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Shakya P, Sood M, Mathur R, Prajapati N, Patil V. Pathways to care and barriers in treatment among patients with Dissociative disorders. Asian J Psychiatr 2024; 95:104000. [PMID: 38507864 DOI: 10.1016/j.ajp.2024.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. METHODS Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. RESULTS 133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. CONCLUSION Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Nisha Prajapati
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Vaibhav Patil
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Sideli L, Santoro G, Fontana A, Guglielmucci F, Caretti V, Schimmenti A. The Relationship Between Obsessive-Compulsive Symptoms and Dissociation: A Systematic Review and Meta-Analysis. J Trauma Dissociation 2023; 24:362-379. [PMID: 36820493 DOI: 10.1080/15299732.2023.2181477] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
This systematic review and meta-analysis aimed to investigate the relationship between dissociation and obsessive-compulsive symptoms (OCS) and disorder (OCD). Specifically, the study aimed to (a) estimate the pooled prevalence of dissociative disorders among individuals with OCD; (b) systematically review the prevalence of OCD among individuals with dissociative disorders; (c) compare the severity of dissociative symptoms between individuals with OCD and non-clinical controls; (d) estimate the association between OCS and dissociative symptoms in the clinical and non-clinical populations. A systematic search was carried out in biomedical databases from inception to January 2022 according to PRISMA guidelines. A total of 41 studies met inclusion criteria (n = 9,438, 34.3% males). The pooled prevalence of dissociative disorders in adult samples with OCD was 8% (95% CI [3, 15], k = 5). Studies on adolescent and adult patients with dissociative disorders found that 17-32% reported comorbid OCD, while a prospective study of patients with early-onset dissociative disorders found no evidence of association with OCD. Individuals affected by OCD reported more dissociative symptoms than non-clinical controls (g = .67, 95% CI [.18, 1.16], k = 9). A moderate correlation between dissociative symptoms and OCS was detected (r = .43, 95% CI [.36, .51], k = 18). Sensitivity analyses showed small/moderate correlations between dissociative experiences and specific types of obsessions and compulsions. Findings suggest that dissociative symptoms are moderately related to OCS in both clinical and non-clinical populations. Interventions aimed to reduce dissociation might improve treatment response of patients suffering from OCD.
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Affiliation(s)
- Lucia Sideli
- Department of Human Science, LUMSA University, Rome, Italy
| | - Gianluca Santoro
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Enna, Italy
| | - Andrea Fontana
- Department of Human Science, LUMSA University, Rome, Italy
| | - Fanny Guglielmucci
- Department of Philosophy, Communication and Arts, University of Rome 3, Roma, Italy
| | | | - Adriano Schimmenti
- Faculty of Human and Social Sciences, UKE - Kore University of Enna, Enna, Italy
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Sappok T, Hassiotis A, Bertelli M, Dziobek I, Sterkenburg P. Developmental Delays in Socio-Emotional Brain Functions in Persons with an Intellectual Disability: Impact on Treatment and Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13109. [PMID: 36293690 PMCID: PMC9603789 DOI: 10.3390/ijerph192013109] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/02/2022] [Accepted: 10/10/2022] [Indexed: 05/06/2023]
Abstract
Intellectual disability is a neurodevelopmental disorder with a related co-occurrence of mental health issues and challenging behaviors. In addition to purely cognitive functions, socio-emotional competencies may also be affected. In this paper, the lens of developmental social neuroscience is used to better understand the origins of mental disorders and challenging behaviors in people with an intellectual disability. The current concept of intelligence is broadened by socio-emotional brain functions. The emergence of these socio-emotional brain functions is linked to the formation of the respective neuronal networks located within the different parts of the limbic system. Thus, high order networks build on circuits that process more basic information. The socio-emotional skills can be assessed and complement the results of a standardized IQ-test. Disturbances of the brain cytoarchitecture and function that occur at a certain developmental period may increase the susceptibility to certain mental disorders. Insights into the current mental and socio-emotional functioning of a person may support clinicians in the calibration of treatment and support. Acknowledging the trajectories of the socio-emotional brain development may result in a more comprehensive understanding of behaviors and mental health in people with developmental delays and thus underpin supports for promotion of good mental health in this highly vulnerable population.
