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Psycology » Psychiatry and psychotherapy » Neurosis: Part II » Conversion and dissociative disorders: Treatment

Usually acute dissociative and conversion disorders observed in general practice or in emergency departments for treatment is enough persuasion and suggestion calming combined with immediate efforts made to resolve the stressful circumstances that triggered the reaction. For cases lasting more than a few weeks, a more aggressive treatment. The usual method of therapy are efforts aimed at eliminating the factors exacerbating symptoms and encourage normal behavior. Patient should explain that its existing malfunctions (eg, impaired memory or inability to move your hand) are not caused by physical illness and psychological factors. It is often useful to explain the disorder result lock psychological process between, for example, a plan to move the patient's arm and neural mechanisms that provide the movement. Then the patient should be said that he can overcome his illness, if it is hard to try. If necessary, it is possible to provide medical care, typically in the form of physiotherapy. However, his attention switched from the symptoms of the problems that triggered the disorder. Hospital staff should be involved in patient care, and this is best done by encouraging him to self-help. It is important not to make excessive concessions to the patient because of its existing disabling disorders, for example, a patient who can not walk, should not be given a wheelchair, and the patient, who fell to the floor, you need to motivate yourself to get up and

did not help him in this. To achieve these goals requires a clear plan under which all medical staff will observe a consistent approach to the patient.

Otreagirovanie

Acting out (removal of the stress caused by repressed emotions by playing in the mind of conflict. Ed.) Can be carried out by means of hypnosis or intravenous injection of a small amount of amobarbital. In the state, coming as a result, encourage the patient to relive those stressful events that triggered the disorder, and to express their attendant emotions. These methods have been used successfully in the treatment of acute dissociative and conversion disorders encountered by soldiers in wartime (see Chap. 18). They are much less valuable in civilian life when more gradual methods allow the patient to take the overcoming symptoms and finding solutions to problems, to provoke them.

Psychotherapy

Patients suffering from dissociative and conversion disorders usually respond well to exploratory psychotherapy concerning their past life, and often produce startling memories of childhood sexual behavior and other problems, apparently related to dynamic psychotherapy. However, a detailed study of these ideas is rarely fruitful. Typically, this study contributes only divert attention from the pressing problems of the patient and can lead to overdependence and transfer reactions that are difficult to control.

Other treatments

Drug therapy Not used in the treatment of these conditions, if they are not secondary to a depressive or anxiety disorder, requiring such treatment. Specific methods Behavioral therapy Also have little value. There are reports on the application of generating operant conditioned reflex, for example, in the treatment of psychogenic blindness (Parry Jones et al. 1970), but netdokazatelstv that these or other technique is more effective than a suggestion.

Subsequent management

Most patients with dissociative and conversion disorder occurs due to a simple improvement of treatment if But no Strong motivations to remain patient, as, for example, the possibility to obtain compensation. Those patients in whom there was no improvement, should be carefully re-examine whether there was nevyyavlennsch physical illness. All patients, regardless of whether they come or not improving, should be observed long enough to exclude the possibility of miss not detected in time physical illness. It usually takes six months to a year, but to prevent such a condition, such as multiple sclerosis, it may take much longer follow-up. It should be carried out carefully and tactfully with the aim to identify any symptoms suggestive of organic disease, without introducing new psychological problems. Often best to leave it to the general practitioner.

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