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Somatoform and Related Disorders

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Psychological state that contributes to the development of a physical illness ... Review clinical vignette. Nursing Diagnoses. Fatigue, pain, disturbed sleep ... – PowerPoint PPT presentation

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Title: Somatoform and Related Disorders


1
Somatoform and Related Disorders
  • Chapter 21

2
Key Terms
  • Psychosomatic
  • Psychological state that contributes to the
    development of a physical illness
  • Mental diagnoses characterized by unexplained
    medical disabilities
  • Somatization
  • Manifestation of physical symptoms from
    psychological distress
  • Primary symptom of somatoform and factitious
    disorders

3
Definition of Disorders
  • Somatoform disorders
  • Patient suffers physical symptoms as a result of
    psychological stress.
  • Factitious disorders
  • Patient self-inflicts injury as a result of
    psychological stress to seek outside treatment.

4
Somatoform Disorders
  • Somatization Disorder
  • Undifferentiated Somatization Disorder
  • Conversion Disorder
  • Pain Disorder
  • Hypochondriasis
  • Body Dysmorphic Disorder

5
Somatization
  • Culture
  • Physical sensations are experienced according to
    culturally defined expectations.
  • Gender
  • Women more than men?
  • Social acceptance
  • Boys taught not to cry
  • Higher incidence of depression (somatic problems)
  • Women can express problems in relationships.
  • Mexican American vs. non-Hispanic
  • Older, separated, widowed or divorced

6
Somatization Disorder
  • Polysymptoms that begin before the age of 30
  • Involve many body systems
  • Prevalence 13 of population (estimated 4-5/1000)
  • Rarely seen by mental health provider
  • In medical office, two or three out of every 50
    patients are undiagnosed.
  • More prevalent in women (90 to 95)

7
Clinical Course
  • Recurring, multiple and clinically significant
    somatic problems involving several body systems
    (GI, neuro and musculoskeletal)
  • Episode of physical illness may last six to nine
    months.
  • Sicker than the sick

8
Somatization Disorder in Special Populations
  • Children
  • Not diagnosed in childhood, typically begins in
    adolescents
  • Menstrual problems usually one of first symptoms
  • Elderly
  • Occurs, but is little research
  • Need to differentiate disorder from medical
    problems
  • Occurs in all populations and cultures

9
Epidemiology
  • 0.2 to 2 of general population, but could be as
    many as two to three of every 50 patients seen in
    primary care. Real prevalence may be 4-5/1000.
  • Before age 30 (by definition)
  • Occurs primarily in women
  • Inversely related to SES
  • Worldwide, may be higher in South Americans,
    Mexican Americans, Puerto Ricans
  • Often co-exists with medical problems

10
Etiology Unknown
  • Biologic
  • Responsive to relevant and irrelevant stimuli
  • Increased risk in first-degree relatives
  • Numerous menstrual problems
  • Psychological
  • A patterned way of communicating
  • Social
  • ASP, alcoholism in family members
  • Cultural expressions of other disorders

11
Risk Factors
  • Women from families with multiple, unexplained
    somatic complaints
  • Abuse
  • For men, not yet identified

12
Interdisciplinary Treatment
  • Providing long-term general management of the
    chronic condition
  • Conservatively treating comorbid psychiatric and
    physical problems
  • Providing care in special settings, including
    group treatment

13
Nursing ManagementBiologic Domain
  • Assessment
  • Review of systems
  • Assessment of pain
  • Physical functioning
  • Pharmacologic
  • Usually taking a large number of meds
  • Self-medicate and provider shop
  • Health attitude survey
  • Review clinical vignette
  • Nursing Diagnoses
  • Fatigue, pain, disturbed sleep

14
Biologic Nursing Interventions
  • Spend time with physical complaints
  • Help patient establish a daily routine
  • Continually monitor medication
  • Pain management need multiple approaches
  • Activity enhancement
  • Nutrition regulation
  • Relaxation

15
Pharmacologic Interventions
  • There is no medication for somatization disorder.
  • Treat the comorbid disorders.
  • Depression antidepressants - MOAI
  • Anxiety Avoid benzodiazepines.
  • Monitor closely.
  • Observe for drug-drug interactions.

16
Nursing Management Psychological Domain
  • Assessment
  • Mental status usually normal
  • Appearance may be flamboyant, exaggerated
  • Preoccupied with personal illness (may keep a
    copy of record), series of personal crisis.
  • Emotional reactions to life stressors
  • Labile mood
  • Nursing Diagnoses
  • Anxiety
  • Ineffective sexuality patterns
  • Impaired social interactions
  • Ineffective coping
  • Ineffective management of therapeutic regimen

17
Psychological Nursing Interventions
  • Maintaining nurse-patient relationship
  • Counseling
  • Problem solving
  • Health teaching

18
Nursing Management Social Domain
  • Assessment
  • How much time seeking medical care and treating
    illnesses?
  • Extent of disability?
  • Employment status?
  • Social network? Do they see their friends as
    providers?
  • Family members
  • Tired of all the complaints?
  • Alcoholism is common.
  • Nursing Diagnosis
  • Caregiver role strain, risk
  • Ineffective community coping
  • Disable family coping
  • Social isolation

19
Nursing Diagnosis
  • Fatigue
  • Pain
  • Sleep pattern disturbance
  • Altered sexuality patterns, anxiety
  • Ineffective coping
  • Impaired social interactions
  • Ineffective management of therapeutic regimen

20
Social Nursing Interventions
  • Problem-solving groups
  • Assertiveness groups
  • Family interventions

21
Continuum of Care
  • Inpatient care very rare
  • Emergency care mostly for physical problems,
    except when depressed
  • Community treatment
  • Spend lifetime in health care system
  • Most care delivered as outpatient

22
Factitious Disorders
  • Factitious disorder (Munchausens syndrome)
  • Different than malingering (has other
    motivations)
  • Injure themselves covertly
  • Produce physical symptoms
  • Factitious disorder NOS (by proxy)
  • Injure others in order to gain attention (mother
    hurting child)

23
Nursing Management
  • Assessment
  • Chronology of medical/psychological illnesses
  • Early childhood experiences (abuse, neglect, role
    of self-injury)
  • Family assessment
  • Nursing Diagnosis
  • Risk for trauma
  • Risk for self-mutilation
  • Ineffective individual coping
  • Low self-esteem

24
Nursing Intervention
  • Goal To replace dysfunctional, attention-seeking
    behaviors with positive behaviors
  • Accept and value patient.
  • Encourage long-term psychotherapy.
  • Confrontation is effective if patient feels
    supported.
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