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Somatoform and Sleep Disorders

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Somatoform and Sleep Disorders Nursing 201 characterized physical symptoms suggesting medical disease but without a demonstrable organic pathological condition or a ... – PowerPoint PPT presentation

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Title: Somatoform and Sleep Disorders


1
Somatoform and Sleep Disorders
  • Nursing 201

2
characterized
  • physical symptoms suggesting medical disease but
    without a demonstrable organic
  • pathological condition or a known
    pathophysiological mechanism to account for them.
  • Somatoform disorders are more common
  • In women than in men
  • In those who are poorly educated
  • In those who live in rural communities
  • In those who are poor

3
Predisposing Factors
  • Theory of family dynamics
  • Psychosomatic families
  • Role modeling
  • Cultural and environmental factors
  • Low socioeconomic, occupational, and
  • educational status
  • Genetic factors
  • Possible inheritable predisposition
  • Transactional Model of Stress/Adaptation
  • The etiology of somatization disorder is more
    likely influenced by multiple factors

4
Pain Disorder Assessment
  • The predominant disturbance in pain disorder is
    severe and prolonged pain that causes
  • Clinically significant distress
  • Impairment in social, occupational, or other
    areas of functioning
  • Even when an organic pathological condition is
    detected, the pain complaint may be evidenced by
    correlation of a stressful situation with onset
    of symptoms.

5
Nursing Process
  • Assessment A syndrome of multiple somatic
    symptoms that cannot be explained medically and
    are associated with psychosocial distress and
    long-term seeking of assistance from health care
    professionals.
  • Nursing Diagnosis
  • Planning/Implementation
  • Outcomes
  • Evaluation

6
  • The disorder may be maintained by
  • Primary gains the symptom enables the client to
    avoid some unpleasant activity.
  • Secondary gains the symptom promotes emotional
    support or attention for the client.
  • Psychodynamic theory
  • Symbolically expressing an intrapsychic conflict
    through
    the body
  • Behavior theory
  • Negative reinforcement results when the pain
    behavior prevents an undesirable phenomenon from
    occurring (i.e., provides relief from
    responsibilities for the client)

7
  • Theory of family dynamics
  • Pain games
  • Tertiary gain
  • Neurophysiological theory
  • Afferent pain fibers
  • Serotonin/endorphins
  • Neurophysiological theory
  • Afferent pain fibers
  • Serotonin/endorphins

8
Hypochondriasis Assessment
  • Unrealistic or inaccurate interpretation of
    physical symptoms or sensations, leading to
    preoccupation and fear of having a serious
    disease
  • Even in the presence of medical disease, the
    symptoms grossly exceed extent of pathological
    condition.
  • Anxiety and depression are common findings, and
    obsessive-compulsive traits frequently accompany
    the disorder.

9
Nursing Process
  • Nursing Diagnosis
  • Planning/Implementation
  • Outcomes
  • Evaluation

10
Predisposing Factors
  • Psychodynamic theory
  • Ego-defense mechanism
  • Transformation of aggressive and hostile wishes
    toward others into physical complaints about self
    to others
  • Defense against guilt
  • Cognitive theory
  • Hypochondriasis arises out of perceptual and
    cognitive
  • abnormalities.
  • Social learning theory
  • Somatic complaints are often reinforced when the
  • sick role relieves the client of the need to
    deal with a
  • stressful situation.

11
  • Past experience with physical illness
  • Previous experience can predispose to
    hypochondriasis.
  • Genetic influences
  • Transactional Model of Stress/Adaptation
  • The etiology of hypochondriasis is likely
    influenced by multiple factors.

12
Conversion Disorder Assessment
  • A loss of or change in body function resulting
    from a psychological conflict, the physical
    symptoms of which cannot be explained by any
    known medical disorder
  • or pathophysiological mechanism
  • The client often expresses a relative lack of
    concern that is out of keeping with the severity
    of the impairment. This lack of concern is
    termed la belle indifference and may be a clue to
    the physician that the problem is psychological
    rather than physical.

