Somatic Symptom and Dissociative Disorders Flashcards
Causes of somatic symptom disorder
Genetic
Reduction in serotonin, > autonomic arousal
Family stress & learned behavior as a child
Emotions due to traumatic events or biological/environmental factors–>exhibit pain
Learning theory of somatic symptom disorder
complaints are reinforced because they can get out of certain situations
Nursing interventions of somatic symptoms disorder
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
Illness anxiety disorder
Persistent conviction that one has or is likely to get a serious disease
Worst case scenario
Extremely conscious of bodily sensations and change
Pharmacologic therapy of illness anxiety
Benzos
SSRIs
Nursing interventions of illness anxiety
Help expand coping skills
Encourage pt to express feelings
Respond in a matter of fact way
Create a supportive relationship
Teach relaxation techniques
To have this disorder:
Conversion disorder
One or more symptoms of impaired motor or sensory function
Causes of conversion disorder
Defense mechanisms to neutralize anxiety
Psychological factors
Biological factors
Nursing interventions of conversion disorder
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
Factitious disorder
Deliberately produces symptoms to assume the role to make themselves sick
Purposely imposing illness or physical illness on others or themselves
Treatment of factitious disorder
Psychotherapy
Family therapy
Relaxation training
Biofeedback
Hypnosis
Benzos
Nursing interventions of factitious disorder
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
Depersonalization/Derealization disorder
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
S&S of depersonalization/derealization disorder
Emotionally numb, detached from body, living in a dream, depression, anxiety, fear of going insane
Treatment of depersonalization/derealizatioin disorder
Can recover even without treatment
Psychotherapy: realize the anxiety stressor is causing their disorder
Pharmacologic therapy of depersonalization/derealization disorder
SSRI
Nursing interventions of depersonalization/derealization disorder
See disorder as defense mechanism
help pt recognize and deal with anxiety
Assist in developing supportive relationships
Dissociative anemia with fugue
person moves to another location, new identity
Selective dissociative amnesia
Recall some but not all events
During specific traumatic time, sketchy, don’t remember full situation
Generalized dissociative amnesia
Forget entire past
Prolonged, amnesia for a lifetime
Continuous dissociative amnesia
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
Systematized dissociative amnesia
limited to specific type of info
Ex. They cannot remember the person that caused the event
Treatment of dissociative amnesia
Sometimes resolves by itself
Psychotherapy, hypnosis, benzodiazepines
Primary vs secondary gain
Primary: Positive reinforcement
Secondary: reinforces the advantages of having the symptom. Get the added nurturing from having the symptom
S&S of somatic symptoms disorder
Body symptoms: GI, cardiopulmonary, or reproductive
Hx multiple medical evaluations
Symptoms aren’t under persons voluntary control
Treatment of somatic symptoms disorder
Most difficult disorder to manage
Control/cope with symptoms
Prevent uneccessary medical test/treatment
Occurs with anxiety/depression
Cognitive behavioral therapy
Family therapy
Acupuncture
Causes of illness anxiety disorder
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
S&S of illness anxiety disorder
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
Treatment of illness anxiety
Always do a full assessment before attributing to their mental disorder
Education
Regular outpatient follow up
Individual, group, family psychotherapy
CBT
Conversion disorder
Loss of change in voluntary motor or sensory functioning that suggests a physical illness but has no physiologic basis
S&S of conversion disorder
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
Treatment of conversion disorder
Psychotherapy
Family therapy
Relaxation training
Biofeedback
Hypnosis
Benzos
Causes of depersonalization/derealization disorder
Exact cause unknown
Early life trauma
Immature defense mechanisms
Hx of mental abuse & substance abuse
Dissociative amnesia
Inability to recall important personal info that can’t be explained by normal forgetfulness
Localized dissociative amnesia
Cannot remember events that took place in a specific period of time
Causes of dissociative amnesia
Severe stress from traumatic experience
Physical, emotional, or sexual abuse
Mild TBI
S&S of dissociative amnesia
Disoriented, wandering, may not recognize inability to recall info
Nursing interventions of dissociative amnesia
Encourage verbalize feelings
Help pt realize memory loss is a defense mechanism
Help pt deal with anxiety producing experiences
Dissociative identity disorder
Marked by two or more distinct identities that recurrently take control of the pt’s consciousness and behavior
Causes of DID
trauma, extreme stress, severe physical and sexual abuse
Survival mechanism
S&S of DID
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
Treatment of DID
Goal is to integrate all personalities
Psychotherapy hypnosis
Antidepressants, anticonvulsants
Nursing Interventions of DID
Promote interventions that help pt identify each sub personality
Encourage pt to identify emotions that occur under stress
Recognize small gains
Coping skills
