Somatic Symptom Disorders

Question 1

what is a Somatic Symptom Disorder?

Answer 1

signs and symptoms with no evidence of disease. “physical manifestations of emotional states”

Question 2

definition of somatization

Answer 2

the expression of psychological stress through physical symptoms

Question 3

what are the types of somatic disorders

Answer 3

1. somatic system disorder
2. illness anxiety disorder
3. conversion disorder
4. psychological factors affecting medical condition
5. Factitious disorder

Question 4

what age group of women are more likely to receive a somatic disorder diagnosis?

Answer 4

16-25

Question 5

people with somatic disorders feel what instead of anxiety, depression or irritability?

Answer 5

1. pain
2. paralysis
3. unexplained skin rashes
4. other physical symptoms

Question 6

symptoms of somatic symptom disorder?

Answer 6

• chest pain
• fatigue
• dizziness
• headache
• swelling
• back pain
• SOB
• insomnia
• abdominal pain
• Numbness

Question 7

What is illness anxiety disorder?

Answer 7

• 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.

Question 8

what is conversion Disorder

Answer 8

• 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

Question 9

what are some signs of conversion disorder

Answer 9

• paralysis
• blindness
• movement disorder
• gait disorder
• numbness
• paresthesia (tingling or burning)
• loss of hearing
• seizures resembling epilepsy

Question 10

what childhood experiences can cause conversion disorder?

Answer 10

• abuse (physical or sexual)
• depression
• anxiety
• PTSD

Question 11

illness anxiety disorder is defense against..

Answer 11

guilt, low self esteem

Question 12

what are secondary gains?

Answer 12

benefits from the symptoms alone.

ie. patient can skip work our home duties or get pity

Question 13

Assessment guidelines of somatic symptom disoder

Answer 13

1. assess for: of symptoms
   - nature
   - onset
   - location
   - characteristics
   - duration
2. ability to meet basic needs
3. risks to safety and security
4. are symptoms under their voluntary control?
5. what are their secondary gains?
6. cognitive style and ability to communicate needs and feelings
7. type and amount of meds they are using

Question 14

which disorder would say, “i woke up this morning and couldnt feel my arms”?

Answer 14

Conversion disorder

Question 15

which disorders say, “The pain was searing, like a hot sword drawn across my forehead”?

Answer 15

illness anxiety disorder and somatic symptom disorder

Question 16

which illness would describe a headache as a potential brain tumour?

Answer 16

Illness anxiety disorder

Question 17

six key recommendations for developing effective relationships with and treatment for patients with somatic symptom disorder

Answer 17

1. continuity of care
2. avoid unnecessary test and procedures
3. frequent, brief, regular office visits
4. always conduct physical exam
5. avoid harsh comments on it not being “real”
6. set reasonable goals

Question 18

how to work around patients and secondary gain?

Answer 18

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.

Question 19

what is factitious disorder?

Answer 19

pts intentionally and consciously feign illness. pretend to be ill

Question 20

what does the first sub type of self directed factitious disorder look like?

Answer 20

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

Question 21

what is the name for the second sub type of self directed factitious disorder?

Answer 21

Munchhausen’s syndrome

Question 22

what is Munchhausen’s syndrome?

Answer 22

when the pt fakes ill and goes from hc provider to another.

Question 23

what is the name of the others-directed factitious disorder?

Answer 23

Munchhausen’s syndrome by proxy

Question 24

what is Munchhausen’s syndrome by proxy?

Answer 24

when a caregiver deliberately feigns illness in a vulnerable dependent.

Question 25

what is malingering?

Answer 25

related to factitious disorders. acting to gain something.. like welfare or disability compensation

Question 26

Which nursing diagnosis should be investigated for patients with somatic symptom disorders?

Answer 26

ineffective coping

Question 27

Which disorder is characterized by the patient's misinterpretation of physical sensations or feelings?

Answer 27

Illness anxiety disorder

Question 28

class of medications commonly prescribed for somatic symptom disorders?

Answer 28

anixiolytics

Question 29

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?

Answer 29

Conversion disorder

Question 30

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..

Answer 30

illness anxiety disorder (Hypochondiasis)

Question 31

what is body dysmorphoric disorder

Answer 31

belief that one's own appearance is unusually defective (worthy of hiding or fixing)

Question 32

what is anhedonia

Answer 32

the inability to experience pleasure from activities usually found enjoyable, e.g. exercise, hobbies, music, sexual activities or social interactions.

Question 33

A patient is given acetaminophen 300 mg with codeine 30 mg (Tylenol No.3) for pain. Acetaminophen and codeine are given together because

Answer 33

One acts on the peripheral and the other on the central nervous system

Question 34

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

Answer 34

body dysmorphic disorder

Question 35

Interventions for all somatic disorders?

Answer 35

CBT

Question 36

Interventions for somatic symptom disorder

Answer 36

Consistent primary care provider with regular pt visits and limited tests Group therapy CBT

Question 37

Interventions for illness anxiety disorder

Answer 37

``` CBT Insight oriented therapy Group therapy Psychopharmacological management for co morbid conditions Stress management ```

Question 38

Interventions for conversion disorder

Answer 38

``` Suggest that conversion symptoms will gradually improve Behavioural therapy Insight oriented therapy Hypnosis Anti anxiety drugs ```

Question 39

Factitious disorder interventions

Answer 39

Highly treatment resistant ** Confrontation is counterproductive Emphasis on management over care Legal interventions may be necessary in case of munchausens by proxy