Functional Confusion in Psychiatry

Year 2022, , 113 - 118, 31.03.2022

Osman Ozdemir , Pınar Guzel Ozdemir

https://doi.org/10.18863/pgy.908344

Cited By: 1

Abstract

In this paper, functional confusion defined as clinical condition which is the patient can not focus on a certain issue, reply the questions and explain his/her story during psychiatric interview is focused. It is hypothesized that functional confusion seem most prevelant in patients with borderline personality disorder and somatic symptom and related disorders. Relationship between inability of mentalization, dissociation, cognitive disturbances and functional confusion seen in patients with borderline personality disorder is emphasized. Similarities are explained between alexitimia and can not expression of emotional complaints in the patients with somatic symptoms and related disorders. Relationship between somatoform dissociation and confusion has been discussed. In the article, also it has been argued that childhood traumatic experiences might play a role on vulnerability to functional confusion. Functional confusion may contribute to emergence of clinical conditions and severity of illness in adulthood period. Patients with functional confusion should be treated with psychotropic medications including low dose antipsychotic drugs rather than psychotherapeutic interventions.

Keywords

Functional, confusion, mentalization, alexitimia, dissociation, somatoform dissociation

Psikiyatride Fonksiyonel Konfüzyon

Abstract

Bu yazıda psikiyatride görüşme esnasında hikâyesini anlatmakta zorlanan, belli bir konuya odaklanamayan ve sorulara amaca yönelik cevaplar veremeyen hastalarda görülen klinik tablo olarak tanımlanan fonksiyonel konfüzyon üzerinde durulmuştur. Fonksiyonel konfüzyonun en sık borderline kişilik bozukluğu ve bedensel belirti ve ilişkili bozuklukları olan hastalarda görüldüğü öne sürülmektedir. Borderline hastalarda görülen fonksiyonel konfüzyonun zihinselleştirme kapasitesindeki yetersizlik, disosiyasyon ve bilişsel bozukluklar ile ilişkili olabileceği vurgulanmıştır. Bedensel belirti ve ilişkili bozukluklarda hastaların duygusal yakınmalarını sözel olarak tanımlayamaması ile alexitimi arasındaki benzerlik üzerinde durulmuştur. Somatoform disosiyasyon ve konfüzyon arasındaki ilişki ele alınmıştır. Yazıda ayrıca çocukluk çağı travmalarının fonksiyonel konfüzyon için yatkınlaştırıcı bir rol oynayabileceği ileri sürülmektedir. İleri dönemde klinik tabloların ortaya çıkmasında ve semptomların şiddetinde fonksiyonel konfüzyonun etkili olabileceği ifade edilmektedir. Fonksiyonel konfüzyonu olan hastalarda tedavide psikoterapötik müdahalelerden önce düşük doz antipsikotik eklenmesini de içeren psikofarmakolojik müdahaleler önerilmektedir.

Keywords

Fonksiyonel, konfüzyon, boderline kişilik bozukluğu, zihinselleştirme, alexitimi, disosiyasyon, bilişsel bozukluklar, bedensel belirti bozukluğu, somatoform disosiyasyon

