Class 7 Somatic / Eating Disorders Flashcards
One or more distressing symptoms
Excessive thoughts, anxiety, behavior around symptoms or health concerns
Without significa physical findings/ med diagnosis
Suffering is authentic / involuntary
high functional impairment
Medical care rarely alleviates concerns
Somatic symptom disorder
Misinterpreting physical sensation
Preoccupation with having/ getting serious illness for atleast 6 months
High anxiety about health
Maybe care-seeking or care-avoidant
Illness anxiety disorder
Neurological Symptoms in absence of a Neurological diagnosis
Deficits in voluntary motor or sensory functions
Common Symptoms: Paralysis, blindness, Gait disorder, numbness, loss vision or hearing, episode resemble epilepsy
La belle indifference - Lack of being upset about the “Distressing” Neurological Symptoms
Functional Neurological Symptom Disorder
AKA
Conversion Disorder
Psychosocial stress can impact these diseases (5)
CV Diseases
Peptic Ulcer
Cancer
Headaches
Essential HTN
Epidemiology
Group most likely to have Somatic Diseases
16 - 25 female
Cultural consideration
Why the West has more somatization issues.
Materialism over sense of belonging & other hippy crap
Psychodynamic theory states that psychogenic pain, illness, and loss of function are…
Related to repressed conflict & transformation of anxiety into physical symptoms
_____ (somatic) disorder is related to anger, Aggression, or hostility with origin in pass losses.
It is expressed as a need for help and concern from others
Illness anxiety disorder
What are secondary gains associated with somatic disorders…
Getting out of responsibility
Attention
Manipulation of others
_____ style
May help distinguish between Illness Anxiety Disorder (more anxiety about symptoms & obsessive attention to details) and somatization disorder (patients is often rambling & vague)
Cognitive style
How is ability for somatoform patients to express themselves.
Poor
May often express themselves through somatic symptoms
Most important initial care plan Diagnosis for somatiform disorder
Establishing a helping relationship
Since they will often go to many drs. To find a cause of their pain
6 key elements for effective treatment of somatoform disorder
- Continuity of care
- Avoid unnecessary procedures
- Provide frequent, brief, regular visits
- Avoid disparaging remarks
5 . Always conduct a physical exam - Set reasonable therapeutic goals
Are SMART Outcomes often meet by patients with somatoform disorders.
No, often partially meet
Artifical, deliberate fabrication of symptoms or self-inflict injury
Assuming of Sick Role / Patient Status
Compulsive
Use ERs esp at nighttime
Fictitious disorder
3 main types
Physical, Psychological, Both
Dramatic description of illness
Demands specific treatments
When staff sets limits patient becomes angry and accuses staff of incompetence
May inject toxins or have multiple surgery to investigate unexplained symptoms
Fictitious Disorder
Describe Munchausen Syndrome by proxy
Making or pretending a vulnerable/ dependent person is ill to gain attention
Malingering
Pretending to be ill for Secondary Gains. Insurance fraud, meds, avoidance of prison or work
This brain dysfunction is the only identified for somatoform disorders
Impaired processing
Nurse often become upset about fictitious diseases presented by these patients and have Countertransference .
What should be done with countertransference
Acknowledged and addressed
It is best to confront patients with Factitious Disorders
T or F
F
May result in defensiveness, elusivness, or leaving the facility
Which doesn’t fit into the group
Malingering
Conversion Disorder
Illness anxiety disorder
SSD
Malingering is faking it
The others really believe they are ill
How does SSD somatic symptom disorder differ from Illness Anxiety Disorder…
SSD the primary focus is on the symptoms
IAD the focus is on having the serious illness
Highest amount of mortality in this dx. Mostly from suicide
Anorexia
Co-morbidity
Anorexia
Bulimia
Anorexia: Bipolar, Depression, Anxiety, OCD
Bulimia: SUD/ AUD
Binge eaters report these 2 psychological issues
Major depression & anxiety
Can anorexia be inherented?
