Somatic Symptom Disorder and Related

Question 1

somatization

Answer 1

expression of stress through physical symptoms
expressed in place of anxiety, depression or irritability in ways such as pain, paralysis, skin rash, etc.
somatization is the hallmark of psychiatric illness

Question 2

specifiers of somatic symptom disorder

Answer 2

with pain predominant
persistent
mild, mod, severe

Question 3

specifiers of illness anxiety disorder

Answer 3

care seeking
care avoiding

Question 4

specifiers of conversion disorder

Answer 4

acute episodes
persistent
with or without psychological stressor

Question 5

epidemiology of somatic symptom disorder

Answer 5

more frequent is females
lower education levels and socioeconomic status
past or recent stressful life event
underdiagnosed in older adults

Question 6

how do children with somatic symptom disorder present?

Answer 6

recurrent abdominal pain
headache
fatigue
nausea

Question 7

etiology of somatic symptom disorder

Answer 7

psychological
neurobiological
behavioral
*always rule out medical causation of presenting symptoms

Question 8

psychological causes of somatic symptom disorder

Answer 8

personality factors: Histrionic personality traits
co-occurring psychiatric illness (anxiety/depression)
childhood physical/emotional abuse
repression of conflict- reaction of pain to traumatic event
exposure to trauma
anxiety transforms into physical symptoms
reaction to pain, medical illness, loss

Question 9

neurobiological causes of somatic symptom disorder

Answer 9

more likely in first degree relatives of women with somatization disorder
no organic cause, no change in peripheral body system
functional brain imaging helps study correlation between brain and body

Question 10

behavioral causes of somatic symptom disorder

Answer 10

familial influence (children mimic mother’s over concern about health, learned helplessness)
learn how to manipulate others to care for them
symptoms intensify with attention
helps avoid activities, obtain financial benefit or gain advantage in a relationship
reason is not evident

Question 11

cultural considerations of somatic symptom disorder

Answer 11

African/southern Asian experience burning hands/feet, sensation of worms in head or ants under skin
Greek/ Puerto Rican symptoms occur more in men
immigrants/refugees fleeing death squads, violence against loved ones

Question 12

Western Culture considerations of somatic symptom disorder

Answer 12

decrease value in family/group needs
decreases development of communities, socialization
decreased overall mental and physical health; increases somatization

Question 13

somatic symptom DSM 5

Answer 13

one or more somatic symptoms that disrupt daily life
excessive thoughts, feelings, behaviors r/t somatic symptoms
for more than 6 months
*worry a lot about illness, think worst about health, think bodily symptoms are life threatening, harmful, and fear medical illness
feel medical care they receive is inadequate

Question 14

possible assessment findings of somatic symptom disorder

Answer 14

a focus on somatic symptoms
interpret normal body sensations as a physical illness
repeatedly checks body for abnormalities
repeatedly seeking medical care and reassurance
avoidance of physical activity
medical consults from a variety of providers
non-acceptance of any suggestions of a mental health referral
comorbid anxiety and depression disorder
increased suicide risk

Question 15

illness anxiety disorder DSM5

Answer 15

preoccupation with having or acquiring serious illness
hypochondriac
somatic symptoms are NOT present, or if present very mild, high risk of developing medical problem, preoccupation is clearly excessive or disproportionate
2 types
care seeking (excessive scans and appts) and care avoiding (does not go to any HCP)
symptoms present for at least 6 months

Question 16

conversion disorder (functional neurological symptoms disorder)

Answer 16

person looses ability to see, hear, or speak or becomes paralyzed, but NO medical explanation can be found to explain symptoms
often begin after some stressful experience, expression of emotional conflict or need
symptoms include psychological and emotional pain may be converted to physical symptoms under conditions of extreme stress
Labelle’ indifference

Question 17

Labelle’ indifference

Answer 17

a paradoxical absence of psychological distress despite having a serious medical illness of symptom related to health condition
“beautiful ignorance”
commonly associated with Conversion disorder, mere diagnosis of LaBelle’ does not confirm dx of conversion disorder however most commonly associated with conversion disorder.

