Clinical mixed dissociative and post-traumatic stress disorders in a 10-year-old boy after a traffic accident

Abstract

The article presents the clinical case of 10-year-old Karim, whose behavior and mental status changed after a traffic accident in which the boy was hit by a car (without loss of consciousness and without traumatic brain injury). In addition to various motor paroxysms (convulsions) that did not meet the criteria for epileptic symptoms, the clinical picture included wave-like psychopathological symptoms and inappropriate behavior. The clinical picture could not be clearly attributed to the manifestation of dissociative disorders or post-traumatic stress disorder. Within two months after the accident, the clinical picture worsened — the "light intervals" during which Karim was completely adequate and critical became less frequent. Neurologists rejected the organic (epileptic) basis of the paroxysmal states. Examination and treatment by psychiatrists did not lead to stabilization of the mental state. In the opinion of the authors, the clinical case belongs to a rare polysyndromic variant of the dissociative subtype of PTSD, not described in the scientific literature, in which a mixture of various psychopathological symptoms was found - dissociative motor paroxysms, Ganser's syndrome, astasia-abasia, onirism, and flashbacks.

Keywords

dissociative disorders / dissociative seizures / Ganser syndrome / puerilism / passing speech / astasia-abasia / onirism / post-traumatic stress disorder / dissociative subtype of post-traumatic stress disorder / differential diagnosis of mental disorders

References

[1] Molchanova ES. Posttravmaticheskoe stressovoe i ostroe stressovoe rasstroĭstvo v formate DSM-V: vnesennye izmeneniya i prezhnie problemy. Medicinskaya psihologiya v Rossii. 2014;6(1):2. (In Russ.) doi: 10.24411/2219-8245-2014-00006

[2] Молчанова Е.С. Посттравматическое стрессовое и острое стрессовое расстройство в формате DSM-V: внесённые изменения и прежние проблемы // Медицинская психология в России. 2014. T. 6. №1. C. 2. doi: 10.24411/2219-8245-2014-00006.

[3] Zajceva EA. Atipichnye formy posttravmaticheskogo stressovogo rasstrojstva (klinicheskij i sudebno-psihiatricheskij aspekty). Avtoref. … diss. kand. med. nauk. M.; 2014. 24 р. (In Russ.)

[4] Зайцева Е.А. Атипичные формы посттравматического стрессового расстройства (клинический и судебно-психиатрический аспекты). Автореф. дисс. … канд. мед. наук. М.; 2014. 24 с.

[5] White WF, Burgess A, Dalgleish T et al. Prevalence of the dissociative subtype of post-traumatic stress disorder: A systematic review and meta-analysis. Psychol Med. 2022;52(9):1629–1644. doi: 10.1017/S0033291722001647

[6] White W.F., Burgess A., Dalgleish T. et al. Prevalence of the dissociative subtype of post-traumatic stress disorder: A systematic review and meta-analysis // Psychol. Med. 2022. Vol. 52. N. 9. P. 1629–1644. doi: 10.1017/S0033291722001647

[7] Ross CA, Ridgway J, Myron T. The symptom criteria for the dissociative subtype of posttraumatic stress disorder. Psychol Trauma. 2023; Nov 30. doi: 10.1037/tra0001612

[8] Ross C.A., Ridgway J., Myron T. The symptom criteria for the dissociative subtype of posttraumatic stress disorder // Psychol. Trauma. 2023; Nov. 30. doi: 10.1037/tra0001612

[9] Misitano A, Moro AS, Ferro M, Forresi B. The dissociative subtype of post-traumatic stress disorder: A systematic review of the literature using the latent profile analysis. J Trauma Dissociation. 2022;4:1–17. doi: 10.1080/15299732.2022.2120155

[10] Misitano A., Moro A.S., Ferro M., Forresi B. The dissociative subtype of post-traumatic stress disorder: A systematic review of the literature using the latent profile analysis // J. Trauma Dissociation. 2022. Vol. 4. P. 1–17. doi: 10.1080/15299732.2022.2120155

[11] Geng F, Liang Y, Zhan N, Wang J. Prevalence, clinical features, and psychological characteristics of dissociative subtype of posttraumatic stress disorder in Chinese prisoners. J Trauma Dissociation. 2023;24(1):63–78. doi: 10.1080/15299732.2022.2079797

[12] Geng F., Liang Y., Zhan N., Wang J. Prevalence, clinical features, and psychological characteristics of dissociative subtype of posttraumatic stress disorder in Chinese prisoners // J. Trauma Dissociation. 2023. Vol. 24. N. 1. P. 63–78. doi: 10.1080/15299732.2022.2079797

[13] Swart S, Wildschut M, Draijer N et al. Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(1):38–45. doi: 10.1037/tra0000474

