaware of the other’s existance.
4. Depersonalization disorder : – Feeling of detachment from self is referred to as depersonalization. Individuals with this disorder will report feeling as if they are living in a dream or watching themselves on movie screen i.e., feeling detached from self and as if one is an outside observer of oneself. People with this disorder feel like they are “going crazy” and they frequently become anxious and depressed
5. Dissociative disorders not otherwise specified :- These are the disorders that are characterized by dissociative response that do not meet diagnostic criteria for one of the other dissociative disorder. Important ones are :-

• Dissociative Trance (Possession) disorders :- There is temporary exchange of person’s personality by a new personality usually attributed to a spirit or divine power. Usually the person is aware of the existance of the other, i.e., possessor (unlike dissociative identity disorder).
• Ganser’s syndrome : – Also known as syndrome of approximate answers. This is characterized by giving approximate answers together with a clouding of consciousness, and frequently accompanied by hallucinations and other dissociative, somatoform or conversion symptoms.

Ans:D.) Dissociative Disorder.

Electroconvulsive therapy is shown in the image.

ECT

• It is used with informed consent in treatment-resistant major depressive disorder, treatment-resistant catatonia, or prolonged or severe mania, and in conditions where “there is a need for rapid, definitive response because of the severity of a psychiatric or medical condition (e.g., when illness is characterized by stupor, marked psycho-motor retardation, depressive delusions or hallucinations, or life-threatening physical exhaustion associated with mania)

Ans. A. Depersonalization disorder

Depersonalization:

• Depersonalization is a sense of unreality or strangeness concerning the self, manifested by feeling detached from and being an outside observer of one’s mental processes or body.
  • A patient who experiences depersonalization may describe feeling like things “I have stepped outside of myself and am watching myself doing things”.

Derealization:

• Derealization  refers to feeling detached from one’s environment so that the sense  of the reality of the external world is lost.

• E.g, I feel as if everything is unreal and those around me are actors in a play or two dimensional cardboard figures.