Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence

<p>Abstract</p> <p>Background</p> <p>In the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. The aim of this follow-up study is to bridge this gap to some extent describing the long-term outcome of juvenile dissociative disorder in a clinical sample. To our knowledge there is no comparable other long-term follow-up study which is based on a case definition according to actual classification systems using standardized interviews for individual assessment of the patients at the time of follow-up.</p> <p>Methods</p> <p>The total study group was made up of all patients treated for dissociative disorder at our department for child and adolescent psychiatry between 1983 and 1992 (<it>N </it>= 62). Two of these former patients committed suicide during the follow-up period (3%). We got information on the clinical course of 27 former patients (44%). 17 out of these 27 former patients were female (63%). The mean age of onset of dissociative disorder was11.7 years and the mean follow-up time was 12.4 years. Most of the patients were reassessed personally (n = 23) at a mean age of 24.8 years using structured interviews covering dissociative disorders, other Axis I disorders and personality disorders (Heidelberg Dissociation Inventory HDI; Expert System for Diagnosing Mental Disorders, DIA-X; Structured Clinical Interview for DSM-IV, SCID-II). Social adjustment was assessed by a semi-structured interview and by patient self report (Social Adjustment Scale – Self Report, SAS-SR). Psychosocial outcome variables were additionally assessed in 36 healthy controls (67% female, mean age = 22.9 years).</p> <p>Results</p> <p>At the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. A total of 56.5% presented with an Axis I disorder (especially anxiety, dissociative and somatoform disorders). Personality disorders were seen in 47.8% (especially borderline, obsessive-compulsive and negativistic personality disorders). More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood.</p> <p>Conclusion</p> <p>Treatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. Limitations of the study refer to the small sample size and the low rate of former patients taking part in the follow-up investigation.</p

Follow up Study of dissociative disorders with beginning in children and adolescents

In der Katamnesestudie zum Langzeitverlauf dissoziativer Störungen mit Beginn im Kindes- und Jugendalter wurde erstmalig eine kinder- und jugendpsychiatrische Inanspruchnahmepopulation mit standardisierten Diagnoseverfahren untersucht. Von besonderem Interesse sind dabei die Entwicklung der dissoziativen Störungen, psychiatrische Komorbidität und die psychosoziale Anpassung der ehemaligen Patienten. Methode: Das Untersuchungskollektiv bildeten 62 Kinder und Jugendliche, die im Zeitraum von 1980-93 in der Klinik für Kinder- und Jugendpsychiatrie der Universität Würzburg wegen einer dissoziativen Störung (ICD 10) ambulant oder stationär behandelt wurden. Die Daten der Ausgangsstichprobe wurden retrospektiv aus den Krankengeschichten gewonnen. Zur Nachuntersuchung erklärten sich 27 ehemalige Patienten bereit. Das Vorliegen einer dissoziativen Störung wurde mit dem Heidelberger Dissoziationsinventar (HDI) erfasst. Um das Vorhandensein anderer psychiatrischer Erkrankungen bzw. Persönlichkeitsstörungen zu überprüfen wurden das diagnostische Expertensystem (DIA-X) sowie das strukturierte klinische Interview für DSM-IV (Achse II, Persönlichkeitsstörungen) durchgeführt. In Hinblick auf die psychosoziale Anpassung, die Belastbarkeit sowie die Erfassung von krankheitsbezogenen Kontrollüberzeugungen (KKG) wurde ein Vergleich zu einer Kontrollgruppe mit 35 psychiatrisch gesunden Personen gezogen. Ergebnisse: Nach einer mittleren Katamnesezeit von 12,4 Jahren wiesen von den 27 ehemaligen Patienten noch 66,6% mindestens eine psychiatrische Erkrankung auf. Es zeigte sich, dass 26% weiterhin eine dissoziative Störung aufwiesen. Auffallend häufig fanden sich Persönlichkeitsstörungen. Trotz der hohen Rate an weiterhin psychiatrisch erkrankten Personen konnte in unterschiedlichen psychosozialen Bereichen eine weitgehend gute soziale Anpassung gefunden werden.In the Katamnesestudie for the long-term process of dissociative disturbances with beginning in the child and Jugendalter child and youth-psychiatric demand population with standardized diagnostic procedures was examined for the first time. Are from special interest thereby the development of the dissociative disturbances, psychiatric Komorbidität and the psychosocial adjustment of the former patients. Method: 62 children and young person, who were treated in the period of 1980-93 in the hospital for child and youth psychiatry of the University of peppering castle because of a dissociative disturbance (ICD 10, formed the investigation collective) ambulatory or stationarily. The data of the output sample were won retrospectively from patient stories. As the re-examination 27 former patients explained themselves ready. Being present a dissociative disturbance was seized with the Heidelberger dissociation inventory (HDI). Around the presence of other psychiatric illnesses and/or personality disturbances to examine the diagnostic expert system (DIA-X) became as well as the structured clinical interview for DSM-IV (axle II, personality disturbances) accomplished. In view to the psychosocial adjustment, the maximum stress as well as the collection of illness-referred control convictions (KKG) a comparison to a control's group with 35 psychiatrically healthy persons was drawn. Results: After a middle Katamnesezeit of 12.4 years still 66.6% exhibited at least a psychiatric illness from the 27 former patients. It was shown that 26% exhibited further a dissociative disturbance. Personality disturbances were remarkably frequent. Despite the high rate on further psychiatrically gotten sick persons a to a large extent good social adjustment could be found within different psychosocial ranges

Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence-1

DSM-IV; HDI: Heidelberg Dissociation Inventory.<p><b>Copyright information:</b></p><p>Taken from "Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence"</p><p>http://www.capmh.com/content/2/1/19</p><p>Child and Adolescent Psychiatry and Mental Health 2008;2():19-19.</p><p>Published online 23 Jul 2008</p><p>PMCID:PMC2517058.</p><p></p

Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence-0

DSM-IV; HDI: Heidelberg Dissociation Inventory.<p><b>Copyright information:</b></p><p>Taken from "Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence"</p><p>http://www.capmh.com/content/2/1/19</p><p>Child and Adolescent Psychiatry and Mental Health 2008;2():19-19.</p><p>Published online 23 Jul 2008</p><p>PMCID:PMC2517058.</p><p></p