References

• Acar T, Acar BA, Karabacak M, Aras YG (2018). Konfüzyon ile prezente olan HaNDL sendromu: Nadir bir olgu sunumu. Nöro Psikiyatr Ars, 4:340-342.
• Allen JG, Fonagy P, Bateman AM (2013). Klinik uygulamada zihinselleştirme. Özakkaş T (Çeviri Ed.) 1. Baskı, İzmit: Psikoterapi Enstitüsü Yayınları.
• American Psikiyatri Birliği. Ruhsal Bozuklukların Tanısal ve Sayımsal Elkitabı, Beşinci Baskı (DSM-5), Tanı Ölçütleri Başvuru elkitabı’ndan (çeviri ed. E Köroğlu) Ankara, Hekimler Yayın Birliği, 2013.
• Berrios GE (1982). Disorientation States and Psychiatry. Comprehensive Psychiatry, 23:479-591.
• Berrios GE (1983). Orientation failures in medicine and psychiatry:discussion paper! Journal of the Royal Society of Medicine Volume, 76:379-385.
• Brand BL, Lanius RA (2014). Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation? Borderline Personality Disorder and Emotional Dysregulation, 1:13.
• Choudhary S, Thapa K (2017). Mental Status Examination of Borderline Personality Disorder. J Psychol Clin Psychiatry, 8: 00476.
• Dell’Osso B, Berlin H, Serati M, Altamura AC (2009). Borderline Personality Disorder: New Research: Neuropsychobiology, comorbidity and dimensional models in borderline personality disorder: Critical issues for treatment. (Eds Jackson MH, Westbrook LF):59-79. Milan, Nova Science Publisher.
• Dereboy İF (1990). Alexitimi: Bir Gözden Geçirme. Turk Psikiyatri Derg, 3:157-165. Deville C, Moeglin C, Sentissi O (2014). Dissociative disorders:Between neurosis and psychosis. Case Reports in Psychiatry, 455892, 6 pages.
• do Espirito Santo HMA, Pio-Abreu JL (2007). Dissociative disorder and other psychopathological groups: exploring the differences through the Somatoform Dissociation Questionnaire (SDQ-20). Braz J Psychiatry, 29:354-358.
• El-Hage W, Darves-Bornoz JM, Allilaire JF, Gaillard P (2002). Post-traumatic somatoform dissociation in French psychiatric outpatients. Journal of Trauma and Dissociation, 3:59-74.
• Farina B, Liotti M, Imperatori C (2019). The role of attachment trauma and disintegrative pathogenic processes in the traumatic-dissociative dimension. Frontier in psychology, 10:1-18.
• Fertuck EA, Stanley B (2006). Cognitive disturbance in borderline personality disorder: Phenomenologic, social cognitive, and neurocognitive findings. Current Psychosis & Therapeutic Reports, 4:105-111.
• Figueroa E, Silk KR (1997). Biological implications of childhood sexual abuse in Borderline personality disorder. Journal of Personality Disorders, 11:71-92.
• Griswold KS, Del Regno PA, Berger RC (2015). Recognition and differential diagnosis of psychosis in primary care. Am Fam physician, 91:856-863. Işık M (2018). Postpartum Psychosis. East J Med, 23:60-63.
• Judd PH (2005). Neurocognitive impairment as a moderator in the development of borderline personality disorder. Development and Psychopathology, 17:1173-1196.
• Kienle J, Rockstroh B, Bohus M, Fiess J, Huffziger S, Steffen-Klatt A (2017). Somatoform dissociation and posttraumatic stress syndrome - two sides of the same medal? A comparison of symptom profiles, trauma history and altered affect regulation between patients with functional neurological symptoms and patients with PTSD. BMC Psychiatry, 17:248.
• Kleinstauber M, Witthöft M, Steffanowski A, Marwijk HV, Hiller W, Lambert MJ (2014). Pharmacological interventions for somatoform disorders in adults. Cochrane Database Syst Rev, 11:CD010628.
• Krauze-Utz A, Frosti R, Winter D, Elzinga BM (2017). Dissociation and alterations in brain function and structure: Implications for borderline personality disorder. Curr Psychiatry Rep, 19:1-22.
• Liappas J, Paparrigopoulos T, Kouzoupis K, Gouzaris A, Christodoulou GN (2001). Functional psychosis in middle-aged people presenting as a long-lasting confusion state: A report of two cases. Psychopathology, 34:268-272.
• Mai F (2004). Somatization Disorder: A practical Review. Can J Psychiatry, 49:652-662. McDougall J (1984). The “Dis-Affected” Patient: Reflections on Affect Pathology. Psychoanal Q, 3: 386-409. Mitrani JL (1995). Toward an understanding of unmentalized experience. Psychoanal Q, 1: 68-112.
• Nijenhuis ERS (2000). Somatoform Dissociation: Major symptoms of dissociative disorders. Journal of Trauma and Dissociation, 1:7-30.
• Nilsson D, Green S, Svedin CG, Dahlström Ö (2019). Psychoform and somatoform dissociation among children and adolescents: An evaluation of a new short screening instrument for dissociation, DSQ-12, European Journal of Trauma and Dissociation, 3:213-220.
• O’Neal MA, Baslet G (2018). Treatment for patients with a functional neurologic disorder (Conversion disorder): An integrated Approach. Am J Psychiatry, 175:307-314. Özdemir O (2020). Psikiyatride hasta yakınlarıyla beraber görüşme. Anadolu Psikiyatri Derg, 6:665.
• Özdemir O, Özdemir PG, Yılmaz E (2014). The Butterfly Effect in Psychiatry: A case example. JMOOD, 1: 34-37.
• Peralta V, Cuesta MJ (2005). Cycloid psychosis. Intenational Review of Psychiatry, 17:53-62.
• Raj YP (2015). Clearing up confusion. Current psychiatry, 14:19-31.
• Salawu FK, Danburan A, Ogualili P (2009). Delirium: Issues in diagnosis and management. Annals of African Medicine, 8:139-146.
• Sartorius N, Üstün TB (1994). Functional Psychiatric Disorders of the Elderly: Functional psychiatric disorder in ICD-10. (Eds Chiu E, Ames D):3-15. Cambridge University Press.
• Schultz HE, Hong V (2017). Psychosis in borderline personality disorder. Current Psychiatry, 16:25-29. Skrzypinska D, Szmigielska BD (2015). Dream-reality confusion in borderline personality disorder: a theoretical analysis. Frontier in psychology, 6:1-8.
• Şar V, Akyüz G, Kundakçı T, Kızıltan E, Doğan O (2004). Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry, 161:2271-2276.
• Thom RP, Levy-Carrick NC, Bui M, Silbersweig D (2019). Delirium. Am J Psychiatry, 176:785-793.
• Ungvari GS, Leung HCM, Tang WK (2000). Reactive psychosis: A classical category nearing extinction? Psychiatry and Clinical Neuroscience, 54:621-624.
• Zanarini MC, Frankenburg FR, Wedig MM, Fitzmaurice GM (2013). Cognitive experiences reported by patients with borderline personality disorder and axis II comparison subjects: A16 year prospective follow-up study. Am J Psychiatry, 170:671-679.