13
Nursing Process
  • Nursing Diagnosis
  • Planning/Implementation
  • Outcomes
  • Evaluation

14
Predisposing Factors
  • Psychoanalytical theory
  • Emotions associated with the traumatic event that
    the client cannot express because of moral or
    ethical unacceptability are converted into
    physical symptoms.
  • Familial factors
  • Findings suggest that conversion disorder occurs
    more often in relatives of people with the
    disorder.
  • Neurophysiological theory
  • Central nervous system involved. Excessive
    cortical arousal creating a negative feedback
    loop between the cerebral cortex and the
    brainstem reticular formation.
  • Behavioral theory
  • Learned through positive reinforcement from
    cultural, social, and
  • interpersonal influences

15
  • Transactional Model of Stress/Adaptation
  • The etiology of conversion disorder is most
    likely influenced by multiple factors.

16
Body Dysmorphic Disorder Assessment
  • Characterized by the exaggerated belief that the
    body is deformed or defective in some specific
    way
  • Common complaints involve imagined or slight
    flaws of face or head
  • Symptoms of depression and characteristics
    associated with OCD common in people with
  • body dysmorphic disorder

17
Nursing Process
  • Nursing Diagnosis
  • Planning/Implementation
  • Outcomes
  • Evaluation

18
Predisposing Factors
  • Etiology unknown
  • In some clients, belief is result of another more
    pervasive psychiatric disorder, such as
  • schizophrenia, major mood disorder, or anxiety
    disorder
  • Classified as one of several monosymptomatic
  • hypochondriacal syndromes
  • Defined as the fear of some physical defect
    thought to be noticeable to others although the
    client appears normal.

19
Sleep Disorders Introduction
  • About 75 percent of adult Americans suffer from a
    sleep problem.
  • 69 of all children experience sleep problems
  • The prevalence of sleep disorders increases with
    advancing age
  • Sleep disorders add an estimated 28 billion to
    the national health care bill.
  • Common types of sleep disorders include insomnia,
    hypersomnia, parasomnias, and
    circadian rhythm
    sleep disorders

20
Sleep Disorders Assessment
  • Insomnia
  • Difficulty falling or staying sleep
  • Hypersomnia (somnolence)
  • Excessive sleepiness or seeking excessive amounts
    of sleep
  • Narcolepsy Similar to hypersomnia
  • Characteristic manifestation Sleep attacks the
    person cannot prevent falling asleep
  • Parasomnias
  • Nightmares, sleep terrors, sleep walking

21
  • Sleep terror disorder
  • Manifestations include abrupt arousal from
  • sleep with a piercing scream or cry
  • Circadian rhythm sleep disorders
  • Shift-work type
  • Jet-lag type
  • Delayed sleep phase type

22
Nursing Process
  • Nursing Diagnosis
  • Planning/Implementation
  • Outcomes
  • Evaluation

23
Predisposing Factors
  • Genetic or familial patterns are thought to play
    a
  • contributing role in primary insomnia, primary
  • hypersomnia, narcolepsy, sleep terror
    disorder, and sleepwalking.
  • Various medical conditions, as well as aging,
    have been implicated in the etiology of insomnia.
  • Psychiatric or environmental conditions can
    contribute to insomnia or hypersomnia.
  • Activities that interfere with the 24-hour
    circadian rhythm
  • hormonal and neurotransmitter functioning
    within the body
  • predispose people to sleep-wake schedule
    disturbances.

24
Treatment Modalities
  • Somatoform disorders
  • Individual psychotherapy
  • Group psychotherapy
  • Behavior therapy
  • Psychopharmacology
  • Sleep disorders
  • Relaxation therapy
  • Biofeedback
  • Pharmacotherapy

25
  • Primary hypersomnia/narcolepsy
  • Pharmacotherapy
  • CNS stimulants such as amphetamines
  • Parasomnias
  • Centers around measures to relieve obvious stress
    within the family
  • Individual or family therapy
  • Interventions to prevent injury
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