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Dissociative Disorders Chapter 9
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Introduction Dissociative disorders are defined by a disruption in the usually integrated functions of consciousness, memory, identity, or perception. Dissociative disorders are thought to be quite rare, but when they do occur they may present a very dramatic clinical picture of severe disturbance in normal personality functioning. There is an increase in reported cases of amnesia.
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Amnesia: Assessment Localized amnesia – Inability to recall all incidents associated with the traumatic event for a specific time period following the event. Selective amnesia – Inability to recall only certain incidents associated with a traumatic event for a specific period after the event. Continuous amnesia – Inability to recall events occurring after a specific time up to and including the present. Generalized amnesia – Rare phenomenon of not being able to recall anything that has happened during the person’s entire lifetime, including his or her personal identity Systematized amnesia – Person cannot remember events that relate to a specific category of information, such as one’s family or on particular person or event.
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Localized amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education
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Selective amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education
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Continuous amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education
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Generalized amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education
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Systematized amnesia Assessment Nursing Diagnosis Nursing Intervention Patient and family Education
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Dissociative Fugue: Assessment Characteristic feature of dissociative fugue is a sudden, unexpected travel away from home or customary workplace A person in a fugue state unable to recall personal identity, and assumption of a new identity is common
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Nursing Process Nursing Diagnosis Planning/Implementation Outcomes Evaluation
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Dissociative Identity Disorder: Assessment Characterized by the existence of two or more personalities within a single individual Transition from one personality to another is usually sudden, often dramatic, and usually precipitated by stress
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Nursing Process Nursing Diagnosis Planning/Implementation Outcomes Evaluation
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Predisposing Factors Biological Theories – Genetics Possible hereditary factor – Organic Certain neurological conditions may predispose individuals to DID Psychological Influences:History of Traumatic Experience Sexual abuse, Psychological abuse andPhysical abuse
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Depersonalization Disorder Assessment: Characterized by a temporary change in the quality of self-awareness that often takes the form of: – Feelings of unreality – Changes in body image – Feelings of detachment from the environment – Sense of observing oneself from outside the body
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Symptoms of depersonalization disorder are often accompanied by: – Anxiety – Fear of going insane – Depression – Obsessive thoughts – Somatic complaints – Disturbance in the subjective sense of time Physiological theory – Neurophysiological basis Psychodynamic theory – Emphasizes the psychological conflict and disturbances of ego structure in the predisposition to depersonalization disorder
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Nursing Process Nursing Diagnosis Planning/Implementation Outcomes Evaluation Client/Family Education
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Treatment Modalities Dissociative amnesia – Remove from stress – Intravenous amobarbital – Supportive psychotherapy Dissociative fugue – Cognitive therapy – Group therapy – Family therapy
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Treatment Modalities Dissociative identity disorder – Intense long-term psychotherapy Depersonalization disorder – Various regimens have been tried, although none has proved widely successful.
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