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

Feature issues

Despite the fact that the conversion and dissociative symptoms are not produced intentionally, they display a representation of the patient about the disease. It happens that mimics the symptoms of a sick relative or friend. Sometimes they occur on the basis of their own experience of the patient in relation to an illness, for example, dissociative amnesia may occur in those who previously suffered a head injury. Playing is the least accurate of the disease in people with little knowledge about it, such as children or the mentally retarded, and most accurate in possessing special knowledge, such as those working in the hospital. As a rule, there are clear differences between the signs and symptoms of conversion and dissociative disorders and signs and symptoms of organic disease, for example, the spread area of ​​anesthesia does not match the anatomical innervation of the site. Therefore, in each case it is necessary to conduct a thorough medical examination.

Symptoms of conversion and dissociative disorders usually provide some benefits to the patient. Therefore, following Freud believed that these disorders bring Secondary benefit (Primary benefit is that the anxiety that arises as a result of psychological conflict is excluded from the consciousness of the patient). So, a woman can be spared from the care of an elderly relative, if it develops conversion disorder, accompanied by paralysis of the arm. Although secondary gain characteristic of the conversion and dissociative disorders, it is not limited to, after all, real people with physical illness sometimes acquire some advantages because of its unhappiness. Woman with hand paralysis due to organic cause can be pleased that relieved of caring for elderly relatives. A secondary benefit is also sometimes observed with other neuroses, for example, a woman suffering from agoraphobia may get more attention from her husband, unable to leave the house. It follows that, although secondary benefit and is an important characteristic feature of the conversion and dissociative disorders, it can not be used to confirm the diagnosis. Patients with conversion and dissociative symptoms often exhibit suffering less than the expected state, which is sometimes called BelleIndifference beautiful indifference (a term taken from the French writers of the XIX century). It is not the same stoicism those patients who do not allow themselves to show their suffering. Patients with conversion disorder may not show concern about their symptoms, but often finds exaggerated emotional reactions in other ways. In support of this Lader and Sartorius (1968) in a small group of patients with conversion disorder have found an exceptionally high level of autonomic responses.

Movement disorders

These disorders include paralysis of voluntary muscles, tremors, tics and gait disturbance. On examination, the patient's limb with psychogenic Palsy Often it turns out that the lack of movement is the result of the simultaneous action of the flexors and extensors. Although in response to a request from the affected part of the body move the muscle activity is absent, other tests are usually found that the muscle is able to respond when the patient's attention is diverted anything. FIELD paralysis innervation does not match Current body. Corresponding changes are absent reflexes, in particular, plantar flexion reflex always. Wasting no, except for chronic cases in which sometimes occurs atrophy. In all other cases, the presence of muscle wasting strongly indicates organic cause. Likewise, despite the fact that the limbs are held in a flexed position, the true contractures occur infrequently. Psychogenic Gait disturbance, As a rule, it is unusual to attract attention to the patient and are exacerbated when watching him. This type of gait is not similar to the one described in certain neurological disorders. And although in testing equilibrium may appear noticeable instability, it often disappears when the patient to divert attention. Psychogenic Tremor, Usually rough and involves the entire limb. It intensified when attract attention to it, but the same is true for other types of tremor caused by neurological causes. Horeoatetoidnye movement, the causes of which are organic in nature, can be easily confused with psychogenic symptoms. Before you diagnose any dysmotility as psychogenic, you should always carefully consider the possibility of diseases of the nervous system. Psychogenic Aphonia And St. Zuchary's disease Not accompanied by any pathology of the lips, tongue, palate, or the vocal cords, and the patient may cough normally. They are usually more pronounced than the corresponding condition caused by organic lesions.

Disorders of perception

Sensory symptoms include anesthesia, paresthesia, hyperesthesia, and pain, as well as deafness and blindness. Generally psychogenic sensory disorders differ from those observed in organic disease spread, the scheme is not appropriate innervation of this part of the body, changing intensity, as well as a reaction to the suggestion. The latter point should be very careful to use in the diagnosis, because suggestible patients with sensory symptoms of organic origin may also respond to the suggestion. Hyperesthesia Usually felt in the head or in the stomach and can be described as painful or burning. Although widely believed that frilly descriptions confirm psychogenic origin of such symptoms, it is an unreliable diagnostic criterion, because patients with hysterical personality traits can describe the symptoms of organic disease of the same pretentious language. Diagnosis Psychogenic pain Should be considered only after a thorough search of organic causes (psychogenic pain is described later in Sec. 12). Psychogenic Blindness May take the form of concentric narrowing of the visual field (tunnel vision), but there are also other visual field defects.

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