Finals Quiz 1 Flashcards
are characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology or a known pathophysiological mechanism to account for them
Somatoform disorders
is a chronic syndrome of multiple! somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health care professionals
Somatization disorder
The essential feature of pain disorder is severe and prolonged pain that causes clinically significant distress or impairment in social, occupational, or
other important areas of functioning
Pain disorder
is an unrealistic preoccupation with the fear of having a serious illness
Hypochondriasis
This disorder, formerly called dysmorphophobia, is characterized by the exaggerated belief that the body is deformed or defective in
some specific way
Body dysmorphic disorder
Body dysmorphic disorder
This disorder, formerly called _____
dysmorphophobia
The pathophysiology of somatoform disorders is ____
unknown
Primary somatoform disorders may be associated with a _____
heightened awareness of normal bodily sensations.
This heightened awareness may be paired with a ______ to interpret any physical symptom as indicative of medical illness
cognitive bias
may be high in some patients with somatoform disorders
Autonomic arousal
This autonomic arousal may be associated with physiologic effects of endogenous noradrenergic compounds such as ___________ or _________
tachycardia or gastric hypermotility.
Heightened arousal also may induce muscle tension and pain associated with muscular hyperactivity, as is seen with ________
muscle tension headaches
Causes of Somatoform Disorders Predisposing factors to somatoform disorders include:
Genetic
Biochemical
Psychodynamic
Family dynamics
Sociocultural/familial factors.
Past experience with physical illness
Cultural and environmental factors
Studies have shown an increased incidence of somatization disorder, conversion disorder, and hypochondriasis in first-degree relatives, implying a possible inheritable disposition
Genetic
Decreased levels of serotonin and endorphins may play a role in the etiology of pain disorder.
Biochemical
Some psychodynamics view hypochondriasis as an
ego defense mechanism; the psychodynamic theory of conversion disorder proposes that emotions associated with a traumatic event that the individual cannot express because of moral or ethical unacceptability are “converted” into physical symptoms
Psychodynamic
Some families have difficulty expressing emotions openly and resolving conflicts verbally; when this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child’s illness, leaving unresolved the underlying issues that the family cannot confront openly.
Family dynamics
Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it be within the society or within the family.
Sociocultural/familial factors
Personal experience, or the experience of close family members with serious or life-threatening illness can predispose an individual to hypochondriasis
Past experience with physical illness
Some cultures and religions carry implicit sanctions against verbalizing or directly expressing emotional states, thereby indirectly encouraging “more acceptable” somatic behaviors.
Cultural and environmental factors.
Clinical Manifestations
Symptoms of somatoform disorder include:
Pain symptoms
Gastrointestinal symptoms
Sexual Symptoms
Pseudo neurologic symptoms
Complaints of headache, pain in the abdomen, head, joints, back, chest, rectum; pain during urination, menstruation, or
sexual intercourse.
Pain symptoms
There is nausea, bloating, vomiting
(other than during pregnancy), diarrhea, or intolerance of several
foods.
Gastrointestinal symptoms
Sexual indifference, erectile or ejaculatory dysfunction, irregular menses, excessive menstrual bleeding, and vómiting through pregnancy
Sexual symptoms
Conversion symptoms such as impaired coordination or balance, paralysis or localized weakness, difficulty swallowing or lump in throat, aphonia, urinary retention, hallucinations, loss of touch or pain sensation, double vision, blindness, deafness, and seizures.
Pseudo neurologic symptoms
Medical Management
1.Cognitive-behavioral psychotherapy
2.Psychosocial therapies
3. Psychoeducation
strategies may be specifically helpful in reducing distress and high medical use.
Cognitive-behavioral psychotherapy
directed by physicians form the basis for successful treatment; a strong relationship between the patient and the primary care physician can assist in long-term management.
Psychosocial therapies
can be helpful by letting the patient know that physical symptoms may be exacerbated by anxiety or other emotional problems; however, be careful because patients are likely to resist suggestions that their condition is due to emotional rather than physical problems
Psychoeducation
The nurse must investigate physical health status thoroughly to ensure there is no underlying pathology requiring treatment.
Nursing Assessment
Clients usually provide a lengthy and detailed account of previous physical problems, numerous diagnostic tests, and perhaps even a number of surgical procedures.
General appearance and motor behavior. Often, clients walk slowly or with an unusual gait because of the pain or disability
caused by the symptoms; they may exhibit a facial expression of discomfort or physical distress.
History
Mood is often labile, shifting from seeming depressed and sad when describing physical problems to looking bright and excited when talking about how they had to go to the hospital in the middle of the night by ambulance.
Mood and affect.
Clients who somatize do not experience disordered thought processes; the content of their thinking is primarily about often exaggerated physical concerns, for example, when they have a simple cold they may be convinced it is pneumonia.
Thought process and content.
Nursing Diagnosis
Chronic pain related to severe levels of anxiety, repressed.
Ineffective coping related to inadequate coping skills.
Disturbed body image related to low self-esteem, severe level of anxiety.
Disturbed sensory perception related to regression to, or fixation in, an earlier level of development.
Self-care deficit related to paralysis of body parts, pain, discomfort.
Deficient knowledge related to lack of interest in learning, severe anxiety
The nurse must help the client establish a daily routine that includes improved health behaviors.
Providing health teaching
Clients may keep a detailed journal of their physical symptoms; the nurse might ask them to describe the situation at the time such as whether they were alone or with others, whether any disagreements were occurring, and so forth.
Assisting the client to express emotions
Emotion-focused strategies include progressive relaxation, deep breathing, guided imagery, and distractions such as music or other activities; problem-focused coping strategies include problem-solving methods, applying the process to identified problems, and role-playing interactions with others.
Teaching coping strategies
