Showing posts with label Disorders. Show all posts
Showing posts with label Disorders. Show all posts

Friday, 27 April 2018

Conversion Disorder: PNES,Trance, Possession disorders Signs, Symptoms and Management

April 27, 2018

Conversion Disorder


Conversion Disorder refers to the presence of sensory and or motor symptoms without an adequate underlying medical explanation. 


The word 'Conversion' is used as the assumption is that psychological distress is 'converted' into physical(usually neurological) symptoms. 

Other terms that are used by clinicians for Conversion Disorder are as 'Non-organic', Psychosomatic, etc
What is a Conversion Disorder?

Examples of Psychological stressors in children are as follows:

  • Being bullied at school.

  • Parental separation.

  • Illness or death of a parent, sibling or a friend.

  • Beak-up

  • Physical, emotional or sexual abuse.

List of Conversion Disorders-

1) Motor:
  • Weakness
  • Loss of speech
  • Limb paralysis
  • Abnormal movements

2) Sensory:
  • Anesthesia
  • Paraesthesia
  • Loss of sight, touch or hearing

3) Mixed Sensory and Motor.


4) Psychogenic non-epileptic seizures (PNES) previously known as pseudoseizures.

Dissociative(Conversion) Disorders in ICD (International Classification of Disease)-10
  1. Dissociative Amnesia
  2. Dissociative Fugue
  3. Dissociative Stupor
  4. Trance and Possession disorders
  5. Dissociative motor disorder
  6. Dissociative convulsions
  7. Dissociative anesthesia and sensory loss
  8. Other Dissociative disorders: 
  •     Ganser's syndrome
  •   Multiple personality disorder

1-Dissociative Amnesia- The patient undertakes an unexpected yet seemingly organized journey away from home, or from their ordinary place of work and social activities. 


There is amnesia, either partial or complete, for the journey.



 2-Trance and Possession disorders- There is a temporary alteration of the states of consciousness, loss of personality, repetitive repertoire of movements and speech.  


Whereas, in Possession disorder, an individual behaves as if taken over by a spirit, deity or higher power. The patient's such behaviors occurring in culturally-sanctioned religious rituals are not diagnosed as pathological.


3-Multiple Personality Disorder- Multiple Personality Disorder also called Dissociative Identity Disorder, in this disorder, the person displays two or more distinct personalities. 

At any one time, one personality takes full control. Each personality has its own memories and behaviors patterns.


EPIDEMIOLOGY OF CONVERSION DISORDERS-

  • More common in females in both adults and children.

  • Can occur at any age but (rare in under age of 8 years, or for a first episode after the age of 35 years).

  • Motor symptoms are common such as paralysis and weakness.

  • These disorders seem to be more common within those with lower levels of education, (particularly lack of medical knowledge.

  • More common in developing countries than in affluent nations.

  • More common in lower socio-economic classes.

  • More common in rural areas than in urban areas.

  • Conversion Disorders are mainly associated with co-morbid depression or anxiety disorder and antisocial personality disorders in males.


FACTORS SUGGESTING CONVERSION DISORDER 


  • Symptoms follow a psychological stressor.

  • Presenting symptoms are atypical.

  • Elicited signs are atypical.

  • Investigations are normal or not consistent with the severity of symptoms.

  • Past history of conversion disorder.

  • Past history of depression/ anxiety and family history of depression/anxiety.


                Psychogenic Non-epileptic Seizures (PNES)

Previously PNES is known as Pseudoseizures, Psychogenic seizures, and Non-epileptic seizures. In ICD-10 PNES is called 'Dissociative convulsion'. 


The usual onset of PNES is in early adulthood but can also occur in children and elders as well. According to the report, it's more common in females (F: M ratio of 7:3).


Factors Suggestive of PNES-

  • Occurrence only in front of an audience (viz. Family)

  • No loss of consciousness.

  • No tongue biting or major injury.

  • Bicycling of leg movements(during the episode).

  • No incontinence. 

  • Side to side turning of the head.

  • Emotional triggers such as arguments and panic attacks.

  • Weeping or stuttering during the episode.

  • Shallow breathing.

  • Multiple vague somatic symptoms such as pain and fatigue.


PNES Management-

  • Supportive counseling.
  • Anxiety management and relaxation training.
  • Cognitive Behaviour Therapy(CBT).
  • Psychotropics such as Antidepressants and Benzodiazepine could be helpful for the patient.

