Functional Confusion in Psychiatry

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

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