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Module 6 (Psych Mental Health) > Somatic Symptom Disorders/Somatiform > Flashcards

Somatic Symptom Disorders/Somatiform Flashcards

(72 cards)

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1
Q

Somatization

A

putting or channeling emotional distress into the body and through physical s/s
- insomnia, high Pulse,

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2
Q

La Belle indifference

A

paradoxical absence
- not concerned with s/s as they do not have mental pain

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3
Q

Malingering

A

exaggerates and fakes an illness to get out of something for secondary and primary gains
- avoid homelessness or jail
- get aware from harm
- cope mechanism to get away

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4
Q

Primary gain

A
  • mainfesting a stomach ache to avoid a bully
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5
Q

Secondary gain

A
  • attention from mom
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6
Q

Self-compassion

A

caring and understanding to one’s self with faced with own failures
- protect and emotional resilence

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7
Q

Psyche + Soma =

A

Psycho-somatic
(mind-body)
- missed in psych because they are seen by HCP or med-surg

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8
Q

What are some medical diagnoses that the emotional state influences?

A

HTN
Colitis

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9
Q

What are some somatic symptoms not necessarily related to a separate medical diagnosis?

A

tension HA
GI upset
i’m worried sick, so nervous i might throw up

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10
Q

Hysteria (hysterical neurosis)

A

Somatic complaints unexplained by organic pathology

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11
Q

Somatic related disorders

A

Pain Disorder (somatic symptom disorder)
Illness Anxiety Disorder (Hypochondriasis)
Functional Neurobiological (Conversion)
Psychological factors affecting other conditions
Factitious Disorder (Munchausen Syndrome)

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12
Q

Which somatic disorder is the most common?

A

pain disorder

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13
Q

Which somatic disorder is the least common?

A

Munchausen Syndrome (Factitious)

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14
Q

Theories of Pathology for Somatic Disorders

A

genetic and biological vulnerability
- higher sensitivity to pain, trauma
- big and small sensory stimuli equally intense
environment
psychological theory
interpersonal theory
decreased levels of serotonin and endorphins

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15
Q

How does the environment cause somatic disorder?

A

childhood trauma
- fmaily with illness
overprotective parents
high wanting of child perfection

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16
Q

What is the psychological cause of somatic disorder?

A

illicit care and nurturing
- coping for needs to be met
culture of not having mental pain goes to physical pain which is acceptable

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17
Q

How does the interperonal model cause somatic disorder?

A

attention from the pain

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18
Q

Somatic S/S Disorder
- Risk Factors

A

females (more common)
decreased serotonin and endorphins
with depression, personality disorders, and anxiety disorders
childhood trauma, abuse, neglect
1st degree relative to the disorder
learned helplessness - maladaptive coping strategy

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19
Q

Key features of somatic symptom disorder

A

1+ s/s present for 6 months+
excessive thoughts/feelings/behaviors r/t somatic s/s
state of being symptomatic is persistent while s/s may vary

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20
Q

Excessive Thoughts

A

out of proportion with the seriousness of s/s
client has high anxiety about health
= SOB, sweating, sense of impending doom,
excessive time and energy given to s/s

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21
Q

The most common s/s of somatic symptom disorder

A

pain
- specific or nonspecific
- possibly associated with another medical condition

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22
Q

The appraisal of s/s for somatic symptom disorder is

A

disproportionate to nurse findings

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23
Q

Typical somatic symptom disorders include what in their chart

A

long, complex medical hx
- chronic or recurrent

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24
Q

Somatic symptom disorder patients will seek out

A

multiple HCPs for answers/relief/dx
- believe HCPs are incompetent
- pt lacks insight into the disorder
- if the HCP does not know what is going on, they might dump them into this category and forgotten
= known as frequent fliers

