Week 3 Dissociative Disorders Psychophysiological Disorders Flashcards Preview

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Flashcards in Week 3 Dissociative Disorders Psychophysiological Disorders Deck (54):
1

Dissociative Disorders

-Group of psychiactric syndromes
-Involuntary and unhealthy
-Disruptions in aspects of Consciousness, identity, memory, motor behavior, or environmental awareness.

2

Dissociative Disorders

The conscious behaviours we do allow us to destress/decompress. WE have the ability to pull out of that. Someone with dissociative disorders cannot control it.

3

Dissociative Disorders- DSM-IV-TR

-Dissociative amnesia
-Dissociative fugue
-Depersonalization disorder
-Dissociative disorder not otherwise specified
-Dissociative identity disorder

4

Dissociate disorder...also known as?

also known as multiple personality disorder. can be HUNDREDS of personalities. Used to manage an overwhelming stressor.

5

Why do the personalities form?

Unconscious attempt to wall off the overwhelming stressors...memories of trauma. Not one traumatic event...a series.

Dissociation: Unconscious process of “walling-off” of emotions and memory
Personality “fragments” due to trauma
Alters develop to “protect” the individual
Failure to integrate aspects of identity, memory, and feeling states

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Disruption in the consciousness processes

sudden disruption in consciousness, identity, or memory.
Blocks of time are lost.
Involuntary process-no decisional process.

7

Assessment and characteristics

-Presence of two or more personalities
-Inability to recall key personal data
-Personalities reveal themselves at intervals
-Depression/Mood Swings
-Suicidal ideation
-Sleep disorders (sleep is frightening to them)
-Anxiety
-Substance abuse (self medicates)
-Loss of time-amnesia

8

Will an individual with DD remember their childhood?

Likely not. If their childhood is when the trauma occurred, they will not recall that period of their life.

9

Call 'alter's change the age/gender/overall health of the individual?

Yes! An adult can have a baby alter, a woman can have male alters and vise versa. Some alters may need glasses, or have high blood sugar.

10

Are personality disorders the same thing as dissociative disorders?

NO! TRUE dissociative disorder is a rare diagnosis.

11

Mental Status Exam - Appearance

wide variation of facial expression during one meeting

12

Mental Status Exam - Mood

anxious, depressed, or “feels empty”

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Mental Status Exam - Memory

amnesia for certain events or periods

14

Mental Status Exam - Perception

depersonalization (their self is in a dream world...doesn't actually exist), derealization (external world is not real...a dream)

15

Nursing Diagnoses

Anxiety
Ineffective coping
Personal identity disturbance
Sensory perceptual alterations
Altered thought processes
Powerlessness
Risk for self harming behaviors
Ineffective role performance

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Planning/Intervention

Establishing the therapeutic alliance (might need to do this each time for each personality)
Minimize risk for violence, self or other directed
Contracting with alters for safety
Encourage healthy functioning
Providing safe environment fosters integration

17

How can you provide a safe environment

Encourage expression of feelings
Help to recognize that alters are a part of host

18

Psychopharmacology

Anxiolytics may reduce anxiety symptoms...very small dose of trazodone. vistaril. depakote. neurontin...none of these produce dependence/tolerance/addiction
Antidepressants may reduce dysphoria and depressive symptoms
Mood stabilizers may help regulate mood fluctuations
Antipsychotics for symptoms of psychotic proportion.

19

Can dissociative disorder be voluntary?

NO if it's voluntary, then it's not real. Dissociate disorder is an involuntary event.

20

What one medication treats DD?

None...best you can do is treat the symptoms. Keep a close eye out for self-medicating.

21

Milieu Therapy...reintegration

Safe, consistent environment
Clear boundaries and they're all going to be different boundaries for each alter
Group therapies
Hypnosis
Expressive therapies
Ongoing supportive psychotherapy

22

Risk to self

Prone to self-harm...cutters. Highly suicidal.

