Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
38 Cards in this Set
- Front
- Back
|
Definition of Psychosomatic Disorder:
|
Psychosomatic Disorder is general medical conditions affected or exacerbated by psychobiological factors.
|
|
|
Definition of Somatoform Disorder:
|
Somatoform Disorder has symptoms that SUGGEST a medical condition, but physical changes are not found.
|
|
|
What are some possible biological theories that can cause Somatoform Disorder?
|
1. Increassed first degree relative risk
2. Neuronal and perceptual pathways/signals 3. Possible limbic structure changes 4. Possible decrease in 5HT and endorphins |
|
|
What are some potential psychosocial theories for the onset of Somatoform Disorder?
|
1. Behavioral: learned helplessness
2. Cognitive: misinterpretation of sensations 3. Psychoanalytical: Disease manifested by failure to alleviate anxiety and somatic symptoms manifested |
|
|
What are the 5 somatoform disorders?
|
1. SomatIZATION (not - oform) Disorder
2. Hypochondriasis 3. Pain Disorder 4. Body Dysmorphic Disorder 5. Conversion Disorder |
|
|
What are signs and symptoms of the Somatization Disorder?
|
1. Hx of multiple physical complaints under the age of 30 yo.
2. All complaints result in seeking tx, or result in significant impairment 3. All of the following symptoms must be present at some time: - 4 pain symptoms - 2 GI symptoms - 1 sexual symptom - 1 pseudoneurological symptom 4. The symptoms are either: - not explained by medical condition or substance - impairment is excessive if medical condition does exist 5. Symptoms are not consciously feigned. |
|
|
What are associated features of Somatization Disorder?
|
1. Colorful, exaggerated, lacking facts
2. Inconsistent historians 3. Several physicians at one time 4. Commonly undergo multiple: exams, tests, hospitalizations and even surgeries 5. Common: prominent anxiety and depressive symptoms 6. May be impulsive and antisocial |
|
|
Hypochondriasis
|
persistent fear of having disease, aging or death that lasts 6 months or more.
|
|
|
Pain Disorder
|
Psychological factors have a role in the onset and severity.
It's a severe disruption in daily life. It increases risk of substance abuse/dependence. |
|
|
Body Dysmorphic Disorder
|
Preoccupation with imagined defect or excessive concern. They frequently check the "defect" and may participate in excessive exercise, dieting, changing clothes.
Causes significant distress and/or impairment. May alternate with avoidance. Seeks surgical and dental interventions. |
|
|
Conversion Disorder
|
Psychological factors are associated with the onset
Symptoms SUGGEST it's a neurological disorder (ex. - blindness, deafness, loss of touch) or a medical disorder. Symptoms present in dramatic or histrionic fashion or show la belle indifference Symptoms may change with suggestions Symptoms most often occur after extreme stress |
|
|
Symptom Assessment #1
|
What is their history of present symptoms (HPI)?
|
|
|
Symptom Assessment #2
|
Are there unmet basic needs?
- oxygen - nutrition - fluid balance - elimination - safety & security - rest & comfort |
|
|
Symptom Assessment #3
|
Is there VOLUNTARY CONTROL of symptoms? (particularly if there is no medical cause behind it)
If there is NOT voluntary control, it is somatoform (deceives self). If there IS voluntary control, then they are deceiving others by one of two ways: - Factitious (person does something to self to make condition real) OR - Malingering (person knows that they're faking it because of some gain) |
|
|
Symptom Assessment #4
|
Do they get some type of secondary gain? Do they get personal benefit derived from having these symptoms?
It's much more difficult to help patient if they're getting secondary gain. Example - older woman complains of symptoms and in return, has children come to visit her that she never gets to see. |
|
|
Therapeutic Management
Cognitive Style: |
- Somatization
- Hypochondriasis - Conversion Are they able to COMMUNICATE EMOTIONS? Do they have MEDICATION dependence? |
|
|
Nursing Diagnosis for Somatoform Disorders:
|
- Ineffective Coping
- Self-care deficit - Chronic low self-esteem - Impaired social interaction - Ineffective family coping - Care giver role strain |
|
|
Related/to:
|
- Distorted perceptions
- Inability to express feelings and emotions - Inability to meet basic needs (specify) - Feelings of inadequacy, helplessness and unworthiness. |
|
|
COMMUNICATION strategies:
|
Avoid further reinforcement after a symptom has been assessed.
