Somatic Symptom Disorders Flashcards
what is a Somatic Symptom Disorder?
signs and symptoms with no evidence of disease. “physical manifestations of emotional states”
definition of somatization
the expression of psychological stress through physical symptoms
what are the types of somatic disorders
- somatic system disorder
- illness anxiety disorder
- conversion disorder
- psychological factors affecting medical condition
- Factitious disorder
what age group of women are more likely to receive a somatic disorder diagnosis?
16-25
people with somatic disorders feel what instead of anxiety, depression or irritability?
- pain
- paralysis
- unexplained skin rashes
- other physical symptoms
symptoms of somatic symptom disorder?
- chest pain
- fatigue
- dizziness
- headache
- swelling
- back pain
- SOB
- insomnia
- abdominal pain
- Numbness
What is illness anxiety disorder?
- misinterpretations of physical sensations as evidence of a serious illness.
- can be very obsessive
- they use 48-78% more health care services then other patients with illness.
what is conversion Disorder
- shows as a neurological symptom with no neurological diagnosis
- deficits in normal voluntary motor or sensory functions
- channeling of emotional conflicts or stressors into symptoms
what are some signs of conversion disorder
- paralysis
- blindness
- movement disorder
- gait disorder
- numbness
- paresthesia (tingling or burning)
- loss of hearing
- seizures resembling epilepsy
what childhood experiences can cause conversion disorder?
- abuse (physical or sexual)
- depression
- anxiety
- PTSD
illness anxiety disorder is defense against..
guilt, low self esteem
what are secondary gains?
benefits from the symptoms alone.
ie. patient can skip work our home duties or get pity
Assessment guidelines of somatic symptom disoder
- assess for: of symptoms
- nature
- onset
- location
- characteristics
- duration - ability to meet basic needs
- risks to safety and security
- are symptoms under their voluntary control?
- what are their secondary gains?
- cognitive style and ability to communicate needs and feelings
- type and amount of meds they are using
which disorder would say, “i woke up this morning and couldnt feel my arms”?
Conversion disorder
which disorders say, “The pain was searing, like a hot sword drawn across my forehead”?
illness anxiety disorder and somatic symptom disorder
which illness would describe a headache as a potential brain tumour?
Illness anxiety disorder
six key recommendations for developing effective relationships with and treatment for patients with somatic symptom disorder
- continuity of care
- avoid unnecessary test and procedures
- frequent, brief, regular office visits
- always conduct physical exam
- avoid harsh comments on it not being “real”
- set reasonable goals
how to work around patients and secondary gain?
teach them to work around their symptom
ie. if pt is blind and eating use the clock to say where it is, or if paralysis on one limb teach them to eat with the other hand.
what is factitious disorder?
pts intentionally and consciously feign illness. pretend to be ill
what does the first sub type of self directed factitious disorder look like?
do not “doctor shop” they stay at the same health care provider.
often in emerg and convincing
dont want family or friends to find out
what is the name for the second sub type of self directed factitious disorder?
Munchhausen’s syndrome
what is Munchhausen’s syndrome?
when the pt fakes ill and goes from hc provider to another.
what is the name of the others-directed factitious disorder?
Munchhausen’s syndrome by proxy
what is Munchhausen’s syndrome by proxy?
when a caregiver deliberately feigns illness in a vulnerable dependent.
what is malingering?
related to factitious disorders. acting to gain something.. like welfare or disability compensation
Which nursing diagnosis should be investigated for patients with somatic symptom disorders?
ineffective coping
Which disorder is characterized by the patient’s misinterpretation of physical sensations or feelings?
Illness anxiety disorder
class of medications commonly prescribed for somatic symptom disorders?
anixiolytics
A 28-year-old woman, who has been experiencing stress from the demands of her three pre-school-age children, suddenly develops paralysis of both lower extremities. Her neurologic examination is negative. The nurse should suspect that the woman is experiencing which somatization disorders?
Conversion disorder
A client with frequent visits to the Ambulatory Health Department has had frequent negative medical work-ups with various specialists but worries frantically that he is dying from a severe catastrophic medical illness. The staff suspect that the client is experiencing symptoms of..
illness anxiety disorder (Hypochondiasis)
what is body dysmorphoric disorder
belief that one’s own appearance is unusually defective (worthy of hiding or fixing)
what is anhedonia
the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, music, sexual activities or social interactions.
A patient is given acetaminophen 300 mg with codeine 30 mg (Tylenol No.3) for pain. Acetaminophen and codeine are given together because
One acts on the peripheral and the other on the central nervous system
Ms. T’s family confides in the nurse that she has stopped going to work and church because she is worried that her breath is offensive to other people despite negative dental and ENT workups. The family reports that no one else can smell anything, but Ms. T is unconvinced and covers her mouth when others are around and won’t eat with her family at home or in public. The nurse suspects the patient may be experiencing symptoms of a
body dysmorphic disorder
Interventions for all somatic disorders?
CBT
Interventions for somatic symptom disorder
Consistent primary care provider with regular pt visits and limited tests
Group therapy
CBT
Interventions for illness anxiety disorder
CBT Insight oriented therapy Group therapy Psychopharmacological management for co morbid conditions Stress management
Interventions for conversion disorder
Suggest that conversion symptoms will gradually improve Behavioural therapy Insight oriented therapy Hypnosis Anti anxiety drugs
Factitious disorder interventions
Highly treatment resistant **
Confrontation is counterproductive
Emphasis on management over care
Legal interventions may be necessary in case of munchausens by proxy