Question 18

sensory symptoms of conversion disorder

Answer 18

anesthesia, hyper anesthesia, analgesia, tingling or crawling sensations

Question 19

motor symptoms of conversion disrorder

Answer 19

any muscle group may be involved: arms, legs, vocal chords, resulting in tremors, tics, disorganized mobility or paralysis

Question 20

visceral symptoms of conversion disorder

Answer 20

dysphagia, frequent belching, spells of coughing or vomiting: all carried to an uncommon extreme

Question 21

other symptoms of conversion disorder

Answer 21

pseudo seizures
pseudo coma
pseudo blindness
pseudo paralysis
pseudo sensory syndromes ( complaints of numbness or lack of sensation to body parts)

Question 22

hysteria (historical)

Answer 22

Greece believed hysteria only occurred in females and was caused by the uterus wondering the body
regarded to as fakers
were thought to be involved with witchcraft and were burned at the stake

Question 23

factitious disorder imposed on self

Answer 23

falsification of physical or psychological signs or symptoms or induction of injury associated with identified deception
presents themselves to others as ill, impaired, or injured
deceptive behavior
behavior is not better explained by another mental disorder

Question 24

factitious disorder imposed by another

Answer 24

Munchausen by proxy
perpetrator receives the diagnosis not the victim

Question 25

psychological factors affecting other medical conditions

Answer 25

a medical symptom or condition is present
psychological or behavioral factors adversely affects the medical
factors have influenced the course of the medical condition
factors interfere with the treatment
examples of psychological/behavioral: anxiety/depression, stressful life event
common clinical examples: anxiety-exacerbating asthma, manipulation of insulin by patient with diabetes to loose weight
acute: takotsubo (octopus pot) cardiomyopathy, broken heart syndrome
chronic: occupational stress increasing risk for HTN

Question 26

malingering

Answer 26

conscious fabrication of illness exaggerating symptoms for secondary gain
for personal gain, where as fictitious is not for personal gain

Question 27

body dysmorphic disorder

Answer 27

imagined defect in appearance
mild to severe symptoms
may have several plastic surgeries, compulsive skin picking, or body mutilation
increased risk of suicide

Question 28

in which of the following disorders is he primary feature loss of voluntary motor or sensory functioning that appears to represent physiologic pathology but, instead, relates to psychological conflict or need?
a- somatic symptom disorder
b- body dysmorphic disorder
c- conversion disorder
d- hypochondriasis

Answer 28

C

Question 29

primary gain

Answer 29

primarily relief from emotional conflict and freedom from anxiety; attained through the use of a defense mechanism or other psychological process such as conversion disorder
symptoms block psychological conflict or anxiety from conscious awareness, as in conversion disorder.

Question 30

secondary gain

Answer 30

indirect benefit obtained through illness or disability such as gains may include monetary and disability benefits personal attention to escape from unpleasant situations and responsibilities
patients are not consciously aware of gains
you DO NOT want to focus on the symptom or complaint, but rather on the feeling

Question 31

assessment of patient with somatic disorders

Answer 31

mental/emotional status- traumatic life event
psychological distress- comorbid symptoms of anxiety/depression, identify if secondary gain
physical exam- assess location, onset, characteristics of symptoms
social/lifestyle/relationships- pt.’s ability to communicate needs, quality of life, social support, coping skills, spirituality

Question 32

potential nursing diagnosis for somatic disorders

Answer 32

risk for suicide
ineffective coping
anxiety
risk for loneliness
anxiety
powerlessness, hopelessness
social isolation
disturbed sleep pattern
pain
altered family process

Question 33

planning and implementing nursing interventions for somatic disorders

Answer 33

monitor for safety
build trusting/ therapeutic relationship
educate regarding treatment
encourage increased and appropriate expression of feelings and emotions
focus on strengths, use positive reinforcement and limit setting to focus patient away from discussion of physical complaints
teach coping strategies
enhance patients self-knowledge and self awareness
agree on how to name illness
regular but brief office visits/ control access to healthcare
frequent supportive contacts
regular check ups
normalize and empathize
explore predisposing factors
use of chronic disease
offer support; partner with patient

Question 34

treatment of somatic disorders

Answer 34

focus is care not cure, care is the cure
coordinated physical and psychiatric care
provide frequent, brief, and regular visits
avoid despairing comments
set reasonable therapeutic goals
individual and group psychotherapy
CBT
psychopharmacologic agents (SSRI)

Question 35

evaluation of somatic disorders

Answer 35

fewer visits to physicians as a result of physical complaints
use less medications and more positive coping strategies
an increase in functional abilities
improved family and social relationships

Question 36

when working with clients with somatic symptom disorders, nurses should extensively explore symptoms form other doctor visits during each visit
true or false

Answer 36

false