Other helpful and useful recourses-

Conversion Disorder Forum.

Conversion Disorders Forums



Thursday, 26 April 2018

Eating Disorders: Anorexia Nervosa, Bulimia and BED- Symptoms, Epidemiology And Etiology

April 26, 2018

Eating Disorders


Studies show that 1/3 of boys and one-half of girls have engaged in some kind of unhealthy behavior to control the weight behaviors like fasting, skipping meals and smoking for their weight down. 


Few facts about eating disorders and also some signs that it's time to seek help.  A diet is not the same thing as an eating disorder but diets can lead to eating disorders because they encourage preoccupation with food and with your weight.


Eating Disorders Anorexia Nervosa, Bulimia and BED- Symptoms And Aetiology orders
 One of the common myths about eating disorders and dieting is that it's all about the weight but its wrong in fact diets can actually give us a perceived sense of control over our lives, taking a diet to the extreme can have serious consequences for your mental and physical health. 


The negative side effects of extreme dieting can include a preoccupation with food. Actually, extreme dieting has been proven to lower your metabolism over the long term which makes it even harder to lose weight and stay fit in the future.



Etiology of Eating disorders- The exact etiology of an eating disorder is still not known yet. But the best way to consider eating disorders as having a complex multifactorial etiology involving cultural, family, genetic, and other biological factors as well.


 For many years AN was thought to be primarily culturally influenced disorders. High co-morbidity with Depression and Anxiety disorders suggests possible shared etiology with those disorders. 


Other potential risk factors include- Early childhood eating, childhood sex abuse.


  Whereas, low confidence(poor self-esteem) and excessive self-criticism are seen in both Anorexia Nervosa and Bulimia Nervosa. 


An obsessive-compulsive personality(Perfectionism) disorder is associated with AN and  Borderline personality disorder (impulsivity) is associated with BN.


(Also, read Personality Disorder: Types, Causes, And Symptoms: Cluster A, Cluster B, and Subtypes.)



Types of Eating Disorders: Signs and Symptoms


                         1. Anorexia Nervosa (AN)


1). Clinical symptoms of Anorexia Nervosa are as follows-

  • Reduced body weight.

  • Self-perception that one is too fat 

  • Intense fear of gaining weight and becoming fat

  • Self-induced weight loss by starvation, vomiting, excessive exercise, misuse of laxatives, appetite suppressants, etc.


2). Common behaviors are seen in Anorexia Nervosa-

  • Wearing multiple layers of clothing.

  •  While eating- cutting food into small pieces, eating very slowly/picking at foods.

  • Counting calories in food items(before eating).

  • Preparing elaborate meals for others.


                                 2. Bulimia Nervosa

1). Clinical Symptoms of Bulimia Nervosa-

  • A strong desire or compulsion (craving) to eat.

  • A large amount of food consumed within a short period(i.e under 2 hours).

  • Lack of control over eating.

  • Self-perception of being too fat (even a person having a normal weight).


                                      3. Binge Eating Disorder  


1). Clinical Symptoms of Binge Eating Disorder-

  •  Eating more faster than usual.

  • Eating even when not hungry.

  • Eating alone(due to embarrassment).

  • Feeling disgusted with self or guilty afterward.

  • No compensatory behaviors like starvation and vomiting 

Types of food that are consumed in Binge eating disorders are mainly cakes, ice-creams, donuts, cookies, chips, etc.
According to the definition, a patient with Anorexia Nervosa has an underweight, a patient with  Bulimia Nervosa are usually with a normal weight and patient with BED tends to have an overweight.



Epidemiology of Anorexia Nervosa-



The Lifetime Prevalence of Anorexia Nervosa is about 1% in the community among females. According to the studies it is more common in females.


  • Incidence is about 8 per 100,000 population.

  • Highest Incidence (more than 100 per 100,000) is in the 15 to 19 age group.



Epidemiology of Bulimia Nervosa-

The Lifetime Prevalence of Bulimia Nervosa is about 2% (in females).


  • Incidence is about 12 per 100,000 population.

  • Much  more common in females with an F: M ratio of  about 5:1

  • Age of onset is decreasing: Highest Incidence used to be in the 25 to 29 age group, but now it is the 15 to 19 age group (due to early detection).


Epidemiology of Binge Eating Disorder-

Lifetime Prevalence is about 4% in females and 2% in males, so F: M ratio is about 2:1
  • The peak age of Incidence is between in the ages of  25 and 34 years.

