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Psych Exam 2 > Somatic and dissociative disorders > Flashcards

Somatic and dissociative disorders Flashcards

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1
Q

types of somatic symptom disorders

A

somatic symptom disorder
illness anxiety disorder
conversion disorder
factitious disorder
psychological factors affecting mental conditions

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2
Q

those who are primarily preoccupied by perceived physical symptoms

A

somatic symptom disorder

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3
Q

those who are primarily focused on fear of illness in general

A

illness anxiety disorder

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4
Q

what identifies somatic symptom disorder

A

DSM-5

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5
Q

psychological or behavioral factors lead to:

A

Influence the course of the medical condition regarding development, exacerbation or delay recovery
The factors / behaviors interfere with treatment of medical condition (poor adherence/compliance)
Factors/behaviors can be well established health risks to the individual
Knowingly doing things that cause exacerbation of symptoms or necessitating medical attention

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6
Q

Somatic Symptoms Disorder is present when:

A

an individual’s excessive focus on somatic symptoms is beyond any medical explanation and the symptoms cause significant distress and impairment in one’s functioning

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7
Q

characteristics of somatic symptom disorder

A

Multiple complaints that can not be explained.
Psychosocial distress and frequent visits to healthcare professionals to seek assistance are common.
Chronic disorder with symptoms beginning usually before the age of 30
Periods of remission and exacerbation
Drug use disorder and dependence are common features.
Excessive time and energy devoted to these symptoms or health concerns

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8
Q

common focus of diagnoses of somatic symptom disorder

A

distress

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9
Q

prevalence of somatic symptom disorder:

A

11%

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10
Q

the health anxiety cycle 1-5

A
  1. sensation
  2. meaning making
  3. catastrophizing
  4. reassurance seeking
  5. temporary relief
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11
Q

possible effects of conversion disorder

A

Likely psychological components involved with initial onset, exacerbation and perpetuation of symptoms though it may or may not be identifiable.
Affect voluntary motor or sensory functioning suggestive of neurological disease

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12
Q

Prevalence of somatic symptom disorder in this lifetime

A

general population have ranged from 5% to 30%.
occurs more frequently in women than in men and more frequently in adolescents and young adults than in other age groups.
A higher prevalence exists in lower socioeconomic groups, rural populations, those with less education, and military personnel who have been exposed to combat situations

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13
Q

diagnostic criteria for somatic symptom disorder

A

A. One or more somatic symptoms that are distressing or result in significant disruption in daily life.
B. Excessive thoughts, feelings, or behaviors related to the somatic symptoms or associated health concerns as manifested by at least one of the following:
1. Disproportionate and persistent thoughts about the seriousness of one’s symptoms.
2. Persistently high level of anxiety about health or symptoms.
3. Excessive time and energy devoted to these symptoms or health concerns.
C. Although any one symptom may not be continuously present, the state of being symptomatic is persistent (typically more than 6 months).

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14
Q

factors of illness anxiety disorder

A

Unrealistic or inaccurate interpretation of physical symptoms or sensations
Leads to preoccupation with and fear of having a serious disease.
Extremely conscious of bodily sensations and changes
Anxiety and depression are common features.
Symptoms may be minimal or absent but the individual is highly anxious about the suspicion of undiagnosed serious medical illness.
Obsessive-compulsive traits are common as is a long history of “Doctor Shopping” and being convinced they are not getting proper care.
Comorbid anxiety, depression, somatization and panic disorders are common, and these patients are 3x’s more likely to have a concurrent personality disorder.

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15
Q

Loss or change in body function not explained by medical disorder or pathophysiological mechanism

A

conversion disorder

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16
Q

possible functioning difficulties of conversion disorder

A

pseudo-seizures
paralysis
aphonia
seizures
coordination disturbance
difficulty swallowing
urinary retention
akinesia
blindness
deafness
double vision
anosmia (unable to smell)
loss of pain sensation
hallucinations
False pregnancy

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17
Q

This term is used when a client displays an apparent indifference to symptoms that seem very serious to others. Example: The patient that wakes one day unable to walk and is calm about it and unconcerned about the dramatic and sudden change.

A

La Belle Indifference

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18
Q

factors of factitious disorder

A

Conscious, intentional feigning of physical and/or psychological symptoms to gain emotional support
Used to be called Munchausen Syndrome
May be imposed on self or others under the care of the perpetrator – by proxy or imposed on others.
Although deliberate and intentional, there may be an unintentional compulsive element that diminishes personal control.
Clients with this can “present symptoms” skillfully and get admitted or undergo treatment often.
They often exaggerate existing symptoms, induce new ones and even inflict painful injury on themselves or others.
Diagnosis is difficult.

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19
Q

falsification or profound exaggeration of illness (physical or mental) to gain external benefits such as avoiding work or responsibility, seeking drugs, avoiding trial (law), seeking attention, avoiding military services, leave from school, paid leave from a job, among other

A

malingering

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20
Q

predisposing factors of somatic/ dissociative disorder

A

Genetics
Biological
Neuroanatomical
Learning Theory
Psychodynamic Theory
Family Dynamics
Transactional Model of Stress/Adaptation

21
Q

possible biochemical factors of factitious disorder

A

Decreased levels of serotonin and endorphins for somatic syndrome disorders have been noted in research

22
Q

neuronatomical factor of factitious disorder

A

Brain dysfunction – impairment in information processing is one theory

23
Q

learning theory for factitious disorder

A

May avoid stressful obligations or be excused from unwanted duties - PRIMARY GAIN
May become the prominent focus of attention because of illness – SECONDARY GAIN
May relieve conflict with family as concern is shifted to the ill person and away from real issues – TERTIARY GAIN

