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Nursing Management of
Patient with Neurotic, Stress
Related and Somatization
Disorders
Neurotic disorder (neurosis) is a less severe
form of psychiatric disorder where, patients
show either excessive or prolo...
Psychosis Neurosis
Etiology
Genetic factors
Stressful life events
-More important
-Less important
-Less important
-More im...
Treatment
Drugs
ECT
Psychotherapy
-Major
tranquilizers
-Very useful
-Not much useful
-Minor tranquilizers
-Not useful
-Ver...
F40-F49- Neurotic, stress-related and
somatoform disorders
F40 Phobic anxiety disorders
F41 Other anxiety disorders
F4...
DISSOCIATIVE
(CONVERSION)
DISORDERS
PRESENTED BY:
MR. VISHAL SHIVAJI THUBE,
ASSISTANT PROFESSOR,
JCN
Conversion disorder is characterized by
the presence of one or more symptoms
suggesting the presence of neurological
diso...
 Studies have estimated that 20%–25% of patients
in a general hospital setting have individual
symptoms of conversion and...
1. Psychodynamic Theory
 The ego defense mechanisms
involved are repression,
dissociation and conversion
 Conversion sym...
2. Behavior Theory
Symptoms are learnt from the surrounding
environment
These symptoms bring about psychological relief
...
Dissociative Motor Disorders
Dissociative Convulsions (hysterical fits or
pseudo-seizures)
Dissociative Sensory Loss and A...
It is characterized by motor
disturbances by like paralysis or
abnormal movements
Paralysis may be a monoplegia,
paraple...
It is characterized by convulsive
movements and partial loss of
consciousness
It is characterized by sensory
disturbances like
hemianesthesia, blindness,
deafness and glove and stocking
anesthesia (a...
1. The symptoms are produced because they
reduce the anxiety of the patient by keeping
the psychological conflict out of c...
5. Physical examination and investigations do
not reveal any medical or neurological
abnormalities.
6. Lack of conscious c...
Dissociation is the mechanism that allows our
mind to separate certain memories from
conscious awareness.
The dissociati...
1. Disturbance in the normal integrative functions of
consciousness, identity and or memory.
2. The disturbance may be sud...
COMMON CLINICAL TYPES
Dissociative
Amnesia
Dissociative
Fugue
Dissociative
Identity
Disorder
Trance and
Possession
Disorde...
 Dissociative amnesia follows a
traumatic or stressful life
situation
 There is a sudden inability to
recall important p...
 Psychogenic fugue is a sudden,
unexpected travel away from
home or workplace, with the
assumption of a new identity
and ...
 In this disorder, the person is dominated by two or more
personalities of which only one is manifest at a time
 Usually...
It is characterized by a temporary loss of both
the sense of personal identity and full
awareness of the person’s surroun...
The focus of attention
is narrowed to a few
aspects of the
immediate
environment, and there
is often a limited but
repeat...
 Ganser’s syndrome (hysterical pseudodementia) is
commonly found in inmates
 The characteristic feature is ‘vorbeireden’...
 Rule out physical disorders and substance
abuse
 Standard tests including Dissociative
Experiences Scale and the Dissoc...
 The DSM-5 provides the following criteria to
diagnose dissociative identity disorder: Two or more distinct
identities or...
Free association
Hypnosis
Supportive psychotherapy
Abreaction therapy
Behavior therapy
Drug therapy
 Nursing Assessment: Any physical condition that could
produce the symptoms of amnesia and dissociation must
be ruled out...
The nurse must first establish a trusting and
supportive therapeutic relationship with patient
Use active listening and ...
Conversion and dissociative disorder
Conversion and dissociative disorder
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Nursing management of patient with neurotic disorder. i.e. conversion and dissociative disorder

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Conversion and dissociative disorder

