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Mental Health

Somatoform and Dissociative Disorders

somatoform disorders occur where on the mental health continum? from moderate to severe
A group of disorders in shich physical symptoms suggest a pjysical disorder for which ther is no demonstrable base, and a strong presumption that the symptomsare linked to psychobiological factors. somatoform disorders
The expression of psychological stress through physical symptoms. somatization
The nurse needs to recognize that in somatoform disorders, the symptom are not intentional or under the conscious control of the client
this involves a conscious process of intentionally producing symptoms for an obvious environmental goal. malingering
An employee complaining ov back pain to get disability income is an example of malingering
This refers to deliberate fabrication of symptoms or self-inflicted injury with the goal of assuming the sick role. Facticious disorder
A client injecting saliva into the skin to for an abscess is an example of facticious disorder
What is the most severe form of factitious disorder? Munchausen Syndrome by proxy
When a caregiver injures a victim to get attention or sympathy for himself or herself. Munchausen Syndrome by proxy
Somatoform disorders are differentiated from _______ in which there is evidence of a general medical condition that may be affected by stress or psychological factors. pyschosomatic illness
The different somatoform disorders are: Somatization disorder, undifferentiated somatoform disorder, conversion disorder, pain disorder, hyochondriasis, body dysmorphic disorder, somatoform disorder not otherwise specified.
What are the medical conditions that can be confused with somatoform disorders? MS, brain tumor, hyperthyroidism, hyperparathyroidism, lupus erythematosus, myasthenia gravis.
What is the age of onset of conversion disorder? Any age
What is the age of onset of somatization disorder? Adolescence to thirties
What is the age of onset of hypochondriasis? 20-30 years of age
What is the age of onset of pain disorder? any age
What is the age of onset of body dysmorphic disorder? adolescence to thirties
What is the gender pridilection of conversion disorder? 2x as frequent in women
What is the gender pridilection of somatization disorder? Women 80% and Men 20%
What is the gender pridilection of hypochondriasis? Equal prevalence in men and women.
What is the gender pridilection of lain disorder? Twice as frequent in women.
What is the gender pridilection of body dysmorhic disorder? Equal prevalence in men and women.
History of many physical complaints beginning before 30 years of age, occuring over a period of years and resulting in impairment in social, occupational, or other important areas of functioning. Somatization Disorder
For somatization disorder to be diagnosed the patient complaints must include what? HX of pain at least 4 different sites or functions; HX of at least 2 gastrointestinal symptoms other than pain; HX of at least 1 sexual or reproduction symptom; HX of at least 1 symptom defined as or suggesting a neurological disorder.
Development of one or more symptoms or deficits suggesting a neurological disorder or grneral medical condition. Conversion Disorder
Psycholical factors are associated with the symptom or deficit because the symptom is initiate or exacerbated by psychological stressors. Conversion Disorder
Conversion disorder is not due to malingering or factitious disorder and not culturally sanctioned.
This disorder cannot be explained by general medical condition or effects of a substance. conversion disorder
This disorder causes impairment in social or occupational functioning, causes marked distress, or requires medical attention. conversion disorder
For at least 6 months, the patient has a preoccupation with fears if having a serious disease, the preoccupation persists despite medical tests and reassurances, other disorders are ruled out and preoccupation causes significant impairment socially. Hypochondriasis
pain in one or more anatomical site is a major part of the clinical picture in pain disorder
This disorder causes significant impairment in occupational or social functioning or causes marked distress. pain disorder
Psychological factors are thougth to cause onset, severity, or exacerbation of pain disorder
The pain in pain disorders is associated with psychological factors
In this disorder, symptoms are not intentionally produced or feigned. If there is a medical condition, it plays a minor role in accounting for pain. pain disorder
Both psychological and/or medical condition are judged in diagnosing this disorder because they are important in onset, severity, exacerbation, and maintenance of pain. pain disorder
Preoccupation with someimagined defect in appearance, and if the defect is present, concern is excessive. Body Dysmorphic Disorder (BDD)
In tnis somatoform disorder, preoccupation causes significant impairment in social or occupational functioning or causes marked distress. Body Dysmorphic Disorder (BDD)
Clients with anxiety or depressive disorders are at high risk for unexplained medical symptoms, because of a tendency to amplify physiological events
When levels of serotonin and norepinephrine are abnormal, the person experiences more sever pain
It is believed that the effect of antidepressants on pain is due to the correction of altered serotoninor norepinephrine levels
Somatization is rarely seen in US men
The belief that psychogenic complaints of pain, illness or loss of physical function are related to repression of a conflict and transformation of anxiety into a physical symptom that is symbolically related to the conflict. Psychoanalytic Theory
Behaviorists suggest that somatoform symptoms are learned ways of communicating helplessness and that they allow the individual to manipulate others.