Other helpful resources:

Epidemiology of Eating Disorders






Epidemiology and Course of Anorexia Nervosa in the Community




Sunday, 22 April 2018

Mood Disorders- Depression Vs Bipolar Disorder :Symptoms, Neurobiology And Treatment

April 22, 2018

Depression vs Bipolar Disorder


Mood disorders are also known as 'Affective' disorders the two main mood disorders are DEPRESSION AND BIPOLAR DISORDER. Patient with depression(both Unipolar and Bipolar) and Mixed states of Bipolar disorder are at increased risk of suicide.

   About 5 to 10% of patients with untreated /inadequately treated Unipolar Depression commit suicide and about to 10 to 15% of patients with Bipolar disorder commit suicide.



Mood Disorders- Depression Vs  Bipolar Disorder :Symptoms, Neurobiology And Treatment

In Depression, the patient experiences one or more episodes of low mood which is also called 'Unipolar' disorder. Whereas in bipolar disorder the patient experiences episodes of both low mood(depression) and abnormally elevated mood which could be either Hypomania or Mania, or the patient might experience 2 or more episode of abnormally elevated mood (i.e Hypomania or Mania).  



 Clinical Symptoms of depression- 

  • A depressed mood that is clearly abnormal for a person.

  • Inability to derive pleasure from normally pleasurable activities.

  • Reduced concentration

  • Sleep disturbance.

  • Appetite disturbance(usually decreased or low weight).

  • Increased fatiguability.

  • Retaradtion.

  • Feeling hopeless, helpless, worthless.

  • Suicidal ideation/plans/acts.

Difference between Mania and Hypomania

  • Mania represents a more severe form of abnormally elevated mood than Hypomania. 

  • Patient with Hypomania has insight into their illness.

  • Patient with  Mania tends not to have insight.

  • Patient with Hypomania never has psychotic symptoms.

  • Patient with Mania may or may not have psychotic symptoms.

Clinical Features of Hypomania 
  • An elevated mood that is clearly abnormal for the person.

  • Increased activity or restlessness.

  • Increased energy.

  • Less sleep.

  • Increased sociability.

  • Decreased concentration. 

Clinical Features of Mania
  • Irritable moods that are clearly abnormal.

  • Severe interference with a personal functioning.

  • Grandiosity/increased self-esteem.

  • Restlessness

  • Disinhibition/inappropriate behavior.

  • Increased perceptual sensitivity.  


                            Depression in Bipolar Disorder

Some symptoms that may suggest bipolar depression:
  • Atypical features (increased sleep, and appetite).

  • Psychomotor retardation.

  • More frequent episodes.

  • A family history of bipolar disorder.

  • Male gender(equal gender for prevalence for bipolar).

  • More abrupt onset.

  • Easily destructible and unable to focus.

  • Engage in risky behavior.



                                  Rapid Cycling Of Bipolar disorder

At least four mood  episodes (hypomania/mania/depression) should occur within  a 12-month period and these episodes are demarcated by: 
  •  period of remission.

  • switch to an episode of opposite polarity.

  • switch to an episode of mixed polarity.

The common risk factors that include are alcohol abuse, Thyroid dysfunction, life stressors, relatively less responsive to treatment and a higher risk of suicide.



Neurobiology Of Mood Disorder-

Depression has been studied far more than Bipolar disorder. Depression reduced the volume of  Hippocampus bilaterally (whether a cause of effect or illness) also it reduced the activity of dorsolateral prefrontal cortex. Whereas in Bipolar disorder, studies have shown the inconsistent results in Hippocampal volume. Other systems potentially involved in Mood disorders :

  • Endocrine: e.g HPA axis dysregulation; Oestrogens

  • Immune system 

  • Abnormalities in emotional processing 

  • Role of Neurotrophic factors: e.g. BDNF




Where can a patient get help?

If you also have bipolar disorder and experiencing those symptoms then please do call to your counselor or physician or your therapist or psychiatrist but if you feel suicidal or having suicide ideation then please call at 911




How is Bipolar disorder treated?

Bipolar disorder can be treated now just like other diseases there are psychotherapy and safe medications. So if you are also going through the Bipolar disorder so, please seek help and see your physician or therapist because doing so will help you to get back into your normal life.

*Some other adjunctive treatment options for mood disorders

  • Physcho-education

  • Guided self-help

  • Phototherapy

  • Yoga

  • Acupuncture

  • Sleep Deprivation

  • Exercise Programmes.