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Module 6 > UNIT 4- SOMATIC SYMPTOM AND RELATED DISORDERS > Flashcards

UNIT 4- SOMATIC SYMPTOM AND RELATED DISORDERS Flashcards

1
Q

What is somatization?

A

Process by which psycological distress is expressed as physical symptoms without a known organic source, causes substantial distress and psychosocial impiarment withor without a known general medical disease

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2
Q

What is la belle indifference

A

Patients usually have very concerning issues but they are oddly not concerned

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3
Q

What is malingering?

A

Intentionally faking or exaggerating symptoms for an obcious benefit, usch as money, housing, medications, avoiding work, or criinal prosecution. Malingering is a vehaviour and not a psychiatric disorder.

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4
Q

What is primary gain

A
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5
Q

What is secondary gain

A
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6
Q

What is self-compassion?

A

tendency to be caring,warm, and understanding toward oneself when faced with personal shortcomings, inadequacies or failures.

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7
Q

What are some medical diagnoses that the emotional state influences?

A

Hyertension, colitis

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8
Q

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

A

Tension headaches when stressed, sometimes GI, “im so nervous I could throw up”

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9
Q

What is hysteria or hysterical neurosis?

A
  1. Somatic complaints unexplained by orgnaic pathology
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10
Q

What are some somatic symptoms & related disorders?

A
  1. Somatic symptom- most common
  2. Illness anciety DO (previously hypochondriasis)
  3. Functional neurobiological symptom DO (Conversion DO)
  4. Psychological factors affecting other medication conditions
  5. Factitious disorder (uncommon)- previously munchanausen syndrome
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11
Q

What are risk factors of developing somatic symptom DO

A
  1. More common in females
  2. Decreased levels of serotonin & endorphines
  3. Comorbidities of depression, personality disorders, and anxiety disorders
  4. Childhood trauma, abuse, or neglect- strong coralations
  5. 1st degree relative with disorder
  6. Learned helplessness
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12
Q

What are some key features of somatic symptom

A
  1. one or more somatic symptoms
  2. Excessive/thoughts/feelings/behaviors r/t somatic symptoms
  3. State of eing symptomatic is persistent while symptoms may vary

Distressing to the patient and interrups daily life… have to be persistence sometimes its one symptoms or 2 symptoms that alternate back n forth for at LEAST 6 months. THe severity is based off how many symptoms they have

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13
Q

What should we know about the excessive thoughts with SOMATIC symptom disorder?

A
  1. Out of proportion with seriousness of symptoms
  2. Cleint has high level of anixeity about symptoms/health
  3. Excessive time & energery given to symptoms/health
  4. excessive time & energy given to symptoms.

Anxiety is the prominent feature what they will describe is symptoms of anxiety… SOB, tightness of chest, sweating, impending doom feeling.

Ask the patinet is something has happened to make them feel this way… we want the patient to think from an emotional standpoint rather than a physical state. DO NOT MINIMIZE anixety.

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14
Q

What are the 4 primary assessment questions for somatic symptom DO

A
  1. Are they experiencing anxiety
  2. Are they experiencing depression
  3. Ability to care for self
  4. How does the family respond to DO
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15
Q

What is the most common symptom of somatic symptom disorder

A

Pain- patient seeks care for this and when the medical team can not find a cause for the pain this is when the patient feels like they dont believe them

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16
Q

What should we know about the pain experienced with somatic symptom disorder

A
  1. may be specific or nospecific
  2. Appriasial of symptoms disproprotionate
  3. May be assocated with another medical condition

Remember that the pain the patient is experiencing is real but it is how there mind is processing and managing the emotinal state.

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17
Q

What are additional features of somatic symptom disorder?

A
  1. Typical: long, complex medical hx
  2. Disorders are chronic or recurrent
  3. Seek out multiple HCPs for answers/relief/diagnosis
  4. Often believe the HCPs are incompetent
  5. Lack of insight

Once dx with somatic symptom DO its very easy for providers to dump patient s into this cat and not look further into a complaint making it easier to overlook an acutal medical need.

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18
Q

How do we treat somatic symptom disorder?

A
  1. Through physical assessment - TOP PRIORITY we have r/o physical cuses to pain
  2. Symptom and pain managment
  3. Meds: NSAIDS and SSRIs
  4. Referal to pain clinic (pain disorder)
  5. relaxation therapy & visual imaging
  6. Group Therapy: peer support, coping mechanisms, & expression of emotions- being around people with the same disorder helps them feel not so alone
  7. Journaling0 out of they body and into their head
  8. Discoruage dr. shopping– encourage a development of a relationship with a small set of providers who can follow them over a long period of time
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19
Q

What are the desired outcomes of treatment for somatic symptom disorder?

