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Dissociative Disorders. Unless otherwise indicated, answers are from DSM-IV-TR or First and Tasman As of 1Sep07. Memory types. Q. What are the two basic memory types?. Memory types. Ans. There are different terms used. declarative and procedural explicit and implicit

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Dissociative disorders l.jpg

Dissociative Disorders

Unless otherwise indicated, answers are from DSM-IV-TR or First and Tasman

As of 1Sep07


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Memory types

Q. What are the two basic memory types?


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Memory types

Ans. There are different terms used.

declarative and procedural

explicit and implicit

episodic and semantic

We will use declarative and procedural in these screens.


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Memory – dissociative disorders

Q. Which type of memory is lost in dissociative disorders?


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Memory - dissociative

Ans. Declarative. The patient still has the memory, for example, to drive a car even though they may not remember their name.


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Classification

Q. Besides NOS category, what are the four dissociative disorders?


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Classification

Ans.

  • Dissociative amnesia

  • Dissociative fugue

  • Dissociative identity disorder

  • Depersonalization disorder

    [also, dissociative trance disorder is in the DSM appendix of disorders in need of research.]


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Dissociative amnesia - basic

Q. Basic features of dissociative amnesia?


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Dissociative amnesia - basic

Ans. An inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness.


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Dissociative amnesia prevalence

Q. There is a controversy as to the prevalence of this disorder. State the controversy.


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Prevalence

Ans. The increase of reported cases is attributed by some to greater clinician awareness. Others claim that the increase is the result of greater suggestibility.


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Dissociative amnesia course

Q. What is the course?


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Dissociative amnesia course

Ans. Some eventually get total recall, others have none.


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Treatment of dissociative amnesia

Q. What is the treatment of dissociative amnesia?


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Treatment of dissociative amnesia

Ans.

Place in safe environment

Hypnosis, e.g., age regression

Or

supportive psychotherapy of integrating memories into consciousness


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Dissociative fugue - basic

Q. What is the basic feature to this disorder?


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Dissociative fugue - basic

Ans. A sudden, unexpected travel away from one’s customary place of daily activities, with inability to recall some or all of one’s past.


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Fugue’s prevalence

Q. What is fugue’s prevalence?


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Fugue’s prevalence

Ans. 0.2% of the general population.


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Fugue’s course

Q. What is the course?


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Fugue’s course

Ans. May last for hours to months. Recovery is rapid, but refractory amnesia may persist.


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Treatment of fugues

Q. What is the treatment of fugues?


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Treatment of fugues

Ans.

First and Tasman prefer hypnosis.

Some examiners may also like to use medication-facilitated [e.g., Amytal] interviews.

Supportive psychotherapy is also used.


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Dissociative identity disorder [DID] - basic

Q. What is the basic findings in DID?


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DID - basic

Ans. The pt has two or more distinct identities or personality states that recurrently take control of behavior.


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DID - prevalence

Q. What is the prevalence?


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DID - prevalence

Ans. Controversial as some believe the increase is the result of clinician suggestion.


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DID - course

Q. What is the course?


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DID - course

Ans. Average time between onset and dx is 6-7 years, and course is episodic or continuous. Episodic is associated with untoward events.


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DID treatment

Q. What is the treatment of DID?


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DID treatment

Ans. Supportive, extensive, psychotherapy directed at integrating the personalities. In doing so, addressing past traumas may become key; but any suggestions as to trauma is seen as iatrogenic by some. Also used as adjuncts:

hypnosis

SSRIs when dysphoria is part of the presentation


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Depersonalization disorder - basic

Q. Basic feature of depersonalization disorder?


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Depersonalization - basic

Ans. Episodes of feeling detachment or estrangement from one’s self.


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“Laboratory” findings

Q. DSM-IV suggests what laboratory finding in folks with depersonalization?


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“Laboratory” findings

Ans. Display high hypnotizability.


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Depersonalization – prevalence

Q. What is the prevalence?


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Depersonalization - prevalence

Ans. About half of all adults have had such an experience, usually precipitated by severe stress.


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Depersonalization - course

Q. What is the age of onset and subsequent course?


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Depersonalization - course

Ans. Mean age of onset is 16 and course is usually chronic, exacerbating in association with actual or perceived stress.


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Depersonalization - treatment

Q. What is the treatment?


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Depersonalization - treatment

Ans. Medications for the co-morbid condition may suffice. Anxiolytics may work, but watch for side effect of depersonalization that may actually increase with these meds. Hypnosis is another option.


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Dissociative trance disorder - basic

Q. Basic feature of this disorder?

BEING IN THE DSM APPENDIX MAKES THIS A VERY UNLIKELY EXAM TOPIC.


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Dissociative trance disorder - basic

Ans. Patient has an involuntary state of trance causes significant distress and is not part of the individual’s cultural practice.


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Trance - treatment

Q. What is the treatment?


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Trance treatment

Ans. First and Tasman suggest adhering to the approach used in the pt’s cultural, e.g., “negotiating a change” in the pt’s “social circumstances.”