somatic syndrome disorders (329 E3)

Question 1

Labelle’ Indifference

Answer 1

A lack of concern or emotional response despite having a serious medical illness or physical symptoms related to a health condition. This condition is most often associated with conversion disorder

Question 2

primary gain

Answer 2

A benefit that provides protection from (INTERNAL) anxiety or emotional symptoms and/or conflicts

Question 3

Secondary Gain

Answer 3

Relieves the individual from (EXTERNAL) expected responsibilities. If an individual’s symptoms/ disease increases the attention and sympathy they receive, allows him/her to miss work, admission to a hospital or psychiatric facility, obtain financial assistance, psychiatric disability, or other disability compensation, receive prescription medication(s), or avoids a jail sentence, these would be few examples of secondary gain

Question 4

Somatic Symptom Disorder (SSD): clinical manifestations

Answer 4

• Actual, persistent, and distressing physical symptoms (pain, fatigue, digestive issues, etc.) that cause significant anxiety
• Often without a clear medical cause
• Preoccupation with health, with excessive time and energy devoted to symptoms

Question 5

Somatic Symptom Disorder (SSD): impact on individual

Answer 5

• Chronic anxiety and worry about health, interfering with daily life
• Frequent doctor visits and unnecessary medical tests, leading to a high emotional and financial burden
• Impaired social and occupational functioning due to health concerns

Question 6

Somatic Symptom Disorder (SSD): treatments

Answer 6

• Cognitive Behavioral Therapy (CBT) to address health anxiety and dysfunctional thoughts
• Mindfulness and relaxation techniques to reduce stress
• Medication: Antidepressants (e.g., SSRIs) for underlying anxiety or depression

Question 7

Illness Anxiety Disorder (IAD): clinical manifestations

Answer 7

• Intense fear and/or worry with having or acquiring a serious illness, despite having few or no actual physical symptoms
• Constant checking for signs of illness, checking their bodies for signs, seeking reassurance from doctors despite normal results or avoidance of medical situations
• Hyperfocus on health-related information (e.g., medical websites)

Question 8

Illness Anxiety Disorder (IAD): impact on the individual

Answer 8

• Persistent fear and/or worry leading to significant distress and disruption in daily activities
• Avoidance of certain activities or places for fear of illness
• Can lead to doctor shopping, high health related costs or avoiding healthcare altogether

Question 9

Illness Anxiety Disorder (IAD): treatment

Answer 9

• Cognitive Behavioral Therapy (CBT) to reduce health anxiety and correct misinterpretations of bodily sensations
• Psychoeducation about health anxiety
• Medication: Antidepressants or anxiolytics may be used to manage anxiety

Question 10

Conversion Disorder: clinical manifestations

Answer 10

• Neurological symptoms (e.g. paralysis, tremors, non-epileptic seizures, or vision problems) that are inconsistent with or cannot be explained by medical tests
• Symptoms often triggered by stress or trauma

Question 11

Conversion Disorder: impact on the individual

Answer 11

• Sudden disability leading to impaired mobility and independence
• Emotional distress due to the sudden onset of symptoms and from a lack of a clear medical explanation
• Social and occupational disruptions due to the disability

Question 12

Conversion Disorder: treatments

Answer 12

• Physical therapy and rehabilitation to help restore function
• Cognitive Behavioral Therapy (CBT) to address stress or trauma
• Psychodynamic therapy to explore unresolved psychological conflict
• Stress management techniques to prevent symptom exacerbation

Question 13

Psychological Factors Affecting Medical Condition: clinical manifestations

Answer 13

Psychological factors (e.g. stress or mental health issues (e.g., anxiety, depression) that worsen a physical medical condition (e.g., chronic pain, asthma, heart disease)

Question 14

Psychological Factors Affecting Medical Condition: impact on the individual

Answer 14

• Poor health outcomes due to the interaction between psychological and physical symptoms
• Difficulty managing multiple health concerns at once
• Impaired quality of life due to both physical and psychological challenges

Question 15

Psychological Factors Affecting Medical Condition: treatments

Answer 15

• Integrated care approach combining medical and psychological treatment
• CBT to help manage stress and coping strategies
• Relaxation techniques and mindfulness to reduce the impact of psychological stress on physical health

Question 16

Factitious Disorder (Imposed on Self or Others): clinical manifestations

Answer 16

• Intentionally pretending, lying about, “faking” or producing physical or psychological symptoms to assume the “sick role” and gain things such as attention or sympathy
• May involve falsifying medical histories, manipulating test results, or intentionally harming oneself

Question 17

Factitious Disorder (Imposed on Self or Others): impact on the individual

Answer 17

• Emotional distress stemming from the need for attention or care
• Trust issues in relationships and among healthcare providers due to deceptive behaviors
• Risk of unnecessary medical treatments and complications

Question 18

Factitious Disorder (Imposed on Self or Others): treatments

Answer 18

• Psychotherapy, particularly CBT or psychodynamic therapy, to uncover underlying emotional distress
• Long-term therapy to address the psychological need to gain attention through illness
• Family therapy if the disorder involves imposed symptoms on others

Question 19

Malingering: clinical manifestations

Answer 19

Intentionally exaggerating or fabricating physical or psychological symptoms for external gain, such as avoiding work, admission to a hospital or psychiatric facility, receiving financial compensation, or obtaining prescription medications

Question 20

Malingering: impact on the individual

Answer 20

• Distrust and breakdown in relationships, especially with healthcare providers
• Legal consequences if fraudulent behavior is detected
• Potential for unnecessary treatments or accommodations based on false information

Question 21

Malingering: treatments

Answer 21

• Psychiatric evaluation to confirm the diagnosis and underlying motivations
• If external gains are discovered, addressing through legal or social intervention
• In some cases, behavioral therapy to manage the underlying motives for malingering

Question 22

how to differentiate between SSD and IAD

Answer 22

The key distinction is that in SSD, the focus is on the distress caused by actual physical symptoms, whereas in IAD, the focus is on the fear, worry and anxiety about the possibility of being seriously ill, despite minimal or no symptoms

Question 23

how to differentiate factitious disorder from malingering

Answer 23

According to the DSM-5 (American Psychiatric Association), the key difference is the motivation behind the behavior:
“The key difference between FD and malingering lies in the third criterion, (c) the motivation behind intentional exaggeration or fabrication: Whereas malingered symptom presentations are motivated by external incentives (secondary gain), factitious symptom presentations are motivated by internal incentives (primary gain), such as seeking nurturance and sympathy for being ill; this has also been referred to as the need to “assume the sick role.”

Question 24

key take aways on treatments: CBT

Answer 24

The primary and most effective treatment approach for these disorders; specifically, to address the relationship between irrational thinking and emotional and behavioral distress; helps the individual reframe thoughts about their health and reduce anxiety.

Question 25

key take aways on treatments: pharm

Answer 25

(Typically antidepressants and anxiolytics); While medications are not the primary intervention for somatic disorders, they can be used to relieve the specific symptoms of these conditions. They are more commonly used when people have co-occurring mental health conditions like anxiety and depression

Question 26

general nursing intervention to consider

Answer 26

*Establish a therapeutic relationship; build trust, empathize with the individual
*Reduce health dependency: Collaborate with healthcare team and coordinate appointments; help the individual develop a structured plan for follow-up appointments and encourage involvement in both medical and psychiatric care to address both physiological and psychological needs
*Provide education on the disorder
*Encourage realistic expectations, set reasonable therapeutic goals, and encourage use of coping skills or techniques; teach coping strategies (Relaxation, Meditation, Biofeedback, etc.)
*Assist with medication management