Out of 1,153 patients seen by psychiatric emergency services, 43.45% received a diagnosis belonging to the ICD 10 category of F40-49, neurotic, stress-related, and somatoform disorders.Ī study by Chaturvedi et al., reported the prevalence of dissociative disorders in the inpatient setting as 1.5 to 11. Patients were referred for “medically unexplained somatic complaints” (47.70%) or with “no physical illness detected” in 38.59%. In a retrospective study by Naskar et al., an analysis of patients being referred to the psychiatry services was done. It is expected that these are tailored to suit the individual needs by the clinicians. These will help clinicians in assessing, diagnosing, and treating dissociative disorders in an emergency setting. The current recommendations are primarily with respect to the management of dissociative disorders presenting as psychiatric emergencies. This was followed by an update on management in the child and adolescent age group in 2019 and one on psychological interventions in dissociative disorders in 2020. In 2007, the Indian Psychiatric Society (IPS), published guidelines for the management of dissociative disorders. There are no standardized practices while dealing with dissociative disorders in an emergency setting. One must also ensure that the patient follows up for further evaluation and long-term management. A decision about inpatient or outpatient management needs to be made. Lack of privacy and space, time available for assessment, and risk of misdiagnoses are some of the drawbacks of managing dissociative disorders in casualty. It is challenging to examine a patient with a dissociative disorder in the emergency setting, consider differential diagnoses, rule them out, and manage the acute symptoms. Dissociative identity disorder is a very rare occurrence in the emergency setting. Commonly seen presentations in India include dissociative convulsions, motor symptoms, possession states, at times dissociative amnesia, and dissociative fugue. Dissociative disorders are quite often present in emergency/casualty.
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