[14] Swart S., Wildschut M., Draijer N. et al. Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: Comparative evaluation of clinical profiles // Psychological Trauma: Theory, Research, Practice, and Policy. 2020. Vol. 12. N. 1. P. 38–45. doi: 10.1037/tra0000474

[15] Hornor G. Posttraumatic stress disorder. Journal of Pediatric Health Care. 2012. Vol. 27. N. 3. Р. E29–Е38. doi: 10.1016/j.pedhc.2012.07.020

[16] Hornor G. Posttraumatic stress disorder // Journal of Pediatric Health Care. 2012. Vol. 27. N. 3. Р. E29–Е38. doi: 10.1016/j.pedhc.2012.07.020

[17] Vasil'eva AV, Karavaeva TA, Radionov DS, Starunskaya DA. Algoritm diagnostiki posttravmaticheskogo stressovogo rasstroĭstva. Obozrenie psihiatrii i medicinskoĭ psihologii im VM Bekhtereva. 2023;57(1):83–95. (In Russ.) doi: 10.31363/2313-7053-2023-741

[18] Васильева А.В., Караваева Т.А., Радионов Д.С., Старунская Д.А. Алгоритм диагностики посттравматического стрессового расстройства // Обозрение психиатрии и медицинской психологии им. В.М. Бехтерева. 2023. Т. 57. №1. C. 83–95. doi: 10.31363/2313-7053-2023-741

[19] Shamreĭ VK, Lytkin VM, Barazenko KV, Zun SA. O dinamike razvitiya problemy posttravmaticheskogo stressovogo rasstroĭstva. Mediko-biologicheskie i social'no-psihologicheskie problemy bezopasnosti v chrezvychaĭnyh situaciyah. 2023;(1):68–77. (In Russ.) doi: 10.25016/2541-7487-2023-0-1-68-77

[20] Шамре В.К., Лыткин В.М., Баразенко К.В., Зун С.А. О динамике развития проблемы посттравматического стрессового расстройства // Медико-биологические и социально-психологические проблемы безопасности в чрезвычайных ситуациях. 2023. №1. С. 68–77. D: doi: 10.25016/2541-7487-2023-0-1-68-77

[21] Kekelidze ZI, Portnova AA. Posttramaticheskoe stressovoe rasstrojstvo u detej i podrostkov. Zhurnal nevrologii i psihiatrii im SS Korsakova. 2002;(12):56–62. (In Russ.)

[22] Кекелидзе З.И., Портнова А.А. Посттраматическое стрессовое расстройство у детей и подростков // Журнал неврологии и психиатрии им. С.С. Корсакова. 2002. №12. С. 56–62.

[23] Haagen JFG, van Rijn A, Knipscheer JW et al. The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD. British Journal of Clinical Psychology. 2018;57(2):203–222. doi: 10.1111/bjc.12169

[24] Haagen J.F.G., van Rijn A., Knipscheer J.W. et al. The dissociative post-traumatic stress disorder (PTSD) subtype: A treatment outcome cohort study in veterans with PTSD // British Journal of Clinical Psychology. 2018. Vol. 57. N. 2. P. 203–222. doi: 10.1111/bjc.12169

[25] Esina OB. Posttravmaticheskoe stressovoe rasstroĭstvo u deteĭ: psihosocial'nye faktory formirovaniya, klinicheskie harakteristiki i problemy diagnostiki. Diss. … kand. med. nauk. SPb.; 2017. 230 р. (In Russ.)

[26] Есина О.Б. Посттравматическое стрессовое расстройство у детей: психосоциальные факторы формирования, клинические характеристики и проблемы диагностики. Дисс. … канд. мед. наук. СПб.; 2017. 230 с.

[27] Portnova AA. Tipologiya posttravmaticheskogo stressovogo rasstroĭstva u deteĭ i podrostkov. Zhurnal nevrologii i psihiatrii im SS Korsakova. 2005;12:9–12. (In Russ.)

[28] Портнова А.А. Типология посттравматического стрессового расстройства у детей и подростков // Журнал неврологии и психиатрии им. С.С. Корсакова. 2005. № 12. С. 9–12.

