Dissociative disorder in Mayer Rokitansky Küster Hauser syndrome with pulmonary agenesis: a case report

Background The Mayer Rokitansky Küster Hauser (MRKH) syndrome is a rare congenital disorder characterized by the absence of uterus and vagina in a patient who is phenotypically a female, with 46 XX karyotypes. It affects 1 in 4000 to 5000 female new-borns. Pulmonary agenesis is a rare association in this MRKH syndrome. Females with MRKH face various mental health issues and psychological disturbances, including dissociative disorder which is a stress-related psychiatric disorder. Dissociative disorder in MRKH syndrome is under-recognized and under-treated. Case presentation A 23-year-old unmarried woman presented to the emergency forabnormal behaviour attack. Recurrent episodes of dissociative convulsions were present most of the time with MRKH syndrome as the pertinent stressor. Both antidepressants and psychotherapy helped to decrease the frequency of dissociative convulsions and come interms with the syndrome. Conclusion This case describes dissociative disorder as the presentation and comorbid condition of MRKH syndrome and the impact of MRKH syndrome on the patient. We attempt to explain the occurrence of dissociative disorder in MRKH syndrome and the results of under-recognition and under-treatment of the same. We aim to highlight the presence of commonly treatable conditions associated with a rare syndrome and its effect when untreated and unrecognized.

A Descriptive Study on the Clinical Correlates of Conversion Disorder

Aim: Conversion disorder is defined by the presence of deficits affecting the voluntary motor or sensory functions lacking any known neurological cause. The aim of the study is to describe the sociodemographic profile and clinical characteristics including the frequency distribution of various types of presentations of patients with conversion disorders in a tertiary care psychiatric facility and to assess the presence of depression and anxiety and its level of severity in those patients. Methods: After obtaining informed consent, 50 consecutive patients who had met with the ICD-10 diagnosis criteria for conversion disorder and those who meet the inclusion/exclusion criteria, were enrolled for the study. They were interviewed using a semi-structured Performa and were administered Hospital Anxiety and Depression scale (HADS) and the results were analysed using SPSS software and interpreted. Results: Majority of the study patients were young adolescents (48%), females (76%), rural residents (60%), mostly unmarried (46%). Dissociative motor disorders (30%) were the most common presentation followed by mixed dissociative disorder (26%) and Dissociative convulsions (22%). HAD scale revealed that, both depression and anxiety scores were significantly high in major number of patients. Conclusion: The most common presenting symptom was that of dissociative motor type followed by dissociative convulsions with considerably high rates of depression (48%) and anxiety (54%). This made us to conclude that conversion as a phenomenon emerges to uphold its significance as a non-verbal communication process of the subconscious Mind. Keywords: Conversion, Dissociation, Hysteria, Dissociative Motor Disorder, Dissociative Convulsions, Laterality, Depression, Anxiety.

Prevalence of Dissociative Convulsions in Patients with Dissociative Disorder in a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Introduction: Dissociative disorder is one of the common psychiatric problems encountered very frequently in the hospital setting. The aim of the study is to find out the prevalence of dissociative convulsions type in patients suffering from dissociative disorder attending Psychiatry outpatient department of a tertiary care hospital. Methods: The descriptive cross-sectional study was carried out in a tertiary care hospital from February 2019 to July 2019 after taking ethical approval (MEMG/IRC/210/GA). The patients attending Psychiatry outpatient department of Manipal Teaching Hospital, Pokhara, Nepal were included in the study. The diagnosis of dissociative convulsion and other types of dissociative disorder was done according to the International Classification of Disease–10 Classification of Mental and Behavioural Disorders - Diagnostic Criteria for Research. Statistical Package for Social Sciences version 22 was used for the analysis of the data and point estimate at 95% Confidence interval was calculated along with frequency and proportion for binary data and the analysis was done. Results: Sixty six patients were included in the study. The prevalence of dissociative convulsion was 86.3% in the present study, at 95% Confidence interval, (78-94.6%). Five patients (7.6%) were found to be suffering from dissociative motor disorders and 4 (6.1%) patients were suffering from trance and possession disorder. Conclusions: The prevalence of dissociative convulsion type is high in patients suffering from dissociative disorder in the Nepalese context. Future studies should be conducted to understand this disorder and to propose therapeutic guidelines.

A case of dissociative convulsions presented as frequent epilepsy-like seizures

Dissociative convulsions, a prominent form of dissociative (conversion) disorder formerly known as hysteria, are a common and elusive differential diagnosis from epilepsy. However, the treatment of such patients is always challenging and frustrating due to poor response to the routinely used interventions in most situations. Here, we present a case with dissociative convulsions in order to catch the eye of the clinicians and researchers on the recognition of clinical manifestation and exploration of therapeutic strategies.

Functional non-epileptic attacks: essential information for psychiatrists

Functional non-epileptic attacks (FNEA) are seizure-like events occurring in the absence of epilepsy. Having had many different names over the years including dissociative convulsions and pseudo-seizures, they now fall in the borderland between neurology and psychiatry, often not accepted by either specialty. However, there is evidence that there is a high rate of psychiatric comorbidity in these patients and therefore it is likely that psychiatrists will come across patients with FNEA and they should know the broad principles of assessment and management.We have provided a clinically based overview of the evidence regarding epidemiology, risk factors, clinical features, differentiation from epilepsy, prognosis, assessment and treatment.By the end of this article, readers should be able to understand the difference between epileptic seizures and FNEA, know how to manage acute FNEA, and understand the principles of neuropsychiatric assessment and management of these patients, based on knowledge of the evidence base.Consent statementInformed consent was obtained from the patient for publication of Box 1.Declaration of interestNone.