These theorists believe that the client with somatoform symptoms focuses on body sensations, misinterprets their meaning, and then becomes excessively alarmed by them. Cognitive Theorists
The most frequent symptoms of somatization disorder are: pain, dysphagia, nausea, bloating, constipation, palpitations, dizziness, and SOB.
Anxiety and depression are common comorbid conditions with somatization disorder
Clients with this disorder misinterpret innocent physical sensations as evidence of a serious illness. Hypochondriasis
Many patients with hypochondriasis have a history of sexual or physical trauma, parental upheaval, or absence from school during childhood for health reasons.
When testing rules out any organic cause for pain and the discomfort leads to significant impairment, what disorder is diagnosed? pain disorder
This disorder is marked by the presence of deficits in voluntary motor or sensory functions. conversion disorder
Common symptoms of conversion disorder are: Involuntary movements, seizures, paralysis, abnormal gait, anesthesia, blindness, and deafness.
Common comorbid psychiatric conditions with conversion disorder include: Depression, anxiety, other somatoform disorders, and personality disorders.
Benefits derived from the symptoms alone secondary gains
The client with ________ exhibits more anxiety and an obsessive attention to detail, along with a preoccupation with the fear of serious illness. hypochondriasis disorder
The patient with ________ is often rambling and vague about the details fo his or her many symptoms and gives a disorganized history. somatization disorder
What are the basic level interventions for somatoform disorders? Promote self care activities, health teaching, case management, and psychobiological interventions.
Disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception. dissociative disorders
an unconscious defense mechanism to protect the individual against overwhelming anxiety. dissociation
When the ability to integrate memories is impaired dissociative amnesia
When the ability to maintain one's identity is affected the individual may develop a dissociative fugue or dissociative identity disorder (DID)
When there is a persisten or recurrent disruption in perception, the individual has depersonalization disorder
A feeling of detachment from the mind or body depersonalization disorder
Dissociative identity disorder (DID) used to be referred to as multiple personality disoder
Clients with dissociative disorders haf intact reality testing, they are not delusional or hallucinating
Mood disorders and substance-related disorders are commonly associated with all of the dissociative disorders
Dissociative amnesia may be comorbid with conversion disorder or personality disorder
Dissociative fugue may co-occur with PTSD
DID patients may also have PTSD. borderly personality disorder, or sexual, eating, or sleep disorders.
Depersonalization disorder occurs with hypochondriasis,anxiety disorder, and personality disorder.
Depersonalization disorder and dissociative fugue have a possible _______ link neurological
What four major dissociative disorders are listed on the DSM-IV-TR? Depresonalization disorder, dissociative amnesia, dissociative fugue, and DID.
A persistent or recurrent alteration in the perception of the self while reality testing remains intact. Depresonalization disorder
How might the perosn experiencing depersonalization feel? mechanical, dreamy, or detached from the body
The inability to recall important personal information, often of a traumatic or stressful nature that is too pervasive to be explained by ordinary forgetfulness. dissociative amnesia
A person with generalized amnesia is unable to recall information about his or her entire lifetime.
This dissociateve disorder is characterized by sudden, unexpected travel away from the customary locale and inability to recall one's identity and information about some or all of the past. dissociative fugue
In rare cases of ______________ an individual assumes a whole new identity. dissociative fugue
Usually a dissociative fugue is precipitated by a traumatic event
The presence of two or more distinct personality states that recurrently take control of behavior. Dissociative Identity Disorder (DID)
It is believed that severe sexual, physical, or psychological trauma in childhood predisposes an individual to the development of DID
A patient with a dissociative disorder needs what characteristics included in their milieu therapy? A quiet, simple, structured and supportive environment.
Advanced nurses may use _______ or ______ to treat dissociative disorders cognitive-behavioral therapy or psychodynamic psychotherapy
Nurses woeking with clients with somatization and dissociative disorders can expect that these clients will fit on the continuum of psychobiological disorders at the moderate to severe level
Mr. R presents with a history of having assumed a new identity in a distant locale and of having no recollection of his former identity. what diagnoiss can the nurse expect the psychiatrist to make? dissociative fugue
Potential for violence is not a nursing diagnosis indicated for clients with somatoform disorders
A physician describes a client as "malingering." The nurse knows this means the client is falsely claiming to have the symptoms
Which neurotransmitter has been implicated as a possible causative factor in both pain disorder and body dysmorphic disorder? serotonin
Dissociative identity disorder is characterized by the existence of two or more subpersonalities, each with its own patterns of thinking
Clients with dissociative disorders do not have voluntary control of symptoms
Voluntary control of symptoms has greater relevance when the nurse is assessing clients with somatoform disorders
Clients with ______ disorder may use alcohol or other central nervous system depressants or anxiolytic drugs to self-medicate. pain
An attitude of unconcern about a symptom that is unconsciously used to lower anxiety. La belle indifference