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25
Somatic disorder nursing interventions - 4 things to ask
- ask what is making them anxious and rate the anxiety - **anxiety and depression s/s periods of sadness or difficulty concentrating or worry - ask about the ability to care for themselves - how does the family react to the s/s (help, enable, cause)** do not acknowledge the physical s/s decrease stimulation ground them
26
Tx of Somatic Symptom Disorder
**1st priority = thorough physical assessment r/o other illnesses** symptom and pain mgmt - **NSAIDs, SSRIs** = tx underlying depression Referral to pain clinic (pain disorder) **relax therapy and visual imaging** Group Therapy: peer support, coping mechanisms, and expression of emotions **Journaling - into heads and connects with events Discourage "doctor shopping"**
27
What medications could be given for somatic symptom disorder?
NSAIDs SSRIs
28
What therapy is used for somatic symptom disorder?
Relaxation therapy visual imaging Group therapy: peer support, coping mechanisms, & expression of emotions Journaling
29
What needs to be discouraged for somatic symptom disorder patients?
discourage "doctor shopping" - encourage meaningful relationship with 1-2 doctors over a long period of time
30
What are the desired outcomes for treatments of Somatic Symptom disorder?
fewer attention-seeking somatic complaints increased insight into the dynamics of behaviors decreased ritualistic behaviors - self-Rx of medications/supplements
31
What self-awareness issues and bias checks does the nurse need to watch when having a patient who has somatic symptom disorder?
remember their **pain is REAL TO THEM** **Don't assume pain is ALWAYS r/t disorders** Control your emotional response, be **nonjudgemental and curious**
32
Illness Anxiety Disorder =
Hypochondriasis
33
What are the key features of illness anxiety disorder?
- preoccupation with having or acquiring a serious illness (6+ months) = - risk of family illness, media, - **somatic s/s absent or very mild** - **high level of anxiety** about health - excessive health-related behaviors - not better explained by another dx
34
Illness Anxiety is often co-morbid with
depression and anxiety - **may have obsessive-compulsive traits**
35
Illness Anxiety Disorder 2 categories
care-seeking - doctor shop care avoidant
36
Illness Anxiety Disorder has _________ ____________ to body sensations and changes
overly sensitive
37
Illness Anxiety Disorder Tx
SSRI - underlying depression and anxiety less s/s to treat (not intense pain) worried about dx more than s/s
38
Conversion Disorder aka
Functional Neurological Symptom Disorder - unconsciously given themselves anxiety and unbothered by the bad s/s because the anxiety has relieved and only on the physical (does not care)
39
What are the key s/s of conversion disorder
1+ altered voluntary motor or sensory functions unable to substantiate a neurological or medical condition causing s/s causes impaired functioning in social, work, or other functioning areas = blind w/o cause, not walk, or can t move arms **La belle difference** identifiable cause for developing s/s = H&P dissociative with major trauma
40
Conversion Disorder examples
paralysis or akinesia aphonia seizures (psychogenic non-epileptic) difficulty swallowing urinary retention blind, deaf, double vision anosmia hallucinations pseudocyesis **have a neuro connection**
41
Aphonia
loss of voice
42
Anosmia
loss of smell
43
Pseudocyesis
false pregnancy - not concerned
44
KEY Features of Psychological Factors Affecting Other Medical Conditions
occurs in the **presence** of other disease or somatic s/s - precede or make worse psychological or behavioral factors adversely affect the condition - fear and not do their tx not better explained by another mental disorder (anxiety, depression, PTSD)
45
S/S of factitious disorder
**purposefully** causing injury or disease to oneself or another presents to others as ill, impaired, or injured **deceptive behavior** evident in the **absence of obvious external rewards** - have **some medical knowledge** not explained by another illness (delusional or psychotic) - **major and irreversible surgeries** **lack of insight** into psychological disorder - unaware of the motivation for it - doctor shop and long distances
46
Munchausen Syndrome
Factitious Disorder Imposed on Self
47
Munchausen Syndrome by Proxy
Factitious Disorder Imposed on Other
48
Body Identity Integrity Disorder (BIID)
alienated from part of their body aka limb - apotemnophilia - want an amputation - will harm themselves to make it medically necessary
49
Nursing with Munchasen's syndrome
nonjudgemental and not biased get as much info as possible
50
What is the comparison between Malingering, Factitious, and conversion disorders?