  1. 1. Nursing Management of Patient with Neurotic, Stress Related and Somatization Disorders
  2. 2. Neurotic disorder (neurosis) is a less severe form of psychiatric disorder where, patients show either excessive or prolonged emotional reaction to any given stress Not caused by organic disease of the brain and however severe, do not involve hallucinations
  3. 3. Psychosis Neurosis Etiology Genetic factors Stressful life events -More important -Less important -Less important -More important Clinical features Disturbances of thinking & perception Disturbances in cognitive function Behavior Judgement Insight Reality testing -Common -Common -Markedly affected -Impaired -Lost -Lost -Rare -Rare -Not affected -Intact -Present -Present
  4. 4. Treatment Drugs ECT Psychotherapy -Major tranquilizers -Very useful -Not much useful -Minor tranquilizers -Not useful -Very useful Prognosis -Difficult to treat -Relapses are common -Complete recovery may not be possible -Relatively easy to treat -Relapses are uncommon -Complete recovery is possible
  5. 5. F40-F49- Neurotic, stress-related and somatoform disorders F40 Phobic anxiety disorders F41 Other anxiety disorders F42 Obsessive-compulsive disorder F43 Reaction to severe stress, and adjustment disorders F44 Dissociative (conversion) disorders F45 Somatoform disorders F48 Other neurotic disorders
  6. 6. DISSOCIATIVE (CONVERSION) DISORDERS PRESENTED BY: MR. VISHAL SHIVAJI THUBE, ASSISTANT PROFESSOR, JCN
  7. 7. Conversion disorder is characterized by the presence of one or more symptoms suggesting the presence of neurological disorder that cannot be explained by any known neurological or medical disorder. In ICD10, conversion disorder is subsumed under “dissociative disorders of movement and sensation”, a subtype under dissociate disorders.
  8. 8.  Studies have estimated that 20%–25% of patients in a general hospital setting have individual symptoms of conversion and 5% of patients in this setting meet the criteria for the full syndrome.  Dissociative identity disorder statistics vary but show that the condition occurs in anywhere from one-half percent to two percent of the population. ... Available research indicates that approximately two percent of people in the world experience dissociative disorders and they are more commonly diagnosed in women.
  9. 9. 1. Psychodynamic Theory  The ego defense mechanisms involved are repression, dissociation and conversion  Conversion symptoms allow a forbidden wish or urge to be partly expressed but sufficiently disguised so that the individual does not have to face the unacceptable wish  The symptoms are symbolically related to the conflict
  10. 10. 2. Behavior Theory 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
  11. 11. Dissociative Motor Disorders Dissociative Convulsions (hysterical fits or pseudo-seizures) Dissociative Sensory Loss and Anesthesia
  12. 12. It is characterized by motor disturbances by like paralysis or abnormal movements Paralysis may be a monoplegia, paraplegia or quadriplegia The abnormal movement may be tremors, choreiform movements or gait disturbances which increase when attention is directed towards them Examination reveals normal tone and reflexes
  13. 13. It is characterized by convulsive movements and partial loss of consciousness
  14. 14. It is characterized by sensory disturbances like hemianesthesia, blindness, deafness and glove and stocking anesthesia (absence of sensations at wrists and ankles) The disturbance is usually based on patient’s knowledge of that particular illness whose symptoms are produced A detailed symptoms does not reveal any abnormalities
  15. 15. 1. The symptoms are produced because they reduce the anxiety of the patient by keeping the psychological conflict out of conscious awareness, a process called primary gain. 2. These symptoms of conversion are often advantageous to the patient called secondary gain. 3. The patient does not produce the symptoms intentionally. 4. The patient shows less distress or shows lack of concern about the symptoms, called as la belle indifference.
  16. 16. 5. Physical examination and investigations do not reveal any medical or neurological abnormalities. 6. Lack of conscious control over the symptoms. 7. Impaired functioning in social work related areas caused by symptoms. 8. Functioning ability and symptoms inconsistent with usual neurological disorders.
  17. 17. Dissociation is the mechanism that allows our mind to separate certain memories from conscious awareness. The dissociative disorders are described as a disturbance in the ordinarily organized functions of the conscious awareness, memory and identity.
