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Module 6 (Psych Mental Health) > Somatic Symptom Disorders/Somatiform > Flashcards

Somatic Symptom Disorders/Somatiform Flashcards

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1
Q

Somatization

A

putting or channeling emotional distress into the body and through physical s/s
- insomnia, high Pulse,

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2
Q

La Belle indifference

A

paradoxical absence
- not concerned with s/s as they do not have mental pain

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3
Q

Malingering

A

exaggerates and fakes an illness to get out of something for secondary and primary gains
- avoid homelessness or jail
- get aware from harm
- cope mechanism to get away

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4
Q

Primary gain

A
  • mainfesting a stomach ache to avoid a bully
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5
Q

Secondary gain

A
  • attention from mom
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6
Q

Self-compassion

A

caring and understanding to one’s self with faced with own failures
- protect and emotional resilence

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7
Q

Psyche + Soma =

A

Psycho-somatic
(mind-body)
- missed in psych because they are seen by HCP or med-surg

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8
Q

What are some medical diagnoses that the emotional state influences?

A

HTN
Colitis

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9
Q

What are some somatic symptoms not necessarily related to a separate medical diagnosis?

A

tension HA
GI upset
i’m worried sick, so nervous i might throw up

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10
Q

Hysteria (hysterical neurosis)

A

Somatic complaints unexplained by organic pathology

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11
Q

Somatic related disorders

A

Pain Disorder (somatic symptom disorder)
Illness Anxiety Disorder (Hypochondriasis)
Functional Neurobiological (Conversion)
Psychological factors affecting other conditions
Factitious Disorder (Munchausen Syndrome)

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12
Q

Which somatic disorder is the most common?

A

pain disorder

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13
Q

Which somatic disorder is the least common?

A

Munchausen Syndrome (Factitious)

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14
Q

Theories of Pathology for Somatic Disorders

A

genetic and biological vulnerability
- higher sensitivity to pain, trauma
- big and small sensory stimuli equally intense
environment
psychological theory
interpersonal theory
decreased levels of serotonin and endorphins

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15
Q

How does the environment cause somatic disorder?

A

childhood trauma
- fmaily with illness
overprotective parents
high wanting of child perfection

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16
Q

What is the psychological cause of somatic disorder?

A

illicit care and nurturing
- coping for needs to be met
culture of not having mental pain goes to physical pain which is acceptable

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17
Q

How does the interperonal model cause somatic disorder?

A

attention from the pain

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18
Q

Somatic S/S Disorder
- Risk Factors

A

females (more common)
decreased serotonin and endorphins
with depression, personality disorders, and anxiety disorders
childhood trauma, abuse, neglect
1st degree relative to the disorder
learned helplessness - maladaptive coping strategy

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19
Q

Key features of somatic symptom disorder

A

1+ s/s present for 6 months+
excessive thoughts/feelings/behaviors r/t somatic s/s
state of being symptomatic is persistent while s/s may vary

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20
Q

Excessive Thoughts

A

out of proportion with the seriousness of s/s
client has high anxiety about health
= SOB, sweating, sense of impending doom,
excessive time and energy given to s/s

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21
Q

The most common s/s of somatic symptom disorder

A

pain
- specific or nonspecific
- possibly associated with another medical condition

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22
Q

The appraisal of s/s for somatic symptom disorder is

A

disproportionate to nurse findings

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23
Q

Typical somatic symptom disorders include what in their chart

A

long, complex medical hx
- chronic or recurrent

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24
Q

Somatic symptom disorder patients will seek out

A

multiple HCPs for answers/relief/dx
- believe HCPs are incompetent
- pt lacks insight into the disorder
- if the HCP does not know what is going on, they might dump them into this category and forgotten
= known as frequent fliers

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25
Q

Somatic disorder nursing interventions
- 4 things to ask

A
  • ask what is making them anxious and rate the anxiety
  • **anxiety and depression s/s
    periods of sadness or difficulty concentrating or worry
  • ask about the ability to care for themselves
  • how does the family react to the s/s (help, enable, cause)**
    do not acknowledge the physical s/s
    decrease stimulation
    ground them
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26
Q

Tx of Somatic Symptom Disorder

A

1st priority = thorough physical assessment r/o other illnesses
symptom and pain mgmt - NSAIDs,
SSRIs = tx underlying depression
Referral to pain clinic (pain disorder)
relax therapy and visual imaging
Group Therapy: peer support, coping mechanisms, and expression of emotions
Journaling - into heads and connects with events
Discourage “doctor shopping”

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27
Q

What medications could be given for somatic symptom disorder?

