ch19 psyc somattoform d/o
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| psychosomatic | connection b/t mind(psyche) & body(soma). the mind can cause the body to create physical s/s or to worsen physical illnesses
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| somatization | transference of mental experiences & states into bodily s/s
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| somatoform d/o | physical s/s that suggest medical condition w/out a demonstrable organic basis to account fully for them
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| 3 central features of somatoform d/o | *physical complaint suggest major medical ill but no organic basis *psychologic factor/conflict important in exsistance of s/s *magnified health concerns NOT under pt control
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| do pt actually experience physical symptoms? | yes! as well as accompyning pain, distress, & function impairment despite neg Dx test results.
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| somatization d/o | multiple physical s/s. begins 30yrs of age extends over several yrs. combo pain/gi, sexual & pseudoneurologic s/s
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| conversion d/o | "conversion reaction" unexplained, sudden deficits in sensory/motor function. attitude of la belle indifference is key feature
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| la belle indifference | seeming lack of concern or distress over conversion reaction
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| pain d/o | pain primary s/s which is unrelieved by analgesics & greatly affected by psychologic factors in terms of onset, severity, exacerbation, & mainenance
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| hypochondriasis | preoccupation with FEAR that one has a serious disease(disease conviction) or will GET a serious disease(disease phobia). they misinterpret bodily functions
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| body dysmorphic d/o | preoccupation w/imagined or exaggerated defect in physical appearance
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| stats for d/os | S d/o, pain d/o ^ in women than men. hypochondriasis & bdd equal
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| malingering | intentional production of false or exaggerated phys/psyc s/s. motivated by external incentives(avoiding work, jail, money, drugs) CONCIOUS
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| factitious d/o | when person intentionally produces or feigns phys/psyc s/s solely to gain attention. pts may even cause injury for attention
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| common term for factitious d/o | Munchausen Syndrome
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| Munchausen Syndrome By Proxy | when someone inflicts illness/injury on someone else to gain attention of emergency to be "hero". most common victim is kid c/o mother or nurse giving K+ OD to save pt life w/CPR
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| internalization | ppl that keep stress, anxiety, or frustration inside rather than express it outwardly. can lead to somatoform d/o
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| primary gain | direct external benifits that being sick provides, relief of cause of anxiety, conflict, or distress
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| secondary gain | attention gained from being sick
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| Dhat (indian) | hypochondriacal concern abt semen loss
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| Koro (southeast Asia) | belief that penis is shrinking & will disappear into abdomen, resulting in death
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| falling-out episodes (southern US & carribean) | sudden collapse; person cant see or move
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| Hwa-byung (korea) | suppessed anger c/o insomnia, fatigue, panic, indigestion, general aches/pains
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| sangue dormido (portuguese) | (sleeping blood) pain, numbness, tremors, paralysis, seizures, blindness, heart attack, miscarriage
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| shenjing shuariuo (china) | physical/mental fatigue, dizziness, headache, pain, sleep problem, memory loss, gi prob, sex dys
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| biologic theories | difference in way pts w/Som d/o regulate & interpret stimuli. cant sort relevent from irrelevent stimuli & respond equally to both types. found more often in relatives of pts w/som d/o
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| Treatmetn | managing s/s & improving quality of life. show empathey & sensitivity to prevent pt from dr shopping. Therapy groups work well.
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| anti-dep used in Som d/o tx | prozac, paxil, zoloft
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| history som d/o | pt usually have lengthy account of past treatment & tests run & surgical procedures. may be angry with healthcare team for not giving a Dx or may have La Belle Indiffernce
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| general appearance/motor behavior | appearance normal. may shuffle or limp depending of symptoms
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| mood/affect | labile, from depressed when describing phys s/s to excited when talking abt going to hospital via ambulance. exaggeratedly describe s/s
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| thought process/content | NO dosordered thought process! pt will answer ow they feel in terms of phys health. hypochondriasis focus on fear of serious illness rather than exsistance of illness
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| hypochoondriasis thought process | preoccupied w/bodily funcitons, ruminate abt illness, fascinated w/medical info, & have unrealistic fears abt potential infection & Rx meds
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| sensorium & intellectual process | intact. alert & oriented
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| judgement insihgt | pts focus only on phys part of self. low self-esteem & deal by totally focusing on phys concern. lack confidence & managing daily issues.
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| roles relationships | unlikely to be employed. consumption w.seeking med care makes family life difficult. they have few friends & dont really socialize for fear of getting sick away from home
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| physiologic & self care concerns | pts have sleep dist, lack basic nutrition, get no exercise. may take multiple Rxs. if using anxiolytics: assess for withdrawal syptoms
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| Nursing Dx for Som d/o | ineffctive coping, ineffective denial, impaired social interaction, anxiety, distured sleep pattern, fatigue, pain. risk for diuse syndrome if pseudoneurologic paralysis s/s
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| goals for Som d/o | ID relationship b/t stress & phys s/s *verbally express emotional feelings *follow established daily routine *show alt ways to deal w/stress *show healthier behaviors (nutrition, rest, activity)
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| health teaching Som d/o | establish daily routine that includes improved health behavior. adequate nutrition intake, improved sleep. validate feelings but encourage involvement!
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| assisting pt to express emotions | teach abt relationship b/t stress & physiological s/s to teach mind-body relationship. Journaling, limiting time pts may focus on phys s/s & focus on emotional feelings. tell family to stop reinforcing the sick role
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| Emotion-focused coping | progressive relaxation, deep breathing, guided imagery, distractions like music. this helps pt relax & reduce feelings of stress.
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| problem-focused coping | helps resolve pt behavior or situation or manage life stressors. inculdes problem-solving methods, ID problem, role-playing interactions with others.
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| evaluation | fewer visits to Dr b/c of phys complaints, less meds used, more positive coping skills, ^ functional ability, improved fam/social relationships
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