  18. 18. 1. Disturbance in the normal integrative functions of consciousness, identity and or memory. 2. The disturbance may be sudden or gradual, and the disturbance is usually temporary, recovery is often abrupt 3. These disorders tend to occur in response to severe trauma or abuse. A frequent stressful situation is an ongoing war. 4. Significant impairment in general and social functioning. 5. Detailed physical examination and investigations do not reveal any abnormality that can explain the symptoms adequately
  19. 19. COMMON CLINICAL TYPES Dissociative Amnesia Dissociative Fugue Dissociative Identity Disorder Trance and Possession Disorders Other Dissociative Disorders
  20. 20.  Dissociative amnesia follows a traumatic or stressful life situation  There is a sudden inability to recall important personal information particularly concerning the stressful life event  The extent of the disturbance is too great to be explained by ordinary forgetfulness  The amnesia may be localized, generalized, selective or continuing in nature
  21. 21.  Psychogenic fugue is a sudden, unexpected travel away from home or workplace, with the assumption of a new identity and an inability to recall the past  The onset is sudden, often in the presence of severe stress  Following recovery there is no recollection of the events that took place during the fugue  The course is typically a few hours to days and sometimes months
  22. 22.  In this disorder, the person is dominated by two or more personalities of which only one is manifest at a time  Usually one personality is not aware of the existence of the other personalities  Each personality has a full range of higher mental functions and performs complex behavior patterns  Transition from one personality to another is sudden, and the behavior usually contrasts strikingly with the patient’s normal state
  23. 23. It is characterized by a temporary loss of both the sense of personal identity and full awareness of the person’s surroundings When the condition is induced by religious rituals, the person may feel taken over by deity or spirit
  24. 24. The focus of attention is narrowed to a few aspects of the immediate environment, and there is often a limited but repeated set of movements, postures and utterances
  25. 25.  Ganser’s syndrome (hysterical pseudodementia) is commonly found in inmates  The characteristic feature is ‘vorbeireden’ giving approximate answers to questions  The term ‘approximate answers’ denotes answers to simple questions that are plainly wrong, but are clearly related to the correct answers in a way that suggest that the latter is known  Hallucinations are usually visual and may be elaborate
  26. 26.  Rule out physical disorders and substance abuse  Standard tests including Dissociative Experiences Scale and the Dissociative Disorders Interview schedule to demonstrate presence of dissociation  ICD 10 criteria and DSM-5 criteria  According to the DSM-5, conversion disorder can be diagnosed with symptom specifiers including the following: weakness paralysis, abnormal movement, swallowing symptoms, speech symptoms, attacks or seizures, anesthesia or sensory loss, or sensory symptoms
  27. 27.  The DSM-5 provides the following criteria to diagnose dissociative identity disorder: Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.  DSM-V, the symptoms and criteria for dissociative amnesia are Unable to recall autobiographical memory associated with a traumatic event. The inability to recall traumatic events creates distress. The memory dysfunction does not have a physiological cause.
  28. 28. Free association Hypnosis Supportive psychotherapy
  29. 29. Abreaction therapy Behavior therapy Drug therapy
  30. 30.  Nursing Assessment: Any physical condition that could produce the symptoms of amnesia and dissociation must be ruled out  Nursing Diagnosis: - Altered thought process, related to memory loss and repressed trauma - Self care deficit related to trance like state or aimless wandering - Ineffective individual coping, related to repressed memories and issues, loss of identity - Personality identity disturbance, related to childhood trauma or more than one personality state - Anxiety, related to repressed traumatic events or loss of identity
  31. 31. The nurse must first establish a trusting and supportive therapeutic relationship with patient Use active listening and encouraging communication techniques for verbalizing feelings, conflicts and information regarding traumatic events
  • MonalishaBhuyan

    Oct. 18, 2020
  • priyankainsan3

    Oct. 10, 2020

Nursing management of patient with neurotic disorder. i.e. conversion and dissociative disorder

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