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Affiliation(s)
- Tanja Sappok
- Berlin Center for Mental Health in Developmental Disabilities, Ev. Krankenhaus Königin Elisabeth Herzberge, 10365 Berlin, Germany
| | - Angela Hassiotis
- Division of Psychiatry, University College London, London W1T 7BN, UK
- Camden and Islington NHS Foundation Trust, London NW1 0PE, UK
| | - Marco Bertelli
- CREA (Research and Clinical Centre), San Sebastiano Foundation, Misericordia di Firenze, 50142 Florence, Italy
| | - Isabel Dziobek
- Clinical Psychology of Social Interaction, Humboldt-Universität zu Berlin, 10099 Berlin, Germany
| | - Paula Sterkenburg
- Bartiméus, 3941 XM Doorn, The Netherlands
- Department of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, 1081 BT Amsterdam, The Netherlands
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The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review. Genes (Basel) 2022; 13:genes13050843. [PMID: 35627228 PMCID: PMC9141026 DOI: 10.3390/genes13050843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 12/04/2022] Open
Abstract
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
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Abstract
The study evaluated the short-term outcome of children diagnosed with conversion disorder and compared their pre- and post-intervention psychological functioning. Fifty children consecutively diagnosed with conversion disorder over a period of one year were recruited from the pediatrics department of a tertiary care teaching hospital in North India. The adverse life events were assessed by the Life Events Scale for Indian Children, emotional and behavioral difficulties by the Childhood Psychopathology Measurement Schedule (CPMS), and adjustment by the Pre-Adolescent Adjustment Scale (PAAS). Majority of the children improved at follow up at 3 mo after initiation of treatment. In addition, total scores on the CPMS significantly declined (t = 5.12, P = 0.0001) and self-reported adjustment improved on the PAAS (t = 5.81, P = 0.0001) as compared to functioning before the initiation of therapy. Timely recognition and multi-disciplinary management can lead to successful outcome and improved functioning in most children diagnosed with conversion disorder.
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Asadi-Pooya AA, Brigo F, Kozlowska K, Perez DL, Pretorius C, Sawchuk T, Saxena A, Tolchin B, Valente KD. Social aspects of life in patients with functional seizures: Closing the gap in the biopsychosocial formulation. Epilepsy Behav 2021; 117:107903. [PMID: 33740497 DOI: 10.1016/j.yebeh.2021.107903] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 01/20/2023]
Abstract
The human, as a biological system, is an open system embedded within larger systems -including the family, culture, and socio-political environment. In this context, a patient with functional seizures (FS) is embedded in relationships, educational/professional institutions, culture, and society. Both connection to these broader systems and the quality of these connections, as well as the soundness of each system in and of itself, influence the health and well-being of patients in positive or negative ways. The social aspects of life are important determinants of health and quality of life across the lifespan. The current narrative review brings out several overarching themes in patients with FS. Sections on attachment, marriage, social networking, and stigma highlight the central roles of supportive and affirmative relationships across the lifespan. The section on education underscores the importance of keeping children and youth with FS connected within their school environments, as well as managing any barriers - learning difficulties, school response to FS events, stigma, etc.-that can diminish this connection. Finally, the sections on employment and driving highlight the value of being an active participant in one's society. In summary, FS impacts patients across most social aspects of life domains regardless of age - factors that are important when developing biopsychosocial formulations. This review concludes that the multidisciplinary management of FS requires careful assessment of social aspects of life in patients which can then be targeted for treatment, to improve their quality of life, facilitating recovery, and reducing the risk of relapse.