A
  1. Fewer attention seeking somatic complaints
  2. Increased insight into dynamics of behavior
  3. Decreased ritualist behavior- teach not to self prescribe
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20
Q

What is our self awareness/bias check with somatic symptom disorder?

A
  1. Remeber their pain is real to them
  2. Dont assume pain is ALWAYS r/t disorder
  3. Control you own emotional response; be nonjudgemental
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21
Q

What are the key features of illness anxiety disorder?

A
  1. Preoccupation with having or acquiring a serious illness (for 6 months or longer)
  2. Somatic symptoms absent or very mild
  3. High level of anxiety about health
  4. Excessive health related behaviors- inhibit ADL because they are related to the health disorder
  5. Not better explained by another diagnosis

Example- they may have a tenson headache and think the worst possible like a tumor… can be triggered by family member hx or hearing aobut it on the news.

FIXATES ON A DIAGNOSIS

22
Q

What should we know about illness anxiety disorder?

A
  1. often co-morbid with depression & anxiety
  2. May have obsessive-compulsive traits
  3. Will fall into one of two categories: Care seeking type or care avoidant type
  4. Overly sensitive to vody sensation & changes

Main tx- SSRI because we will treatment underlying depression and anxiety

Many fewer symptoms to tx unlike somatic disorder because they dont have the pain…more worried about diagnosis than the physical symptom

23
Q

What is the key feature of conversion disorder (functional neurological symptom disorder)

A
  1. One or more symptoms of altered voluntary motor or sensory function
  2. Unable to substantiate a neurological or medical condition causing symptoms.
  3. Causes impaired functioning in social, occupational, or other areas of functioning
  4. La belle indifference-lack of concern regarding the symptoms
  5. Often there is an identifiable causes developement of the symptom

Completely and unconsiously aware that they are changing the anxiety to a physical symptom. They are completely unworried because that intense emotional stress has been transferred into the sensory function.

Good hx will help us find an underlying cause of the symptoms

ex- a person can go blind… and there is no medical cause.. except anxiety

24
Q

What are some examples of conversion disorder?

A
  1. Paralysis or akinesia
  2. Aphonia
  3. Seizures (psychogenic non-epileptic sz)
  4. Difficulty swallowing
  5. Urinary Retention
  6. Blindness, deafness, double vision
  7. Anosmia
  8. Hallucinations
  9. Pseudocyesis (false pregnancy)

neuro symptoms sudden onset and return

25
Q

What are the key features of psychological factors affecting other medical condition?

A
  1. Occurs in the presence of disease or somatic symptom
  2. Psychological and/or behavioral factors adversely affect the condition
  3. Not better explained by another mental disorder (i.e. anxiety DO, PTSD, MDD)

Like depression, having difficulty caring for self can make it harder for patient to get better

EX- teenerger with seizure disorder no longer takes medication because she wants to be “normal”

26
Q

What are the key features of factitious disorder?

A
  1. Purposefully causing injury or disease to onself (or another)
  2. Presents self (or other) to others as ill, impaired or injured
  3. Deceptive behavior evident evven in the absence of obvious external rewards
  4. Not better explained by another mental disorder (delsuional dos or psychiotic do)
  5. Lack of insight into psychological disorder

There is not really a primary or secondary gain from this. Will agree to permenant or serious procedures for themselves or others. They will literally harm themselves to recieve tx. Not aware of the motivation for it.

27
Q

Fatctitious disorder impoased on others is called….

A

Munchausen syndrome by proxy

28
Q

Factitious disorder imposed on self is called…

A

Munchausen syndrome

29
Q

What is a common characteristic of factitious disorder?

A

They will doctor shop and travel distances and they are smart enough to network the hospitals for treatment.

30
Q

Communication with a patient with factitious disorder should be….

A

open and non-biased. want patient to believe they have a safe place to communicate

31
Q

What is body identity integrity disorder (BIID)

A

Suddenly feels unassociated with part of there body and seeks amputation. They will harm themselves in order to have the amputation done.

32
Q

What is malingering?

A

Fake an illness for the sake of primary and secondary reward.

exmaple.. homless man fakes illness for to gain shelter

33
Q

Disorder: Malingering
Symptom production & motivation… is it conscious or unconscious?

A

Symptom production: Concious
Motivation: Consious

34
Q

Disorder: Factitious disorder is the symptom production and motivation conscious or unconscious?