23

Psychophysiological Disorders

Mind body connection
Emotional influences physical
Physical influences emotional
Comorbidity lengthens illness

24

Psychophysiological Disorders (voluntary or involuntary?)

some can be voluntary, some are involuntary

25

Physiological Health Problems

Cardiovascular
Musculoskeletal
Respiratory
Gastrointestinal
Genitourinary
Endocrinologic

26

Type "C" personality related to..

incidence of cancer
repression of negative emotions, passivity, apologetic, overly cooperative, low self esteem, needs of others placed before self...all this is linked to incidence of cancer

27

Somatoform Disorders

Somatization disorder
Conversion disorder
Pain disorder
Body dysmorphic disorder
Hypochondriasis

28

Factitious disorders

munchausen's
munchausen's by proxy

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Somatoform disorders produce

real physical symptoms that cannot be medically explained

30

Factitious disorders are

abnormal cognitive patterns that are related to how a person thinks and feels in relation to the their physical surroundings. They THINK there is a problem, and there IS a problem...but the individual created it.

It can be evaluated medically.

31

Primary Gain

Exempt from usual activities (if you're sick, you don't go to work/school)
Not responsible for illness
Expected to desire health
Expected to seek assistance
Expected to cooperate with plan of care

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Primary gain is the direct

benefit from having that illness

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Secondary Gain

Indirect benefit of illness (you get lay down and watch tv all day)
Increased attention
Treats and special privileges
Not responsible for illness
Recipient of care and nurturing

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When you desire the secondary gain

dependency needs that haven't been met at some point in a particular way

35

Etiology

Genetic
Biochemical
Psychodynamic
Learning Theory

36

Somatoform disorders

Physical symptoms not fully explained by a medical condition
Symptoms do cause impairment or distress
****Symptoms are not intentionally produced****

37

Somatoform disorder example

Exam the next day, you FEEL sick. (but no fever, etc)

38

Somatization disorder

Physical complaints
Cannot be explained medically
Usual onset before age 30
Extends to a period over years
Pain, GI, Sexual, Neuro symptoms
Symptoms are not intentionally produced
0.2-2% women, 0.2% men, prevalence

39

Conversion Disorder

Voluntary motor/sensory functions
Symptom is initiated or exacerbated by stressor
Symptoms not intentionally produced
Symptoms cannot be explained medically
Impaired social, occupational, or role functioning
“La belle indifference”

40

"La belle indifference"

very matter-a-fact about the situation. i woke up and I can't walk. Meh.

41

Pain disorder

Pain requiring clinical focus
Causes distress in social, occupational or role function
Psychological factors contribute to onset
Not intentionally produced
Not accounted for by a Mood, Anxiety or Psychotic disorder

42

Body dysmorphic disorder

Unrealistic focus regarding a deformed or defective feature
Excessive grooming to disguise
Clinically significant impairment of social, occupational or role function
Not better accounted for by another disorder

43

Somatoform Disorder : Nursing Diagnosis

Ineffective/maladaptive coping
Disturbance in self perception
Fears of chronic disease
Disturbance in sensory perception

44

Nursing intervention

Identify gains provided by symptoms
Clear review of objective findings
Regular supportive brief contacts
Hear concerns regarding emotional pain
Incentive to resolve symptoms
Support healthy function- no focus on disability
ID maladaptive coping- teach adaptive strategy
ID episodes of increased symptoms

45

Nursing interventions, cont

Establish therapeutic alliance
Non judgmental approach
Careful documentation
Behavioral therapy
Individual and/or group psychotherapy
Psychopharmacology
Team management of boundaries

46

Evaluation

Recognition of symptoms
Replace maladaptive coping with adaptive strategies
Verbalize relationship of increased anxiety to increased symptoms
Increased role function
Acceptance of self

47

Factitious Disorders

Conscious fabrication of physical or psychological disorder symptoms
Need to be seen as ill, impaired
Often co-morbid with personality disorders
Does not preclude true disorder
Diagnosis *always* implies psychopathology

48

Munchausen's syndrome

Predominant physical symptoms
Signs and symptoms of an apparent medical condition
Life revolves around obtaining care
Disorder limited only by patient’s ability to maintain the symptoms
Chronic disorder- lifelong pattern

49

Munchausen's by proxy

Intentional production of symptoms in another (usually a child or a dependent individual)
Goal is indirect assumption of sick role
Usual co-morbidity personality disorder

50

Can munchausen's and/or munchausen's by proxy be treated?

No...treatment is unsuccessful

51

Munchausen's by proxy...what happens to the dependent?

Prognosis is poor if child remains with offending adult
Prognosis is good if child is separated from offending adult

52

Nursing Approach - assessment

Thorough, written team approach
Documentation of communications, behaviors

53

Nursing approach plan/intervention

Communicate among the team
Care provided by team members
Teaching

54

nursing approach evaluation

Team communication with family