Renielle Raphael N.

Laurean NMF BSN 3

February 4, 2011

Dissociative Disorders
Conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception. The hypothesis is that symptoms can result, to the extent of interfering with a person's general functioning, when one or more of these functions is disrupted.

Psychogenic Amnesia
Also known as functional amnesia or dissociative amnesia is a memory disorder characterized by extreme memory loss that is caused by extensive psychological stress. As well as, abnormal memory functioning in the absence of structural brain damage or a known neurobiological cause; severe cases are very rare. Psychogenic amnesia is defined by the presence of retrograde amnesia an absence of anterograde amnesia Dissociative amnesia is due to psychological rather than physiological causes and can sometimes be helped by therapy.

Fugue State
Formally Dissociative Fugue, is a rare psychiatric disorder characterized by reversible amnesia for personal identity, including the memories, personality and other identifying characteristics of individuality. The state is usually short-lived, but can last months or longer. Dissociative fugue usually involves unplanned travel or wandering, and is sometimes accompanied by the establishment of a new identity. After recovery from fugue, previous memories usually return intact, but there is complete amnesia for the fugue episode. Additionally, an episode is not characterized as a fugue if it can be related to the ingestion of psychotropic substances, to physical trauma, to a general medical condition, or to psychiatric

conditions such as delirium, dementia, bipolar disorder or depression. Fugues are usually precipitated by a stressful episode, and upon recovery there may be amnesia for the original stressor.

Depersonalization Disorder
A dissociative disorder in which the sufferer is affected by persistent or recurrent feelings of depersonalization and or derealization. Diagnostic criteria include persistent or recurrent experiences of feeling detached from one's mental processes or body. The symptoms include a sense of automation, going through the motions of life but not experiencing it, feeling as though one is in a movie, feeling as though one is in a dream, feeling a disconnection from one's body; out-of-body experience, a detachment from one's body, environment and difficulty relating oneself to reality.

Dissociative Identity Disorder

A psychiatric diagnosis that describes a condition in which a person displays multiple distinct identities or personalities each with its own pattern of perceiving and interacting with the environment.

Diagnosis
A mental health professional makes a diagnosis of a dissociative disorder by taking a careful personal history from the client/patient and family members. It is important that the therapist learn the details of the person's life. No laboratory tests are required to make a diagnosis of dissociative disorder nor are there any physical conditions that must be met. However, it is very important not to overlook a physical illness that might mimic or contribute to a psychological disorder. If there is any question that the individual might have a physical problem, the mental health professional should recommend a complete physical examination by a medical doctor. Laboratory tests might be necessary as a part of the physical workup.

Nursing Diagnosis
Ineffective individual coping Social isolation Impaired social interaction High risk for violence to self or others Anxiety Risk for injury

Short Term Objectives

Recognizes potentially dangerous behaviors or personalities and contracts for safety. Client or family is participating in therapeutic regimen.

Long Term Objectives

Effective coping skills, understanding of underlying dynamics of condition are demonstrated Recovers deficits in memory. Major/emerging personality has been chosen and accepted or client is managing stress without resorting to dissociation.

Medical Interventions
The treatment for dissociative amnesia is therapy aimed at helping the client restore lost memories as soon as possible. If a person is not able to recall the memories, hypnosis or a medication called Pentothal can sometimes help to restore the memories. Psychotherapy can help an individual deal with the trauma associated with the recalled memories. Hypnosis is often used in the treatment of dissociative fugue. Hypnosis can help the client recall his/her true identity and remember the events of the past. Psychotherapy is helpful for the person who has traumatic, past events to resolve.

 Treatment for dissociative identity disorder involves long-term psychotherapy that helps the person merge his/her multiple personalities into one. The trauma of the past has to be explored and resolved with proper emotional expression. Hospitalization may be required if behavior becomes bizarre or destructive. Treatment for depersonalization disorder is very difficult. However, the condition can improve with a thorough therapeutic exploration of the trauma in the individual's past and the expression of the emotions associated with that trauma.

Nursing Invterventions
Provide safe environment; protect client/others from injury. Assist client to recognize anxiety. Promote insight into relationship between anxiety and development of dissociative state/other personalities. Support client/family in developing effective coping skills and participating in therapeutic activities.

Evaluation
Neurological Testing - To rule out organic brain conditions related to trauma, tumor, congenital defects, and temporal lobe epilepsy, symptoms of which often parallel manifestations of Dissociative identity disorder. Psychosocial Assessment - such as Rorschach, Thematic Apperception Test, Weschler Adult Intelligence Scale, Dissociative Experiences Scale, Dissociative Disorders Interview Schedule, and Hypnosis or Amobarbital Interviews - As indicated to provide behavioral observation and documentation describing the character, duration, frequency, and precipitation of behavioral changes and client comments or complaints essential to the diagnostic process, as these clients are frequently misdiagnosed initially because of blurring of symptoms that parallel other psychiatric problems, commonly depression, neuroses, personality disorders, and schizophrenia.

 Drug Screen - Assess for concomitant substance use.