24
Q

psychodynamic theory

A

Ego defense mechanism
Emotions associated with a traumatic event
Family Dynamics
Transactional Model of Stress and Adaptation

25
Q

possible nursing diagnoses of somatic and dissociative disorders

A

ineffective coping
knowledge deficit
fear or anxiety
disturbed self image
self care deficit
disturbed sensory perception

26
Q

Outcome Criteria: Somatic Symptom Disorders

A

The client:
Copes effectively without resorting to physical symptoms
Has decreased frequency of physical complaints and interprets bodily sensations rationally
Is free of physical disability

27
Q

Disruption in functions of consciousness, memory, and identity
When anxiety becomes overwhelming
When personality becomes disorganized

A

dissociative disorder

28
Q

That is about the best way to describe the feeling of dissociative disorder.

A

Clients often have a history of a single (sometimes several) brief instances of severe psychosocial stress or a trauma event that seems to precipitate initial alter.
More prevalent in women than in men
Symptoms usually begin in adolescence or early adulthood.

29
Q

Dissociative Disorders are a group of conditions defined as psychological disturbances that impact an individual’s ability to function and closely overlap withpsychotic disorder. These include disturbances affecting:

A

Memory
Motor Control
Concept of Identity
Behaviors
Emotions
Perceptions

30
Q

Inability to recall all incidents associated with a stressful period

A

localized amnesia

31
Q

recall only certain incidents associated with a stressful event for a specific period after the event

A

selective amnesia

32
Q

amnesia for his/her identity and total life history

A

generalized amnesia

33
Q

Sudden, unexpected travel away from customary places or by bewildered wandering
Inability to recall some or all of one’s past
Individual may not be able to recall personal identity or information
Sometimes client even assumes a new ‘identity’.

A

dissociative fugue

34
Q

Existence of two or more personality states in a single individual
Transition from one personality state to another may be sudden or gradual

A

dissociative identity disorder

35
Q

occurs when you persistently or repeatedly have the feeling that you’re observing yourself from outside your body or you have a sense that things around you aren’t real, or both.

A

Depersonalization-derealization disorder

36
Q

occurs when you persistently or repeatedly have the feeling that you’re observing yourself from outside your body or you have a sense that things around you aren’t real, or both.

A

Depersonalization-derealization disorder

37
Q

symptoms of Depersonalization-derealization disorder

A

Temporary change in quality of self-awareness
Feelings of unreality
Changes in body image
Feelings of detachment from the environment
Sense of observing oneself from outside of the body

Symptoms can include:
Anxiety and depression
Fear of going insane
Obsessive thoughts
Somatic complaints
Disturbance in the subjective sense of time

38
Q

disturbance in perception of oneself

A

depersonalization

39
Q

disturbance in perception of external environment

A

derealization

40
Q

Statistics and facts on depersonalization-derealization disorder include:

A

Both depersonalization and derealization are triggered by episodes of severe stress
About half of the population at large experiences depersonalization-derealization at least once in their lives
Approximately 2% of the general population goes on to develop a depersonalization-derealization disorder

41
Q

predisposing factors of dissociative disorder

A

Neurobiological
Dissociative amnesia: neurophysiological dysfunction
Electroencephalogram abnormalities: DID
Psychodynamic theory
Dissociation: repression of distressing mental contents from conscious awareness
Psychological trauma
DID: set of traumatic experiences that overwhelm individual’s capacity to cope by any means other than dissociation
Severe physical, sexual, or psychological abuse by significant other in the child’s life
Survival strategy for child in traumatic environment
Transactional model of stress/adaptation

42
Q

possible interventions for dissociative disorder

A

Care is aimed at restoring normal thought processes

Efforts to determine strategies for coping with stress by means other than dissociation from the environment

43
Q

Outcome Criteria: Somatic Symptom Disorders

A

The client:
Can recall events associated with stressful situations
Can recall all events of past life
Can verbalize anxiety that precipitates the dissociation
Can demonstrate coping methods to avert dissociative behavior
Verbalizes existence of multiple personalities
Is able to maintain a sense of reality during stress events.
Develops a safety plan in the event they experience fugue

44
Q

evaluation for dissociative disorder

A

Can the client recognize s/s of escalating anxiety?
Can the client intervene with adaptive coping strategies to interrupt the escalating anxiety before physical symptoms are exacerbated?
Can the client verbalize an understanding of the correlation between physical symptoms and times of escalating anxiety?
Does the client have a plan to deal with increased stress to prevent exacerbation of physical symptoms?

45
Q

treatment modalities for somatic symptom disorders

A

Individual psychotherapy
Group psychotherapy
Cognitive behavior therapy (CBT) and psychoeducation
Psychopharmacology

46
Q

treatment modalities for dissociative identity disorder

A

Individual psychotherapy
Hypnosis
Supportive care
Cognitive therapy
Group therapy
Integration therapy (DID)
Psychopharmacology

47
Q

treatment modalities of dissociative amnesia

A

Can resolve spontaneously when client is removed from stressful situation
Psychotherapy is used as primary treatment
Techniques of persuasion and free association help the client remember
Hypnosis may be required to mobilize memories

48
Q

treatment modalities of depersonalization-derealization

A

Information about treatment is inconclusive
Various psychiatric medications may help
Antidepressants, mood stabilizers, anticonvulsants, and antipsychotics
Results have been sporadic at best.
Hypnotherapy
CBT

Psych Exam 2 (9 decks)

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