A

NSAIDs
SSRIs

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28
Q

What therapy is used for somatic symptom disorder?

A

Relaxation therapy
visual imaging
Group therapy: peer support, coping mechanisms, & expression of emotions
Journaling

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29
Q

What needs to be discouraged for somatic symptom disorder patients?

A

discourage “doctor shopping”
- encourage meaningful relationship with 1-2 doctors over a long period of time

30
Q

What are the desired outcomes for treatments of Somatic Symptom disorder?

A

fewer attention-seeking somatic complaints
increased insight into the dynamics of behaviors
decreased ritualistic behaviors
- self-Rx of medications/supplements

31
Q

What self-awareness issues and bias checks does the nurse need to watch when having a patient who has somatic symptom disorder?

A

remember their pain is REAL TO THEM
Don’t assume pain is ALWAYS r/t disorders
Control your emotional response, be nonjudgemental and curious

32
Q

Illness Anxiety Disorder =

A

Hypochondriasis

33
Q

What are the key features of illness anxiety disorder?

A
  • preoccupation with having or acquiring a serious illness (6+ months)
    = - risk of family illness, media,
  • somatic s/s absent or very mild
  • high level of anxiety about health
  • excessive health-related behaviors
  • not better explained by another dx
34
Q

Illness Anxiety is often co-morbid with

A

depression and anxiety
- may have obsessive-compulsive traits

35
Q

Illness Anxiety Disorder 2 categories

A

care-seeking - doctor shop
care avoidant

36
Q

Illness Anxiety Disorder has _________ ____________ to body sensations and changes

A

overly sensitive

37
Q

Illness Anxiety Disorder Tx

A

SSRI - underlying depression and anxiety
less s/s to treat (not intense pain)
worried about dx more than s/s

38
Q

Conversion Disorder aka

A

Functional Neurological Symptom Disorder
- unconsciously given themselves anxiety and unbothered by the bad s/s because the anxiety has relieved and only on the physical (does not care)

39
Q

What are the key s/s of conversion disorder

A

1+ altered voluntary motor or sensory functions
unable to substantiate a neurological or medical condition causing s/s
causes impaired functioning in social, work, or other functioning areas = blind w/o cause, not walk, or can
t move arms
La belle difference
identifiable cause for developing s/s = H&P
dissociative with major trauma

40
Q

Conversion Disorder examples

A

paralysis or akinesia
aphonia
seizures (psychogenic non-epileptic)
difficulty swallowing
urinary retention
blind, deaf, double vision
anosmia
hallucinations
pseudocyesis
have a neuro connection

41
Q

Aphonia

A

loss of voice

42
Q

Anosmia

A

loss of smell

43
Q

Pseudocyesis

A

false pregnancy - not concerned

44
Q

KEY Features of Psychological Factors Affecting Other Medical Conditions

A

occurs in the presence of other disease or somatic s/s
- precede or make worse
psychological or behavioral factors adversely affect the condition
- fear and not do their tx
not better explained by another mental disorder (anxiety, depression, PTSD)

45
Q

S/S of factitious disorder

A

purposefully causing injury or disease to oneself or another
presents to others as ill, impaired, or injured
deceptive behavior evident in the absence of obvious external rewards
- have some medical knowledge
not explained by another illness (delusional or psychotic) - major and irreversible surgeries
lack of insight into psychological disorder
- unaware of the motivation for it
- doctor shop and long distances

46
Q

Munchausen Syndrome

A

Factitious Disorder Imposed on Self

47
Q

Munchausen Syndrome by Proxy

A

Factitious Disorder Imposed on Other

48
Q

Body Identity Integrity Disorder (BIID)

A

alienated from part of their body aka limb
- apotemnophilia
- want an amputation
- will harm themselves to make it medically necessary

49
Q

Nursing with Munchasen’s syndrome

A

nonjudgemental and not biased
get as much info as possible

50
Q

What is the comparison between Malingering, Factitious, and conversion disorders?

A

Malingering - conscious symptoms and motivation
- homelessness fake illness for shelter
- get out of abusive relations
- keep the s/s for a long time until they have confidence and come clean
Factitious - conscious symptoms and unconscious motive
Conversion - unconscious to symptoms and motive

51
Q

What are the general assessments for Somatic Disorders?