[29] Choi KR, Ford JD, Briggs EC et al. Relationships between maltreatment, posttraumatic symptomatology, and the dissociative subtype of PTSD among adolescents. J Trauma Dissociation. 2019;20(2):212–227. doi: 10.1080/15299732.2019.1572043

[30] Choi K.R., Ford J.D., Briggs E.C. et al. Relationships between maltreatment, posttraumatic symptomatology, and the dissociative subtype of PTSD among adolescents // J. Trauma Dissociation. 2019. Vol. 20. N. 2. P. 212–227. doi: 10.1080/15299732.2019.1572043

[31] Dutra SJ, Wolf EJ. Perspectives on the conceptualization of the dissociative subtype of PTSD and implications for treatment. Curr Opin Psychol. 2017;14:35–39. doi: 10.1016/j.copsyc.2016.10.003

[32] Dutra S.J., Wolf E.J. Perspectives on the conceptualization of the dissociative subtype of PTSD and implications for treatment // Curr. Opin. Psychol. 2017. Vol. 14. P. 35–39. doi: 10.1016/j.copsyc.2016.10.003

[33] Choi KR, Seng JS, Briggs EC et al. The dissociative subtype of posttraumatic stress disorder (PTSD) among adolescents: Co-occurring PTSD, depersonalization/derealization, and other dissociation symptoms. J Am Acad Child Adolesc Psychiatry. 2017;56(12):1062–1072. doi: 10.1016/j.jaac. 2017.09.425

[34] Choi K.R., Seng J.S., Briggs E.C. et al. The dissociative subtype of posttraumatic stress disorder (PTSD) among adolescents: Co-occurring PTSD, depersonalization/derealization, and other dissociation symptoms // J. Am. Acad. Child Adolesc. Psychiatry. 2017. Vol. 56. N. 12. P. 1062–1072. doi: 10.1016/j.jaac. 2017.09.425

[35] Spodenkiewicz M, Taïeb O, Speranza M et al. Case report of Ganser syndrome in a 14-year-old girl: Another face of depressive disorder? Child and Adolescent Psychiatry and Mental Health. 2012;(6):6.

[36] Spodenkiewicz M., Taïeb O., Speranza M. et al. Case report of Ganser syndrome in a 14-year-old girl: Another face of depressive disorder? // Child and Adolescent Psychiatry and Mental Health. 2012. Vol. 6. P. 6.

[37] Adler R. Pseudodementia or Ganser syndrome in a ten year old boy. Australian & New Zealand Journal of Psychiatry. 1981;15(4):339–342. doi: 10.3109/00048678109159457

[38] Adler R. Pseudodementia or Ganser syndrome in a ten year old boy // Australian & New Zealand Journal of Psychiatry. 1981. Vol. 15. N. 4. P. 339–342. doi: 10.3109/00048678109159457

[39] Agarwal S, Dhami A, Dahuja M, Choudhary S. Ganser syndrome in adolescent male: A rare case report. J. Indian Assoc. Child Adolesc. Ment. Health. 2018;14(1):93–99. doi: 10.1177/0973134220180109

[40] Agarwal S., Dhami A., Dahuja M., Choudhary S. Ganser syndrome in adolescent male: A rare case report // J. Indian Assoc. Child Adolesc. Ment. Health. 2018. Vol. 14. N. 1. P. 93–99. doi: 10.1177/0973134220180109

[41] Wincewicz K, Sapota-Zare K, Nasierowski T. Ganser syndrome — a dissociative disorder or a factitious disorder? A case report. Psychiatr. Pol. 2022;56(1):63–75. doi: 10.12740/PP/129012

[42] Wincewicz K., Sapota-Zare K., Nasierowski T. Ganser syndrome — a dissociative disorder or a factitious disorder? A case report // Psychiatr. Pol. 2022. Vol. 56. N. 1. P. 63–75. doi: 10.12740/PP/129012

[43] Dobryakov IV. Stressovye rasstroĭstva u deteĭ i podrostkov. Metodicheskie rekomendacii. SPb.: NMIC PN im VM Bekhtereva; 2022. 23 р. (In Russ.)

[44] Добряков И.В. Стрессовые расстройства у детей и подростков. Методические рекомендации. СПб.: НМИЦ ПН им. В.М. Бехтерева; 2022. 23 с.

[45] Bui E, Ohye B, Palitz S et al. Ostrye i hronicheskie reakcii na stress u detej i podrostkov. https://iacapap.org/_Resources/Persistent/438d045e97d518a00419a865296f5a791e790cf9/F.4-Trauma-Russian-UKR.pdf (access date: 03.01.2024). (In Russ.)

[46] Bui E., Ohye B., Palitz S. et al. Острые и хронические реакции на стресс у детей и подростков. https://iacapap.org/_Resources/Persistent/438d045e97d518a00419a865296f5a791e790cf9/F.4-Trauma-Russian-UKR.pdf (дата обращения: 03.01.2024).

