ATI Ch 20, Somatic Symptom and Related Disorders Flashcards
What are somatic symptom and related disorders?
Somatic symptom disorder, illness anxiety disorder, functional neurological symptom disorder, factitious disorder, and psychological factors affecting other medical conditions.
What is somatization?
The expression of psychological stress through physical manifestations.
What is a key characteristic of somatic symptom disorder?
Physical manifestations cannot be explained by underlying pathology.
How do somatic manifestations affect clients?
They cause distress and often lead to long-term use of health care services.
What are the typical characteristics of somatic manifestations?
They can be vague or exaggerated.
What is the typical course of somatic symptom disorder?
It can be acute but is often chronic, with periods of remission and exacerbation.
How do clients with somatic symptom disorder view psychological diagnoses?
They often reject a psychological diagnosis as the cause for their physical manifestations.
Where are clients with somatic symptom disorder usually seen first?
In a primary or medical care setting.
What common comorbidities are associated with somatic symptom disorder?
Anxiety and depression.
What are some risk factors for somatic symptom disorder?
- First-degree relative with somatic symptom disorder
- Decreased levels of neurotransmitters: serotonin and endorphins
- Depressive disorder, personality disorder, or anxiety disorder
- Low socioeconomic status
- Adverse childhood experiences
- Learned helplessness
What are expected findings in clients with somatic symptom disorder?
- Somatic manifestations that disrupt daily life
- Excessive preoccupation with somatic manifestations
- Increased anxiety about somatic manifestations
- Symptoms present for longer than 6 months
- Remissions and exacerbations of symptoms
- Possible substance use
- High utilization of health services
What laboratory and diagnostic tests may be performed for somatic symptom disorder?
CT scans and MRIs can be performed to rule out underlying pathology.
What is the purpose of the Patient Health Questionnaire 15 (PHQ-15)?
To identify the presence of the 15 most commonly reported somatic manifestations.
List some common somatic manifestations identified by the PHQ-15.
- Abdominal pain
- Back pain
- Pain in extremities/joints
- Menstrual problems or cramps
- Headaches
- Chest pain
- Dizziness
- Fainting
- Heart pounding or racing
- Dyspnea
- Problems with sexual intercourse
- Bowel elimination issues
- Nausea, indigestion, or gas
- Lethargy
- Sleep problems
What nursing care strategies are recommended for clients with somatic symptom disorder?
- Accept somatic manifestations as real
- Assess for suicidal ideation
- Identify cultural impacts on health views
- Identify secondary gains from somatic symptoms (attention, distraction from problems, etc.)
- Report new manifestations to the provider
- Limit discussion time on symptoms
- Encourage self-care and verbalization of feelings
- Educate on coping mechanisms and assertiveness
- Encourage daily physical exercise
What is reattribution treatment?
A treatment that assists clients to identify the link between physical manifestations and psychological factors while promoting a sense of caring and understanding.
This approach is critical in managing somatic symptom disorder.
What is the first stage of reattribution treatment?
Feeling understood: Use therapeutic communication, active listening, and empathy to obtain a thorough history of manifestations and focus on the client’s perception.
This stage includes a brief assessment of the client’s physical assessment.
What occurs in the second stage of reattribution treatment?
Broadening the agenda: Acknowledge the client’s concerns and provide feedback about assessment findings.
This stage helps in validating the client’s feelings.
What is the focus of the third stage of reattribution treatment?
Making the link: Acknowledge the lack of a physical cause for the manifestations while allowing the client to maintain self-esteem.
What happens in the fourth stage of reattribution treatment?
Negotiating further treatment: Work with the provider and client to develop a treatment plan for regular follow-up visits.
What types of medications may be administered for somatic symptom disorder?
- Analgesics
- Antidepressants
- Anxiolytics
What client education should be provided for somatic symptom disorder?
- Participate in individual and group therapy
- Utilize prescribed medications
- Assist a case manager in developing a follow-up appointment schedule
What is illness anxiety disorder?
A disorder where clients misinterpret physical manifestations as evidence of a serious disease process, leading to obsessive thoughts and fears about illness.
What are common behaviors of clients with illness anxiety disorder?
- Excessively researching their suspected disease
- Repeatedly examining themselves
- Seeking numerous medical opinions or avoiding healthcare
What are some risk factors for illness anxiety disorder?
- First-degree relative with illness anxiety disorder
- Previous losses or disappointments
- Childhood trauma, maltreatment, or neglect
- Depressive or anxiety disorders
- Major life stressor
- Low self-esteem
What are expected findings in clients with illness anxiety disorder?
- Excessive anxiety about a serious illness for more than 6 months
- Preoccupation with health-related behaviors
- Variability in seeking medical care (health-seeking vs. avoidant type)
What types of diagnostic tests can be performed for illness anxiety disorder?