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Affiliation(s)
- Ali A Asadi-Pooya
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; Jefferson Comprehensive Epilepsy Center, Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano-Meran, Italy
| | - Kasia Kozlowska
- The Children's Hospital at Westmead, Westmead Institute of Medical Research, University of Sydney Medical School, Sydney, NSW, Australia.
| | - David L Perez
- Functional Neurological Disorder Clinical and Research Programs, Departments of Neurology and Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Chrisma Pretorius
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
| | - Tyson Sawchuk
- Department of Pediatrics, Cumming School of Medicine, Alberta, Canada; Alberta Children's Hospital Research Institute, University of Calgary, Alberta, Canada.
| | - Aneeta Saxena
- Epilepsy Division, Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA; Functional Neurological Disorder Clinical and Research Program, Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | - Benjamin Tolchin
- Yale Comprehensive Epilepsy Center, Department of Neurology, Yale School of Medicine, New Haven, CT, USA.
| | - Kette D Valente
- Laboratory of Clinical Neurophysiology, Department of Psychiatry, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo, Brazil.
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Wiggins A, Court A, Sawyer SM. Somatic symptom and related disorders in a tertiary paediatric hospital: prevalence, reach and complexity. Eur J Pediatr 2021; 180:1267-1275. [PMID: 33185780 DOI: 10.1007/s00431-020-03867-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 10/20/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
Specialist paediatric services manage a variety of presentations of functional somatic symptoms. We aimed to describe the presentation and management of children and adolescents with somatic symptom and related disorders (SSRDs) requiring admission to a tertiary children's hospital with the objective of informing the development of a local clinical pathway. Patients admitted to any hospital department from May 2016 to November 2017 were identified through an electronic medical record (EMR)-linked diagnosis of SSRD. Each record was reviewed for demographic details and admission histories. The frequency of interspecialty consultations and multidisciplinary team (MDT) family meetings were recorded. One hundred twenty-three patients with SSRD were admitted on 203 occasions to 17 different departments. The median (range) age was 14.3 (7.3-18.3) years. Interspecialty consultations occurred in 84.6% of patients, and MDT family meetings occurred in 18.9% patients. SSRD was diagnosed as an inpatient in 79.9% patients, yet only 40.7% of patients, including those with multiple admissions, had SSRD recorded as a discharge diagnosis.Conclusion: Despite high rates of consultation with hospital teams, the frequency of MDT family meetings was low, and less than half the patients had SSRD documented at discharge. This affirms the value of developing a local clinical pathway. What is Known • Functional somatic symptoms are commonly seen in children and adolescents. • Few studies have explored the reach of functional somatic symptoms across a tertiary paediatric hospital; the majority of inpatient studies have focused on a limited set of disorders or cases referred to psychiatry departments. What is New • Symptoms that spanned multiple body systems were the most common presentation of SSRDs in admitted children and adolescents. • Somatic symptom disorders are less likely to be recorded as a discharge diagnosis compared with functional neurological symptom disorder.
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Affiliation(s)
- Aaron Wiggins
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia.
| | - Andrew Court
- Department of Mental Health, Royal Children's Hospital, Melbourne, Australia
| | - Susan M Sawyer
- Department of Adolescent Medicine, Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
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Raper J, Currigan V, Fothergill S, Stone J, Forsyth RJ. Long-term outcomes of functional neurological disorder in children. Arch Dis Child 2019; 104:1155-1160. [PMID: 31326916 DOI: 10.1136/archdischild-2018-316519] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 06/14/2019] [Accepted: 07/02/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To establish the incidence and long-term outcomes (up to 21 years) of children presenting to a University hospital paediatric neurology service with symptoms due to functional neurological disorder (FND) with particular reference to occurrence of FND or similar symptoms in adulthood. METHODS Retrospective chart review to determine characteristics of the original paediatric FND presentation plus record-linkage with providers of Child and Adolescent Mental Health Services. Chart review of adult medical records for documentation of functional symptoms in adulthood. RESULTS 124 individuals (56% female) met entry criteria. The most common presentations were seizures (18%), sensory loss (18%) and motor symptoms (16%). Frequency gradually increased with age of onset with an incidence in paediatric neurological services of 6 per 100 000 children under 16. In up to 21 years' follow-up (median 8.3 years), 114/124 attained their 16th birthdays by the study census date and were thus eligible for inclusion in an analysis of symptom persistence/recurrence in adulthood. 26/114 (23%) showed evidence of FND in adulthood of sufficient significance to be recorded in medical records. CONCLUSION Paediatric FND is commoner than previous estimates. Even in this selected population of children reaching specialist paediatric neurology services, a high long-term remission rate is observed.