Don't imply that symptoms aren't real. Respect and support are key to this pt. Shift focus from physical complaints to feelings Be matter-of-fact Positive reinforcement of strengths |
|
|
Helpful Therapies:
|
Insight-oriented Therapy (individual and group counseling designed to foster development of insight)
Cognitive Therapy (with guidance, clients explore their thoughts about their illnesses and correct their misconceptions through logical questioning and reasoning) Family Therapy (helps family members place the client's illness in perspective, teaching ways to support each other and provide anticipatory strategies for coping with predictable problems) Behavioral Therapy (the client is forced to confront personal fears by reading about the feared disease, writing extensive information about the illness, and visiting hospitals. They are not allowed to seek reassurance during this time. |
|
|
Coping Skills:
|
Self-care
Body Knowledge Relaxation Assertiveness Exercise |
|
|
Goals/Expected Outcomes:
|
More adaptive skills
Realistic appraisal Articulate feelings |
|
|
Dissociative Disorder
(seen after traumatic events such as floods, tornados, etc. very similar to PTSD) |
Disruption in usually integrated functions of:
- Consciousness - Perception - Memory - Identity The disruptions can be sudden, gradual, transient or chronic. |
|
|
What are some biological theories of DD?
|
1. Possible limbic system
2. Possible 5HT link 3. Effect of some neurological diseases |
|
|
Psychosocial Theories of Dissociative Disorders:
Associated with TRAUMA!! |
Learning Theory
Conscious avoidance (may become "automatic" the more it is used) AND/OR Unconscious DM |
|
|
4 Identifications of Dissociative Disorders:
|
1. Depersonalization Disorder
2. Dissociative Amnesia 3. Dissociative Fugue 4. Dissociative Identity Disorder (DID) |
|
|
Depersonalization Disorder
|
Person feels detached from body, parts of body, or mental process
Occurs in: 50% of adults will have a single, brief episode 40% of people who are hospitalized mentally ill 33% of people who experience a life-threatening danger |
|
|
Dissociative Amnesia
|
Person is unable to recall important personal information (usually of a traumatic nature)
Person often has more than one episode, though the associated memory loss is reversible. There are several types of memory disturbances. Examples of traumatic events: violent outbursts, self-mutilation, and suicide attempts. |
|
|
Dissociative Fugue
|
Sudden, unexpected travel without remembering past
New identity (rare symptom) or confusion of identity Usually a single episode that can span from hours to months with a rapid recovery. May have amnesia of past trauma's |
|
|
Dissociative Identity Disorder (formerly called - Multiple Personality Disorder)
*DID is a severe form of PSTD* |
Presence of 2 or more distinct identities (personality states) of which at least 2 of them control the person's behavior.
Cannot recall extensive important information. Is considered identity fragmentation rather than separate personalities. |
|
|
What are some associated features of DID?
|
1. Hx of severe physical and sexual abuse
2. Post-traumatic symptoms 3. Self-mutilation and suicidal behaviors 4. Each personality state is experienced as if having a distinct personal history. 5. DID reflects a failure to integrate: memory, consciousness, and identity |
|
|
Assessment of DID Symptoms:
|
In addition to complete medical and neurological examinations, assess for:
1. Identity and memory 2. Focused hx questions 3. Mood 4. Use of substances 5. Functional impact 6. Suicide |
|
|
Nursing Diagnosis for DID:
|
1. Anxiety
2. Risk for injury 3. Ineffective coping 4. Alteration in self-concept: personal identity. |
|
|
Related to...
|
*Feelings of unreality
*Body image disortions *Feeling out of control *Feelings of frustration *Feeling overwhelmed *Feelings of depression and sadness |
|
|
Psychosocial Interventions:
|
Re-orientation as needed by:
1. Use of name to confirm identity 2. Safety and support 3. Simple structure and routine 4. Encourage independence 5. Positive reinforcement of non-dissociative coping 6. Stress reduction techniques |
|
|
Focus of DID Therapies:
|
1. Therapeutic alliance/relationship (esp. in DID)
2. Identification of triggers 3. Prevention of further episodes |
|
|
Coping Strategy:
|
DISTRACTION!!!
|
|
|
Goals/Expected Outcomes:
|
1. Safety
2. Decreased anxiety 3. Positive coping 4. Stress is handled without dissociating |