Yes, 60% chance
Dysregulation of this neurotransmitter contributes to lack of appetite, mood, impulse control
Serotonin
Which amino acid essential for serotonin synthesis must be obtained through diet
Tryptophan
Continued malnutrition will result in a positive feedback loop that reinforces the eating Disorder
Antidepressants that boost serotonin do not improve symptoms until patient is restored to ____ % of their body weight
90
Current psychological explanation for Anorexia
CBT.
Learned behaviors due to positive reinforcement
Terror of gaining weight
Preoccupation with food & cooking
View self as far even when emaciated
Peculiar handling of food
Self-starvation
May use Laxatives, diuretics, exercise, vomiting
Anorexia nervosa
Explain
Abnormal Lab Values
Abnormal CT & EEG
Associated with Anorexia
Lab values may show electrolyte imbalances (low potassium, sodium, chloride), low glucose, anemia, leukopenia, and abnormal liver and kidney function.
CT scans often reveal brain atrophy and, in severe cases, cerebral edema.
EEGs may show diffuse slowing or abnormal brain activity due to the effects of starvation on the brain
Discuss Cardiovascular issues with Anorexia
Waves..
Hypotension, Bradycardia, heart failure
Prolonged QT & ST-T
Purging behavior in Bulimia Nervosa includes (6)
Vomiting, Laxatives, diuretics, enemas, fasting, excessive exercise
Appearance (weight) of a bulimic
At or near ideal body weight
Hypokalemia, Alkalosis, dehydration, idiopathic (unknown origin) edema, hyponatremia
Hypotension/arrhythmias cardiomyopathy (harder to pump blood) due to Ipecac intoxication
Peripheral edema
Hypoglycemia, menstrual dysfunction
Name disease
Bulimia Nervosa
What is Russell’s sign
Calluses / scars on hands
Parotid gland enlargement can cause Chipmunk like cheeks and is associated with…
Bulimia
Criteria for Hospitalization
< ____% of ideal body weight
Rapid decline in weight
Severe hypothermia
HR <____
SBP <_____
Hypokalemia/ EKG CHANGES
Weight below 75%
HR <50
SBP <90
Refeeding syndrome is potentially fatal due to…
Fluid-balance abnormalities
Abnormalities in Glucose metabolism
Increase in Insulin causes:
Hypophosphatemia / magnesium/ kalemia
Bariatric surgery is controversial for treatment of obesity.
Name possible complications…
Impaired fasting glucose
High Triglycerides
Urinary incontence
Why is Wellbutrin Contradicted in patients who purge?
Increased risk of seizures
metoclopramide (Reglan)
Used to speed up gastric motility, decrease heart burn, and lessen N/V
SSRI at high end of dosage for…
Binge eating
Belviq is used for…
Precautions…
SE…
Belviq can make patient feel full after eating small meal
Activities serotonin- blocks appetite signals
High Dose cause patient to feel High
Schedule IV
SE: Anticholinergic
What is Qsymia used for…
Describe medication….
Contradictions & SE
Qsymia used to stop binge eating
1/2 is anti seizure medicine (Topiramate)
1/2 is appetite Suppressant (Phentermine)
Avoid when Preggers
Schedule IV due to amphetamine like Phentermine
SE: Paresthesia, dizzy,insomnia, constipation, dry mouth
Lisdexamfetamine dimesylate (Vyvanse)
Used for…
Control binge eating / ADHD
Schedule II stimulate
Not first line treatment/ Use after trial woth SSRI
The following are examples of which class of medication
Dulaglutide
Extenatide
Semaglutide
Liraglutide
GLP-1 Meds
How do GLP-1 & GIP medications work to promote weight loss.
Delays gastric emptying & makes you feel full.
Reduce weight by 16%
SE of GLP-1 meds
N/V
Hypoglycemia
Thyroid dysfunction
Stomach issue
Pancreatitis
Mood / Suicide
Most effective treatment for Bulimia Nervosa
CBT
Name 3 childhood feeding disorders
Pica
Rumination
Avoidant/ restrictive food intake
Helps control blood glucose and insulin levels and promotes feelings of fullness.
GLP-1