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Affiliation(s)
- Joseph Raper
- Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Victoria Currigan
- Paediatric Neurology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sarah Fothergill
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Jon Stone
- Centre for Clinical Brain Sciences, University of Edinburgh Division of Health Sciences, Edinburgh, UK
| | - Rob J Forsyth
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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Prevalence of dissociative symptoms in adolescent psychiatric inpatients. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2018. [DOI: 10.1016/j.ejtd.2017.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Reddy LS, Patil NM, Nayak RB, Chate SS, Ansari S. Psychological Dissection of Patients Having Dissociative Disorder: A Cross-sectional Study. Indian J Psychol Med 2018; 40:41-46. [PMID: 29403129 PMCID: PMC5795678 DOI: 10.4103/ijpsym.ijpsym_237_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patients present with dissociative disorders as a decompensation to underlying stressful situation. It is clinically important to evaluate the presence, type, and temporal relation of the stressors resulting in dissociation. Further knowing the sociodemographic and psychological profile of the dissociative patient helps in better management. MATERIALS AND METHODS The study included 55 dissociative patients aged between 5 to 45 years. Psychiatric diagnosis was made using ICD-10 DCR. Psychosocial stressors and stressful life events were assessed using presumptive stressful life events scale/life events scale for Indian children and clinical interview. Personality and temperament traits were assessed using medico psychological questionnaire and temperament measurement schedule, respectively. Intelligence quotient (IQ) was assessed using standard progressive matrices and colored progressive matrices. Statistical analysis was done using Epi Info 7 software. RESULTS All patients had significant psychosocial stressors preceding dissociation. Precipitating factor with temporal association was observed in only 83.64%. Family disharmony (41.82%) followed by education-related problems (29.09%) was the most common psychosocial stressors. 61.82% of the dissociative patients had psychiatric comorbidity. Mean IQ of study sample was 92.47. Dissociative children had high emotionality and energy levels but low sociability, rhythmicity, and distractibility. 50% of the adults were neurotic and had emotionally unstable personality. CONCLUSION Dissociative disorders are commonly seen in females, adolescents, and in those from lower socioeconomic status and rural areas. They are always preceded by psychosocial stressors. Most of them have comorbid psychiatric disorders such as depression and anxiety. Neuroticism and emotionally unstable personality traits are common in adult patients while temperamental traits such as low sociability, low rhythmicity, low distractibility, high emotionality, and high energy levels are common in children.
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Affiliation(s)
| | - N M Patil
- Department of Psychiatry, Jawaharlal Nehru Medical College, Belgaum, India
| | - Raghavendra B Nayak
- Department of Psychiatry, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
| | - Sameeran S Chate
- Department of Psychiatry, Jawaharlal Nehru Medical College, Belgaum, India
| | - Saba Ansari
- Specialy Doctor, General Adult Psychiatry, Campbell Centre, Milton Keynes, CNWL, England
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Weber P, Erlacher R. Dissociative sensibility disorders - A retrospective case series and systematic literature review. Eur J Paediatr Neurol 2018; 22:27-38. [PMID: 28899586 DOI: 10.1016/j.ejpn.2017.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 08/09/2017] [Accepted: 08/22/2017] [Indexed: 11/28/2022]
Abstract
CONTEXT Dissociative disorders present a huge challenge in clinical settings. In contrast to other dissociative symptoms, dissociative sensibility disorders are rarely focused on. OBJECTIVE To identify the clinical characteristics and outcomes of dissociative sensibility disorders in children and adolescents, and to review the use of diagnostic procedures. DATA SOURCES For the review, a literature search used Pubmed, Embase, Web of Science, and PubPsych (to 02/2015) and the reference lists of the studies identified. STUDY SELECTION Screening of titles and abstracts; full-text assessment by two reviewers. DATA SELECTION The original case series was identified by using the local data register. DATA EXTRACTION Two reviewers independently reviewed the data and, if they agreed on the relevance, extracted the data. In the original case series, data were extracted retrospectively from the records. RESULTS Sixteen studies and seven case reports were identified, including 931 cases with dissociative disorders. In 210 cases the patient suffered either from a single sensibility disorder or predominantly from sensibility disorders. We identified thirteen further cases in our cohort. In both groups there was female predominance; the mean age of manifestation was early adolescence. The timing of admissions was variable. In approximately 50% of cases a premorbid stressful life event could be identified. Over 75% of cases had a good prognosis with complete resolution. LIMITATIONS Retrospective character of our own data collection, partially missing differentiation between the subgroups of dissociative disorders in the reviewed studies. CONCLUSIONS There is no uniform procedure for diagnostic work-up. The overall short-term prognosis is good.
