Somatic Symptom and Dissociative Disorders

Question 1

Causes of somatic symptom disorder

Answer 1

Genetic
Reduction in serotonin, > autonomic arousal
Family stress & learned behavior as a child
Emotions due to traumatic events or biological/environmental factors–>exhibit pain

Question 2

Learning theory of somatic symptom disorder

Answer 2

complaints are reinforced because they can get out of certain situations

Question 3

Nursing interventions of somatic symptoms disorder

Answer 3

Acknowledge the symptoms
Emphasize strengths
Help manage symptoms, not eliminate them
Matter of fact manner
Can’t help until underlying problem that’s causing the symptom is addressed first

Question 4

Illness anxiety disorder

Answer 4

Persistent conviction that one has or is likely to get a serious disease
Worst case scenario
Extremely conscious of bodily sensations and change

Question 5

Pharmacologic therapy of illness anxiety

Answer 5

Benzos
SSRIs

Question 6

Nursing interventions of illness anxiety

Answer 6

Help expand coping skills
Encourage pt to express feelings
Respond in a matter of fact way
Create a supportive relationship
Teach relaxation techniques

Question 7

To have this disorder:
Conversion disorder

Answer 7

One or more symptoms of impaired motor or sensory function

Question 8

Causes of conversion disorder

Answer 8

Defense mechanisms to neutralize anxiety
Psychological factors
Biological factors

Question 9

Nursing interventions of conversion disorder

Answer 9

Don’t force individual to talk, convey a caring attitude
Help pt identify emotional conflicts
> coping ability
Don’t insist they use affected body part

Question 10

Factitious disorder

Answer 10

Deliberately produces symptoms to assume the role to make themselves sick
Purposely imposing illness or physical illness on others or themselves

Question 11

Treatment of factitious disorder

Answer 11

Psychotherapy
Family therapy
Relaxation training
Biofeedback
Hypnosis
Benzos

Question 12

Nursing interventions of factitious disorder

Answer 12

Don’t force individual to talk, convey a caring attitude
Help pt identify emotional conflicts > coping ability
Don’t insist they use affected body part

Question 13

Depersonalization/Derealization disorder

Answer 13

Persistent or recurring feelings that one is detached from one’s own mental processes or body or by feelings of detachment from other persons, objects, or surroundings
Feel the word is unreal or distorted

Question 14

S&S of depersonalization/derealization disorder

Answer 14

Emotionally numb, detached from body, living in a dream, depression, anxiety, fear of going insane

Question 15

Treatment of depersonalization/derealizatioin disorder

Answer 15

Can recover even without treatment
Psychotherapy: realize the anxiety stressor is causing their disorder

Question 16

Pharmacologic therapy of depersonalization/derealization disorder

Answer 16

SSRI

Question 17

Nursing interventions of depersonalization/derealization disorder

Answer 17

See disorder as defense mechanism
help pt recognize and deal with anxiety
Assist in developing supportive relationships

Question 18

Dissociative anemia with fugue

Answer 18

person moves to another location, new identity

Question 19

Selective dissociative amnesia

Answer 19

Recall some but not all events
During specific traumatic time, sketchy, don’t remember full situation

Question 20

Generalized dissociative amnesia

Answer 20

Forget entire past
Prolonged, amnesia for a lifetime

Question 21

Continuous dissociative amnesia

Answer 21

Forget things from a given time
Something happened in the late 20s so they forget what happens from the start of the event to now, before that time they can remember

Question 22

Systematized dissociative amnesia

Answer 22

limited to specific type of info
Ex. They cannot remember the person that caused the event

Question 23

Treatment of dissociative amnesia

Answer 23

Sometimes resolves by itself
Psychotherapy, hypnosis, benzodiazepines

Question 24

Primary vs secondary gain

Answer 24

Primary: Positive reinforcement
Secondary: reinforces the advantages of having the symptom. Get the added nurturing from having the symptom

Question 25

S&S of somatic symptoms disorder

Answer 25

Body symptoms: GI, cardiopulmonary, or reproductive Hx multiple medical evaluations Symptoms aren't under persons voluntary control

Question 26

Treatment of somatic symptoms disorder

Answer 26

Most difficult disorder to manage Control/cope with symptoms Prevent uneccessary medical test/treatment Occurs with anxiety/depression Cognitive behavioral therapy Family therapy Acupuncture

Question 27

Causes of illness anxiety disorder

Answer 27

Similar to somatic symptom disorder Self-centeredness Emotional links Death of a loved one, associated with depression, living with a family member that has a serious illness

Question 28

S&S of illness anxiety disorder

Answer 28

Specific to general complaints Describes PQRST Examination by healthcare provider doesn't relieve concerns Reject that symptoms are psychological Use symptoms to avoid difficult situations

Question 29

Treatment of illness anxiety

Answer 29

Always do a full assessment before attributing to their mental disorder Education Regular outpatient follow up Individual, group, family psychotherapy CBT

Question 30

Conversion disorder

Answer 30

Loss of change in voluntary motor or sensory functioning that suggests a physical illness but has no physiologic basis

Question 31

S&S of conversion disorder

Answer 31

Depends on pt Pseudoseizures Loss of sense Dysphagia Impaired balance or coordination Weakness of paralysis La Belle indifference: have the symptoms but doesn't really bother them

Question 32

Treatment of conversion disorder

Answer 32

Psychotherapy Family therapy Relaxation training Biofeedback Hypnosis Benzos

Question 33

Causes of depersonalization/derealization disorder

Answer 33

Exact cause unknown Early life trauma Immature defense mechanisms Hx of mental abuse & substance abuse

Question 34

Dissociative amnesia

Answer 34

Inability to recall important personal info that can't be explained by normal forgetfulness

Question 35

Localized dissociative amnesia

Answer 35

Cannot remember events that took place in a specific period of time

Question 36

Causes of dissociative amnesia

Answer 36

Severe stress from traumatic experience Physical, emotional, or sexual abuse Mild TBI

Question 37

S&S of dissociative amnesia

Answer 37

Disoriented, wandering, may not recognize inability to recall info

Question 38

Nursing interventions of dissociative amnesia

Answer 38

Encourage verbalize feelings Help pt realize memory loss is a defense mechanism Help pt deal with anxiety producing experiences

Question 39

Dissociative identity disorder

Answer 39

Marked by two or more distinct identities that recurrently take control of the pt's consciousness and behavior

Question 40

Causes of DID

Answer 40

trauma, extreme stress, severe physical and sexual abuse Survival mechanism

Question 41

S&S of DID

Answer 41

Lack of recall about personal history Confrontation with evidence of activity they don't recall Hallucinations, PTSD symptoms, sleep disorders, eating disorders, self mutilation, suicidal tendencies

Question 42

Treatment of DID

Answer 42

Goal is to integrate all personalities Psychotherapy hypnosis Antidepressants, anticonvulsants

Question 43

Nursing Interventions of DID

Answer 43

Promote interventions that help pt identify each sub personality Encourage pt to identify emotions that occur under stress Recognize small gains Coping skills