[47] Alisic E, Zalta AK, van Wesel F et al. Rates of posttraumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. Br J Psychiatry. 2014:204:335–340. doi: 10.1192/bjp.bp.113.131227

[48] Alisic E., Zalta A.K., van Wesel F. et al. Rates of posttraumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis // Br. J. Psychiatry. 2014. Vol. 204. P. 335–340. doi: 10.1192/bjp.bp.113.131227

[49] Fastovcev GA. Struktura dissomnicheskih rasstroĭstv u kombatantov. Rossiĭskiĭ psihiatricheskiĭ zhurnal. 2010;(1):68–73. (In Russ.)

[50] Фастовцев Г.А. Структура диссомнических расстройств у комбатантов // Российский психиатрический журнал. 2010. №1. С. 68–73.

[51] Zhmurov VA. Psihopatologiya. Chast' II. Irkutsk, Izdat-vo Irkutskogo Universiteta; 1986. 217 р. (In Russ.)

[52] Жмуров В.А. Психопатология. Часть II. Иркутск, Издат-во Иркутского университета; 1986. 217 с.

[53] Sidorov PI, Parnyakov AV. Vvedenie v klinicheskuyu psihologiyu. T. I. Uchebnik dlya studentov medicinskih vuzov. M.: Akademicheskij Proekt; Ekaterinburg: Delovaya kniga; 2000. 416 р. (In Russ.)

[54] Сидоров П.И., Парняков А.В. Введение в клиническую психологию. Т. I. Учебник для студентов медицинских вузов. М.: Академический Проект; Екатеринбург: Деловая книга; 2000. 416 с.

[55] Miller P, Bramble D, Buxton N. Case study: Ganser syndrome in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1997;36(1):112–115. doi: 10.1097/00004583-199701000-00024

[56] Miller P., Bramble D., Buxton N. Case study: Ganser syndrome in children and adolescents // J. Am. Acad. Child Adolesc. Psychiatry. 1997. Vol. 36. N. 1. P. 112–115. doi: 10.1097/00004583-199701000-00024

[57] Yella SA, Divya R, Gupta P. A rare case of Ganser syndrome presenting with associated symptoms of auditory hallucinations and amnesia. International Journal of Psychiatry Research. 2019;1(2):8–9.

[58] Yella S.A., Divya R., Gupta P. A rare case of ganser syndrome presenting with associated symptoms of auditory hallucinations and amnesia // International Journal of Psychiatry Research. 2019. Vol. 1. N. 2. P. 8–9.

[59] Tassniyom K, Paholpak S, Tassniyom S et al. Ganser syndrome: A case report from Thailand. Asia-Pacific Psychiatry. 2009;1:30–33. doi: 10.1111/j.1758-5872.2009.00007.x

[60] Tassniyom K., Paholpak S., Tassniyom S. et al. Ganser syndrome: A case report from Thailand // Asia-Pacific Psychiatry. 2009. Vol. 1. P. 30–33. doi: 10.1111/j.1758-5872.2009.00007.x

[61] Stanković M, Kostić J, Grbeša G et al. Astasia-abasia and Ganser syndrome in a preadolescent girl: A case report. Srp Arh Celok Lek. 2015;143(7–8):446–450. doi: 10.2298/SARH1508446S

[62] Stanković M., Kostić J., Grbeša G. et al. Astasia-abasia and Ganser syndrome in a preadolescent girl: A case report // Srp. Arh. Celok. Lek. 2015. Vol. 143. N. 7–8. P. 446–450. doi: 10.2298/SARH1508446S

[63] Agarkov VA. Dissociaciya kak mekhanizm psihologicheskoj zashchity v kontekste posledstvij psihicheskoj travmy. Avtoref. diss. … kand. med. nauk. M.; 2002. 22 р. (In Russ.)

[64] Агарков В.А. Диссоциация как механизм психологической защиты в контексте последствий психической травмы. Автореф. дисс. … канд. мед. наук. М.; 2002. 22 с.

[65] Kogan BM, Semina TE. Problema dissociacii v psihologii i psihiatrii. Cistemnaya psihologiya i sociologiya. 2010;2(I):43–52. (In Russ.)

[66] Коган Б.М., Семина Т.Е. Проблема диссоциации в психологии и психиатрии // Системная психология и социология. 2010. Т. 2. №1. C. 43–52.

[67] Deen A, Biedermann SV, Lotzin A et al. The dissociative subtype of PTSD in trauma-exposed individuals: A latent class analysis and examination of clinical covariates. European Journal of Psychotraumatology. 2022;13(1):2031591. doi: 10.1080/20008198.2022.2031591

[68] Deen A., Biedermann S.V., Lotzin A. et al. The dissociative subtype of PTSD in trauma-exposed individuals: A latent class analysis and examination of clinical covariates // European Journal of Psychotraumatology. 2022. Vol. 13. N. 1. P. 2031591. doi: 10.1080/20008198.2022.2031591

RIGHTS & PERMISSIONS

Eco-Vector