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54 Cards in this Set
- Front
- Back
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What is somatization?
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Conversion of emotional or mental states into body symptoms
-patient suffers from physical symptoms as a result of psychological stress |
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What % of primary care patient visits are associated with somatoform disorders? Which providers are often avoided?
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5%
Mental health care providers are avoided |
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Which gender is affected by somatoform disorders more often?
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Women
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What effect do somatoform disorders have on social or occupational functioning?
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Significant impairment
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The symptoms experienced by somatoform patients are under what kind of control?
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Involuntary
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In the psychobiologic Theory of Somatoform disorders, the four independent mechanisms at work are what?
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1. Heightened body sensations
2. Increased autonomic arousal 3. Identification of "patient" 4. Perceived need to be sick |
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What are the cognitive behavioral theories behind somatoform disorders?
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1. Anxiety expressed through somatization
2. Cognitive distortions of benign symptoms |
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THe psychoanalytic theories of somatoform disorders include?
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1. psychological source of ego conflict denied
2. displacement of anxiety onto physical symptoms |
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LIst the combination of symptoms that are common in somatization disorders? How many of each symptom is needed to be Dx with somatizaion?
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- 1 psuedoneurologic
- 2 gastrointestinal - 1 sexual - 4 pain symptoms |
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When is the onset of somatization disorder and how long does it usually last?
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Occurs before age 30 and persists for several years
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What are the most common pseudoneurologic symptoms to occur in somatization?
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Paralysis, deafness, blindness and swelling
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What are the common GI issues found in somatization?
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NVD, bloating
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What are the most common sexual symptoms experienced in somatization?
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Indifference, erectile dysfunction, increased menstrual bleeding
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What is a contributing factor to the addition of new symptoms in somatization?
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Emotional stress
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What symptoms are most commonly sought treatment for in somatization?
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The physical ones
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What is one of the most crucial nursing interventions for somatization?
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Maintaining the nurse-patient relationship
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What is the pain associated with somatization often considered, in thinking about the psychoanalytic model for the disorder?
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Pain is an atonement of guilt/emotions: it is deserved
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What aspects should be incorporated into counseling patients with somatization?
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- Encourage identification and expression of feelings
- Focus on problem solving - Assertiveness training - Impaired social interaction |
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What medications are given for somatization?
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None have been effective.
Treat comorbid anxiety and depression -Want to avoid benzos because it doesn't treat the pain and is highly addictive |
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What are the characteristics for the interdisciplinary approach to somatization treatment?
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-Complete work-up
- accurate Dx of somatoform disorder - Long term relationship with single , trusted HCP - Minimize specialist referrals - Effective patient monitoring - Use great sensitivity with psychiatric referrals |
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What form of therapy has been found to be the most effective for somatization?
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CBT: 71% effective
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What is the primary gain for somatization?
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The relief that you feel when you cover the psychological conflict with a physical symptoms
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Describe the secondary gains of somatization?
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The attention and sympathy that you get from physical symptoms
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WHat are the important things to assess for when seeing a patient with somatization?
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-History
-Primary and secondary gain -Mental status -Physical functioning - Fatigue - Preoccupied with illness - Coping skills - Sexual functioning - Employment status - Social network - Family members |
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WHat is hypochondriasis?
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Unrealistic fear of serious illness despite medical evaluation and reassurance
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Give an example of how a person with hypochondirasis would misinterpret a normal bodily symptom?
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Pressure=pain
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How long must symptoms of hypochondirasis last to be diagnosed?
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At least 6 months
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What is the best way to characterized the symptoms experienced in hypochondriasis?
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Vague
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How much time during a typical day will a person with dysmorphic disoder obsess with their "defect"?
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3-8 hours a day
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WHat is dysphorminc disorder?
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Preoccupation with defect in appearance that causes significant distress or impairment in functioning.
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Describe the referential thinking that is experienced by patients with dysmorphic disorder?
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They believe that other people obsess over their defect as well.
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What are the common comorbidities associated with dysmorphic disorder?
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depression and suicidal ideation
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What area of the body is most common the focus of dysmorphic disorder?
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The face ( ie the nose)
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What is pain disorder?
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Chronic pain in 1 or more anatomic sites with insufficient organic basis for pain or intensity
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What are the common comorbidities with pain disorder?
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MDD and dysthymic disorder.
Depression and suicide |
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Describe the physical and psychogenic pains associated with pain disorder?
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Physical: Fluctuates in intensity, sensitive to emotional, cognitive, and situational factors
Psychogenic: doesn't fluctuate. not sensitive to any factors |
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What is Conversion disorder? Describe it.
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Motor, sensory or visceral function is lost and person is usually indifferent, with no organic cause for the loss.
Often has a clear psychological factor, but is reversible. |
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What % of individuals will have lifelong symptoms of conversion disorder when the stressor does not go away?
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60%
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What are the 3 general characteristics of conversion disorder?
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-Sensory dysfunction
-Motor system dysfunction -La Belle Indifference |
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What are some common symptoms experienced by patients with conversion disorder?
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-Paralysis
-Aphasia -Mutism -Tremors -Blindness -Deafness -Numbness -Urinary retention |
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What is the best form of Tx for conversion disorder?
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Insight oriented psychotherapy
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What is undifferentiated somatoform disorder?
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6 months or 1 or more physical symptoms with no organic basis
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What is the primary objective of individuals with Factitious Disorders?
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Hospitalization
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What are Factitious disorders and what do the patients do?
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-Deliberate production of exaggeration of symptoms of a physical or mental illness in order to assume sick role.
-Patients create symptoms -Patients often infect themselves with bacteria, ingest allergens, tear surgical sites or insert objects into bodily orifices |
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What is malingering?
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pretending to have an illness to avoid something directly ie jail
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What is the other name for Factitious Disorder?
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Munchausen Syndrome
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How are factitious disorders coded?
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Based on type:
-With predominantly psychological SxS -with predominantly physical SxS -with combined psychological and physical SxS |
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What key aspects of malingering are absent in factitious syndrome?
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External incentives for behavior.
ie. economic gain, avoiding legal responsibility or improving physical well being. |
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What characterizes Munchausen's syndrome by proxy?
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Factitious NOS
-intentional production or feigning of physical or psychological symptoms in another person under individual's care for the purpose of indirectly assuming the sick role -Ex. Parent/child |
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What must the nurse assess for with a patient who has factitious disorder?
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-Chronology of the illness
-Early childhood experiences -Family assessment |
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What is the goal of treatment for factitious disorder?
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Replace dysfunctional, attention-seeking behaviors
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What should the focus of treatment be for factitious disorders?
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Management not treatment
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What is a controversial treatment technique for factitious patients? Why?
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Confrontation, because their disorder may be a cry for help
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What type of therapy should be encouraged for factitious disorder?
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Long-term psychotherapy.
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