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Affiliation(s)
- Peter Weber
- University of Basel, University Children's Hospital Basel, Division of Neuropediatrics and Developmental Medicine, Switzerland.
| | - Rahel Erlacher
- University of Basel, University Children's Hospital Basel, Division of Neuropediatrics and Developmental Medicine, Switzerland
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Zarrella I, Russolillo LA, Caviglia G, Perrella R. Continuity and discontinuity between psychopathology of childhood and adulthood: a review on retrospective and prospective studies. RESEARCH IN PSYCHOTHERAPY (MILANO) 2017; 20:248. [PMID: 32913738 PMCID: PMC7451328 DOI: 10.4081/ripppo.2017.248] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/19/2017] [Accepted: 04/22/2017] [Indexed: 02/07/2023]
Abstract
The knowledge of the possible development of a psychiatric disorder, diagnosed for the first time in childhood, is very crucial for all specialists in helping professions working with children and adults. Recent longitudinal studies have demonstrated the possibility that disturbances in childhood may increase the risk of psychiatric illnesses in adulthood, through a homotypic or heterotypic continuity. The aim of this study is to perform a systematic review of existing literature on the psychopathological progression from childhood to adulthood, taking into account both prospective and retrospective studies, and the antecedents and conditions that may encourage/disadvantage the process of continuity of psychopathological syndromes. The study of the possible trajectories of psychopathological disorders is considered fundamental, as it allows the clinician to configure prevention strategies and evaluate interventions, but also to offer to the parent a more concrete vision of the possible risks of their child's disorders to minimize them.
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Affiliation(s)
- Immacolata Zarrella
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome
| | | | - Giorgio Caviglia
- Department of Psychology, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Raffaella Perrella
- Department of Psychology, University of Campania Luigi Vanvitelli, Naples, Italy
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Abstract
Dissociative fugue is rare entity to encounter with possible differentials of epilepsy and malingering. It is one of the dissociative disorders rarely seen in clinical practice more often because of the short lasting nature of this condition. This might also be because of organized travel of the individuals during the episodes and return to their families after the recovery from episodes. This is a case description of a patient who has experienced total three episodes of dissociative fugue. The patient has presented during the third episode and two prior episodes were diagnosed as fugue episodes retrospectively based on the history. Planned travel in this case by the patient to a distant location was prevented because of early diagnosis and constant vigilance till the recovery. As in this case, it may be more likely that persons with Dissociative fugue may develop similar episodes if they encounter exceptional perceived stress. However, such conclusions may require follow-up studies.