A

Symptom production: Conscious
Motivation: Unconscious

35
Q

Disorder: Conversion
is the symptom production & motivation conscious or unconscious?

A

Symptom production: Unconscious
Motivation: Unconscious

36
Q

General assessment of the somatic symptoms and related disorders include assessing…

A
  1. Symptoms
  2. Level of independance
  3. Safety and securtiy risks r/t symptoms
  4. Childhood trauma
  5. Suicide risk
  6. Level of self-compassions

** physical assessment is key for ALL disorders**

37
Q

What is our nursing diagnosis for somatic symptoms and related disorders?

A

Ineffective coping r/t
1. Distorted perceptions of body functions and symptoms
2. Chronic pain of psychological orgin
3. Dependance on pain relievers or anxiolytics

38
Q

What is our outcomes for somatic symptoms and related disorders?

A

Patient will
1. Identify and articulate feelings
2. Resume performance of work/role behaviors
3. Identify ineffective coping patterns
4. Make realistic appraisal of strengths and weaknesses

39
Q

What are our interventions for somatic symptoms and related disorders?

A
  1. Health teaching
    • straightforward
    • reduce secondary gain
  2. Assertiveness training
    • empowering
    • “I” statements- assertive languate and thinking about themselves that way instead of “help me”
  3. Case Management
  4. Psychotherapy
    • CBT
    • Trauma-focused
    • Family therapy
  5. Pharmacology-SSRIs
40
Q

What is our goals for somatic symptoms and related disorders?

A
  1. Partilaly met goals considered a sucess
  2. Remission of symptoms will occur
  3. Intensity and focus will diminish over time.
41
Q

What is dissociation?

A

Splitting off clusters of mental contents from conscious awareness

42
Q

What is depersonalization?

A

Periods of feeling disconnected or detached fom onself physically or mentally or having a decreased sense of reality

43
Q

What is derealization?

A

Feeling of being detached from your environment

44
Q

What dissociative disorders etiology?

A

Biological factors
1. Aletered size of hioppocampus and amygdala
-Caused by early emotional trauma
2. Trauma may affect devleopment of limbic system

Genetic
1. 1st degree relative often diagnosed with this disorder

Psychosocial factors
1. Developed in response to extreme stress, such as severe abuse

45
Q

What are key features of depersonalization/derealization disorder?

A
  1. Recurrent periods of feeling unreal, detached and outside the body
  2. Numbness
  3. dreamlike state
  4. Distortions in sense of time and visual perception

Key here- help patient focus on the here and now…. help ground the patient

46
Q

What are key features of dissociative amnesia & dissociative amenesia w/fugue

A
  1. Inability to recall specific information about the self typically regarding a traumatic event
  2. Recall may be lost for a particular time period or selective for a traumatic event or even the entire life history
  3. May include a fugue state
47
Q

What are key features of dissociative identiy disorder?

A
  1. Most severe of these disorders
  2. Disruption of identitiy by two or more distinct perionality states
  3. Loss of time
  4. Changes in affect, behavior, memory & functioning during discruption of “self”
  5. Disruption of self hinders social & occupational functioning & interpersonal relationships

common risk factor– prolonged repetitive child abuse

48
Q

What is our nursing care priorities for dissociative disorders?

A
  1. Safety
  2. Symptom reduction
  3. Stabiliztion
49
Q

Nursing communicaiton guidelines for somatic symptoms and related disorders and dissociative disorder incldudes

A
  1. build trust
  2. Offer emotional presence
  3. Procide a sense of safety
  4. Encourage optimal functioning
50
Q

What are interventions for dissociative disorders?

A
  1. Establish a therapeutic relationship, patient-centered treatment planning
  2. Proide safe environment, reassuring presence, orientation to current surroundings, support
  3. Help identify s/s of anxiety, connect anxiety and dissociative behaviors, identify triggers
  4. Teach grounding techniques, adaptive copoing stratagies, stress reduction techniques, daily journaling
51
Q

What are our short-term outcome goals for dissociative disorders?

A
  1. Refrain from self-harm
  2. Report a decrease in perceived distress
  3. Plan coping strategies for stressful situations
  4. report comfort with role expctations
  5. Verbalize clear sense of personal identity
52
Q

What are our long-term outcome goals for a patient with dissociative disorders?

A

Patient will
1. Develop trust
2. Correct faulty percpetions
3. Heal emotional damage resulting from abuse
4. Practice living in the present

Module 6 (19 decks)

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