Laboratory and diagnostic tests (CT scans, MRIs) to rule out underlying pathology.
What nursing care strategies should be employed for clients with illness anxiety disorder?
- Build rapport and trust
- Encourage independence in self-care
What client education is recommended for illness anxiety disorder?
- Participate in individual and group therapy
- Attend community support groups
- Utilize prescribed medications
- Collaborate with the provider for brief, frequent visits
- Verbalize feelings
- Utilize alternative coping mechanisms
- Perform stress management techniques
What is functional neurological symptom disorder?
A condition characterized by deficits in voluntary motor or sensory functions
What are some examples of symptoms in functional neurological symptom disorder?
- Paralysis
- Blindness
- Seizures
- Gait disorders
- Inability to speak (aphonia)
- Numbness
- Deafness
- Angling/burning sensations
What is la belle indifference?
A phenomenon where clients exhibit a lack of concern about their symptoms
List some risk factors for functional neurological symptom disorder.
- First-degree relative with the disorder
- Childhood physical or sexual abuse
- Comorbid psychiatric conditions
- Recent acute stressful events
- Female sex
- Adolescent or young adult
- Low socioeconomic status
- Low educational status
What are the expected findings in a patient with functional neurological symptom disorder?
- Alterations in voluntary motor or sensory function
- Symptoms like paralysis, movement disorders, blindness, inability to speak, numbness, or deafness
What types of laboratory and diagnostic tests can be conducted for this disorder?
CT scans and MRIs to rule out underlying pathology
What is the primary goal of patient-centered care in functional neurological symptom disorder?
To establish basic rapport and trust with the patient
Fill in the blank: The relapse rate for functional neurological symptom disorder is approximately ______.
20%
What medications are commonly prescribed for functional neurological symptom disorder?
- Antidepressants
- Anxiolytics
What psychological factors can affect medical conditions?
Psychological and behavioral factors can play a role in any medical condition
List some medical conditions linked to psychological disorders.
- Heart disease
- Cancer
What are some common risk factors for psychological factors affecting medical conditions?
- Chronic stressors
- Depressive disorder
- Anxiety disorder
- Malfunction of neurotransmitters
What is the relationship between psychological state and physical condition?
Research has shown a link between a client’s psychological state and their physical condition
What is pseudocyesis?
A condition where a person has a desire to become pregnant but is not actually pregnant
What is the onset of delirium?
Rapid over a short period of time (hours or days)
Delirium can develop quickly, often within hours or days.
What are the manifestations of delirium?
Impairments in memory, judgment, ability to focus, and ability to calculate; disorientation and confusion often worse at night and early morning
Symptoms can fluctuate throughout the day, and the level of consciousness is usually altered.
How many types of delirium are there and what are they?
Four types:
* Hyperactive with agitation and restlessness
* Hypoactive with apathy and quietness
* Mixed, having a combination of hyper and hypo manifestations
* Unclassified for those whose manifestations do not classify into the other categories
Each type presents different symptoms and behaviors.
What are common symptoms of delirium?
Restlessness, anxiety, motor agitation, and fluctuating moods
Personality changes can occur rapidly, and perceptual disturbances like hallucinations and illusions may be present.
What can cause vital signs to become unstable in delirium?
Change in reality can cause fear, panic, and anger
This instability may require medical intervention.
What is the primary cause of delirium in older adults?
Often associated with hospitalization
Other causes include medical conditions like infection, malnutrition, depression, electrolyte imbalance, or substance use.
What is the outcome of delirium if diagnosed and treated promptly?
Reversible if diagnosis and treatment of underlying cause are prompt
Early intervention is crucial for recovery.
What characterizes neurocognitive disorders?
Gradual deterioration of function over months or years
Unlike delirium, symptoms do not fluctuate throughout the day.
What are the impairments associated with neurocognitive disorders?
Impairments in memory, judgment, speech (aphasia), ability to recognize familiar objects (agnosia), executive functioning (managing tasks), and movement (apraxia)
These impairments are stable and do not change throughout the day.
What is the level of consciousness in neurocognitive disorders?
Usually unchanged
Unlike delirium, the level of consciousness remains stable.
What is the primary risk factor for neurocognitive disorders?
Advanced age
Other causes include genetics, sedentary lifestyle, metabolic syndrome, and diabetes mellitus.
What are the subtypes of neurocognitive disorders?
Related to:
* Alzheimer’s disease
* Traumatic brain injury
* Parkinson’s disease
* Other disorders affecting the neurologic system
These subtypes can vary in symptoms and progression.
Are neurocognitive disorders reversible?
No, they are irreversible and progressive
Unlike delirium, neurocognitive disorders develop gradually and do not improve.