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Affiliation(s)
- Hareesh Angothu
- Department of Psychiatry, Kakatiya Medical College, M.G.M. Hospital, Warangal, Telangana, India
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Ensink K, Fonagy P, Berthelot N, Normandin L, Bernazzani O. Response: Behind the closed doors of mentalizing. A commentary on "Another step closer to measuring the ghosts in the nursery: preliminary validation of the Trauma Reflective Functioning Scale". Front Psychol 2015; 6:697. [PMID: 26097458 PMCID: PMC4457017 DOI: 10.3389/fpsyg.2015.00697] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 05/11/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Peter Fonagy
- Research Department of Clinical, Educational and Health Psychology, University College London, Anna Freud Centre London, UK
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Bhattacharya A, Goyal N, Sinha VK. Childhood dissociation as a precursor of mood disorder: A 5 years follow-up case study. Indian J Psychiatry 2015; 57:108-10. [PMID: 25657477 PMCID: PMC4314908 DOI: 10.4103/0019-5545.148548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
| | - Nishant Goyal
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Vinod Kumar Sinha
- Centre for Child and Adolescent Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India. E-mail:
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Emich-Widera E, Kazek B, Szwed-Białożyt B, Kopyta I, Kostorz A. Headaches as somatoform disorders in children and adolescents. Ment Illn 2012; 4:e9. [PMID: 25478111 PMCID: PMC4253363 DOI: 10.4081/mi.2012.e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 02/27/2012] [Accepted: 02/27/2012] [Indexed: 01/30/2023] Open
Abstract
Somatoform disorders are often the main cause for seeking professional advice and performing a number of specialist checks. The aim of the study was to determine the frequency of somatoform disorders in the form of headaches in children and adolescents neurologically diagnosed and the risk factors thereof. Analysis of the biological and situational risk factors were established. Somatoform disorders were diagnosed in 27 out of 276 children with headaches. We concluded that in the differential diagnosis of headaches, somatoform headaches should not be omitted as every 10(th) patient in the developmental age diagnosed on the neurological ward because of headache shows signs of somatoform headaches. In diagnostically difficult cases it is recommended that analysis of biological and situational risk factors be performed with special attention paid to chronic disease of the patient and/or in his immediate family, the patient's psychological disorders and dysfunctional or low social status families. The creation of separate criteria for somatoform disorders of the developmental age should be considered.
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Affiliation(s)
- Ewa Emich-Widera
- Department of Pediatrics and Child Neurology, Medical University of Silesia , Katowice, Poland
| | - Beata Kazek
- Department of Pediatrics and Child Neurology, Medical University of Silesia , Katowice, Poland
| | - Barbara Szwed-Białożyt
- Department of Pediatrics and Child Neurology, Medical University of Silesia , Katowice, Poland
| | - Ilona Kopyta
- Department of Pediatrics and Child Neurology, Medical University of Silesia , Katowice, Poland
| | - Anna Kostorz
- Department of Pediatrics and Child Neurology, Medical University of Silesia , Katowice, Poland
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17
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Abstract
Zu den dissoziativen Störungen vom Bewusstseinstyp werden psychogene Syndrome mit Amnesie, Stupor, Fugue, Trance- und Besessenheit, Identitätsdiffusion sowie Depersonalisation und Derealisation gerechnet. Dissoziative Symptome treten nicht nur im Rahmen dieser dissoziativen Störungen auf, sondern auch bei anderen, vor allem posttraumatischen Störungen. Dass behandlungsbedürftige dissoziative Syndrome bereits im Kindesalter vorkommen, ist unbestritten. Allerdings fehlen adaptierte diagnostische Kriterien für diese Altersgruppe. Stark ergänzungsbedürftig sind auch die Erkenntnisse zu Auftretenshäufigkeit, Komorbidität und Verlauf des Störungsbildes. Behandlungsstrategien sind nicht hinreichend evidenzbasiert. Vor diesem Hintergrund wird ein kurzer Überblick zu Symptomatik, Diagnostik, Komorbidität, Verlauf und Behandlung psychoformer dissoziativer Störungen im Kindes- und Jugendalter gegeben.
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Affiliation(s)
- Thomas Jans
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg
| | - Andreas Warnke
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie Psychosomatik und Psychotherapie des Universitätsklinikums Würzburg
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18
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Renaud S. [Understanding dissociation in patients with borderline personality disorder]. SANTE MENTALE AU QUEBEC 2011; 36:217-242. [PMID: 21983912 DOI: 10.7202/1005822ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Dissociation is a disturbing psychiatric concept fraught with controversy. It is however encountered in clinical contexts and has to be understood by clinicians. This article based on a Pubmed/Ovid on line research with key words dissociation and borderline personality disorder and other references, describes the clinical aspects of the dissociative phenomena in patients with borderline personality disorder. Psychodynamic hypotheses and neurophysiological data are examined to explain dissociation. Neurophysiological and neuroanatomical variables provided by cerebral imagery controlled studies support hypotheses brought forward. The article concludes with a defence mechanism developed within a context of biological predisposition, deprived psychological development and in reaction to trauma. In conclusion, emerging psychotherapeutic solutions are summarized.
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