A

Thorough physical assessments
Symptoms
Level of independence
Safety and security risks r/t symptoms
Childhood trauma
Suicide risk
Level of self-compassions - how hard on themselves are they

52
Q

What must the nurse identify in a patient with Somatic Disorders upon assessment?

A

Whether symptoms are under voluntary control
Type and amount of medication/supplements the patient uses
Previous med hx
Interpersonal dynamics/resources
- Support network
- Stressors
- Family dynamics

53
Q

The nursing dx of ineffective coping with somatic illnesses r/t

A

Distorted perceptions of body functions and symptoms
Chronic pain of psychological origin
Dependence on pain relievers or anxiolytics (benzo)

54
Q

What are the expected outcomes for a somatic disorders patient?

A

Identify and articulate feelings
Resume performance of work/role behaviors
Identify ineffective coping patterns
Make a realistic appraisal of strengths and weaknesses

55
Q

What interventions need to be taken for a somatic patient?

A

Teaching straightforward and reducing secondary gains
Assertiveness training (empowering and “I” statements)
Case Management
Psychotherapy (CBT, Trauma, and family)
1st SSRIs - not Benzo due to not long term

56
Q

What should the nurse evaluate after tx of a somatic patient?

A

partially met goals = success
remission of s/s
intensity and focus will dimish over time

57
Q

Dissociation

A

splitting off clusters of mental content from conscious awareness
- break away from awareness

58
Q

Depersonalization

A

experiences of seeing themselves outside of their body

59
Q

Derealization

A

detachment from reality
aware and see themselves from above

60
Q

Biological factors of dissociative illnesses

A

Altered size of hippocampus and amygdala
– caused by early emotional trauma
Trauma may affect the development of the limbic system

61
Q

Genetic and psychosocial factors of dissociative disorders

A

1st-degree relatives often diagnosed with this disorder
Developed in response to extreme stress, such as severe abuse

62
Q

KEY Features Depersonalization/Derealization Disorder

A

recurrent periods of feeling unreal, detached, and outside the body
- that man is scared not I and me statements
numb
dreamlike
distortions in the sense of time and visual perception

63
Q

KEY Features Dissociative Amnesia & Dissociative Amnesia w/Fugue

A

inability to recall specific info about self typically regarding a traumatic event
recall may be lost for a particular time, period or selective for a traumatic event or even the entire life hx
- possible fugue

64
Q

Nursing Interventions for Dissociation Disorder

A

grounding to reality
- cold drink of water
change environment
reorientation to present
Are they redirectable?
- sundown time with dementia )this will help)

65
Q

Fugue =

A

loses memory and does not know who they are
- wander
- can have a new identity or a new life along the way

66
Q

KEY Features Dissociative Identity Disorder (DID)

A

most severe
- disruption of identity by 2 + distinct personality states
- loss of time
- change in effect, behavior, memory, and functioning during the disruption of “self”
-Disruption of self hinders social & occupational functioning & interpersonal relationships
- CAUSED BY By prolonged AND REPETITIVE CHILDHOOD ABUSE

67
Q

Nursing Care Priorities for Dissociative Disorders

A

safety
symptom reduction
stabilization

68
Q

Communication of Dissociative Disorder patient

A

build trust
emotional presence
sense of safety
optimal functioning - washing, ADLs

69
Q

Milieu environment

A

Quiet
Structured
Supportive

70
Q

Interventions for Dissociative Disorders

A

LONG Therapeutic relationship and therapies
Patient-centered treatment planning
Safe environment
Reassuring presence
Orientation to current surroundings
Support
Identify S/S anxiety
Connect anxiety and dissociative behaviors
Identify triggers earlier and implement interventions
Grounding techniques
Adaptive coping strategies
Stress reduction techniques
Daily journaling

71
Q

Short-term goals for dissociative patient interventions

A

Refrain from self-harm
Report a decrease in perceived distress
Plan coping strategies for stressful situations
Report comfort with role expectations
Verbalize a clear sense of personal identity

72
Q

Long-term goals for dissociative patient interventions

A

Developtrust
Correct faulty perceptions
Heal emotional damage resulting from abuse
Practice living in the present

Module 6 (Psych Mental Health) (12 decks)

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