Malingering - conscious symptoms and motivation - homelessness fake illness for shelter - get out of abusive relations - keep the s/s for a long time until they have confidence and come clean Factitious - conscious symptoms and unconscious motive Conversion - unconscious to symptoms and motive
51
What are the general assessments for Somatic Disorders?
**Thorough physical assessments** Symptoms Level of **independence** **Safety** and security risks r/t symptoms Childhood **trauma Suicide risk** Level of **self-compassions - how hard on themselves are they**
52
What must the nurse identify in a patient with Somatic Disorders upon assessment?
Whether symptoms are under **voluntary control** Type and amount of **medication/supplements** the patient uses **Previous med hx** Interpersonal dynamics/resources - Support network - Stressors - Family dynamics
53
The nursing dx of ineffective coping with somatic illnesses r/t
Distorted perceptions of body functions and symptoms Chronic pain of psychological origin **Dependence on pain relievers or anxiolytics (benzo)**
54
What are the expected outcomes for a somatic disorders patient?
Identify and articulate feelings Resume performance of work/role behaviors Identify ineffective coping patterns Make a realistic appraisal of strengths and weaknesses
55
What interventions need to be taken for a somatic patient?
Teaching straightforward and **reducing secondary gains** Assertiveness training (empowering and "I" statements) Case Management Psychotherapy (CBT, Trauma, and family) **1st SSRIs** - not Benzo due to not long term
56
What should the nurse evaluate after tx of a somatic patient?
partially met goals = success remission of s/s intensity and focus will dimish over time
57
Dissociation
splitting off clusters of mental content from conscious awareness - break away from awareness
58
Depersonalization
experiences of seeing themselves outside of their body
59
Derealization
detachment from reality aware and see themselves from above
60
Biological factors of dissociative illnesses
Altered size of hippocampus and amygdala – caused by early emotional trauma Trauma may affect the development of the limbic system
61
Genetic and psychosocial factors of dissociative disorders
1st-degree relatives often diagnosed with this disorder Developed in **response to extreme stress, such as severe abuse**
62
KEY Features Depersonalization/Derealization Disorder
recurrent periods of feeling unreal, detached, and outside the body - that man is scared not I and me statements numb dreamlike **distortions in the sense of time and visual perception**
63
KEY Features Dissociative Amnesia & Dissociative Amnesia w/Fugue
inability to recall specific info about self typically regarding a traumatic event recall may be lost for a particular time, period or selective for a traumatic event or even the entire life hx - possible fugue
64
Nursing Interventions for Dissociation Disorder
grounding to reality - cold drink of water change environment reorientation to present Are they redirectable? - sundown time with dementia )this will help)
65
Fugue =
loses memory and does not know who they are - wander - can have a new identity or a new life along the way
66
KEY Features Dissociative Identity Disorder (DID)
most severe - disruption of identity by 2 + distinct personality states - loss of time - change in effect, behavior, memory, and functioning during the disruption of "self" -Disruption of self hinders social & occupational functioning & interpersonal relationships - **CAUSED BY By prolonged AND REPETITIVE CHILDHOOD ABUSE**
67
Nursing Care Priorities for Dissociative Disorders
safety symptom reduction stabilization
68
Communication of Dissociative Disorder patient
build trust emotional presence sense of safety optimal functioning - washing, ADLs
69
Milieu environment
Quiet Structured Supportive
70
Interventions for Dissociative Disorders
**LONG Therapeutic relationship and therapies** Patient-centered treatment planning Safe environment Reassuring presence Orientation to current surroundings Support Identify S/S anxiety Connect anxiety and dissociative behaviors **Identify triggers earlier** and implement interventions **Grounding techniques Adaptive coping strategies Stress reduction techniques Daily journaling**
71
Short-term goals for dissociative patient interventions
Refrain from self-harm **Report a decrease in perceived distress** Plan coping strategies for stressful situations Report comfort with role expectations **Verbalize a clear sense of personal identity**
72
Long-term goals for dissociative patient interventions
Develop trust Correct faulty perceptions Heal emotional damage resulting from abuse Practice living in the present

Module 6 (Psych Mental Health) (12 decks)

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