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EXAM 3 - MENTAL HEAL
Somatic & Sleep Disorders
| Question | Answer |
|---|---|
| Conversion Disorder | Neurological symptoms in the absence of a neurological diagnosis. Often experience deficits in voluntary motor or sensory functions. Common symptoms include paralysis, blindness, movement and gait problems, numbness, paresthesia, loss of vision or hearing, episodes resembling epilepsy |
| Illness Anxiety Disorder | Misinterpretation of physical sensations. Preoccupation with having or acquiring a serious illness. Must occur for at least 6 months. Patient has high anxiety about health. Excessive health-related behaviors or maladaptive avoidance. May be care-seeking or care-avoidant |
| Somatic System Disorder | One or more distressing symptoms. Excessive thoughts, anxiety, and behaviors surrounding symptoms, or health concerns, without significant physical findings or medical diagnosis. Suffering is authentic, and patients may experience high level of functional impairment. |
| La Belle Indifference | Lack of emotional concern about symptoms. Typically occurs in conversion disorder |
| Somatization | Expression of psychological stress through physical symptoms. Symptoms are expressed in place of anxiety, depression, or irritability (may be pain, paralysis, or unexplained skin rashes) |
| Factitious Disorder on Self (Munchausen Syndrome) | Characterized by the patient going from one provider to the another, in an attempt to seek attention |
| Factitious Disorder on others (Munchausen Syndrome by Proxy) | Characterized by a primary caregiver faking an illness in a vulnerable dependent (such as child, sibling, parent, spouse). They do not do it for monetary compensation. They do it for attention that they receive from others |
| Malingering | Intentional production of false or exaggerated symptoms. The conscious act to deceive someone else which is based on the patient's desire for material gain. Involves either fabricating or exaggerating an illness so that the patient may have a longer inpatient stay to obtain disability, obtain meds, evade military service, or evade law enforcement |
| Primary Gain | Direct internal benefits of being sick, relief of anxiety, conflict, or distress |
| Secondary Gain | External or personal benefits from others because one is sick. Attention and comfort measures |
| Biologic Theories | Differences in regulation, interpretation of stimuli. Tends to run in families, occurs in 10-20% of first-degree relatives of women with somatization disorder |
| Psychodynamic Theories | Complaints of pain, illness, or loss of physical function are relation to the repression of a conflict and/or unwelcome experience. |
| Nursing Assessment in Somatic Illnesses | Physical health status, screening, detailed medical history, general appearance, motor behavior, mood and affect (labile, exaggerated emotions). Thought process and content (physical health/sensations). Sensorium and intellectual processes. Judgment and insight (little or no insight to behavior). Self-concept (focus on physical self). Role and relationships (unlikely to be employed). Physiological and self-care concerns |
| Nursing Interventions in Somatic Illnesses | Provide health teaching to improve health behaviors. Help client express emotions (such as journaling, limiting time focused on physical complaints). Teach coping strategies (such as emotion-focused & problem-focused) |
| Nursing Outcome Identification in Somatic Illnesses | Identify the relationship between stress and physical symptoms. Verbally express emotions/feelings. Establish and follow a daily routine. Demonstrate alternative ways to deal with stress, anxiety, and other feelings. Demonstrate healthy behaviors regarding rest, activity, and nutritional intake |
| Treatment of Somatic Illnesses | Antidepressants, referral to chronic pain clinic, involvement in therapy groups, education |
| Considerations in patients with Somatic Illnesses | Involve the patient in usual activities, withdraw attention from client's physical status except for necessary care. Do not argue with the client, focus attention on the client's feelings, home or work situations & relationships. Teach client and family/spouses about conversion reaction, stress management, interpersonal dynamics, coping, and conflict resolution strategies |
| Importance Nursing Care Actions in Somatic Illnesses | Nurse must utilize a holistic approach in the care of patients. Help the patient address the multidimensional interplay of biological, psychological, and sociocultural needs and its effect on somatization. |
| Psychosomatic | Connection between mind (psyche) and body (soma) |
| Hysteria | Multiple physical complaints with no organic bases. Proposed by Freud that people can convert unexpressed emotions into physical symptoms |
| First Line Treatment of Somatic Disorders | Selective Serotonin Reuptake Inhibitors (SSRIs) |
| Goal in Somatic Disorders | Symptom management and improvement of quality of life. |
| Insomnia Disorder | Difficulty with falling asleep, maintaining sleep, or waking early and having difficulty falling back asleep. |
| Insomnia Treatments | Relaxation therapy, sleep hygiene measures, and stimulus control therapy |
| Hypersomnolence Disorders | Excessive daytime sleepiness. Begins in young adulthood. Impairs social and vocational functioning. Impairs the ability to participate and enjoy relationships and functioning in the workplace |
| Narcolepsy Disorder | Uncontrollable need to sleep. Disturbed night sleep with automatic behaviors and memory lapses. Cataplexy, paralysis, hypnagogic hallucinations are present. May feel rested upon awakening but within 2-3 hours will feel sleeping again. Diagnosis is by measuring hypocretin levels in CSF |
| Hypersomnolence Treatment | Focuses on maintaining a regular sleep-wake schedule. Amphetamine-based stimulants as well as non-amphetamine based stimulants |
| Narcolepsy Treatment | Lifestyle modifications and long-acting stimulant medication. Behavioral structuring, such as scheduling naps at convenient times |
| Obstructive Sleep Apnea | Episodes of upper airway collapse and obstruction that results in sleep fragmentation. Essentially the person cannot breathe and sleep at the same time. It is the most common breathing and sleep disorder Diagnosis through clinical evaluation and polysomnography |
| Treatment of Obstructive Sleep Apnea | Continuous positive airway pressure CPAP therapy. Stagg patient with a one on one night shift due to safety concern |
| Central Sleep Apnea | Cessation of breathing during sleep. Caused by the instability of the respiratory control symptom. Often related to aging, advanced cardiac or pulmonary disease, neurological disorders |
| Sleep-Related Hypoventilation | Associated with sustained oxygen desaturation in sleep. No apnea or respiratory events occur while sleeping. Associated with morbid obesity, lung parenchymal disease, or pulmonary vascular pathology |
| Circadian Rhythm Disorders | Occurs when there is misalignment between the timing of normal circadian rhythm and external factors that affect timing or duration of sleep. Diagnosis by clinical evaluation, sleep diaries, actigraphy |
| Treatment of Circadian Rhythm Disorders | Aggressive lifestyle management strategies aimed at adapting to or modifying the required sleep schedule. Different types include delayed sleep phase type, advanced sleep phase type, irregular sleep-wake type, non-24-hour sleep-wake cycle (70% occur in blind patients) and shift work type. |
| Nightmare Disorder | Repeated occurrence of frightening dreams that lead to waking from sleep. Dreams are often lengthy and elaborate, provoking anxiety or terror and causing the person to have trouble returning to sleep and to experience significant distress and sometimes lack of sleep |
| Restless Leg Syndrome | Sensory and movement disorder characterized by an uncomfortable sensation in the legs (occasionally the arms and trunk are affected). Accompanied by an urge to move |
| Substance-Induced Sleep Disorders | Can be caused by caffeine, nicotine, alcohol, as well as OTC meds and certain illegal substances |
| Somnambulism | Consists of a sequence of complex behaviors that begin in the first third of the night during NREM sleep. Leave bed and walk about without full consciousness or later memory |
| Sleep Terrors | Refer to sudden terrified near-awakenings. Occur in response to fear or CNS depressant withdrawal |
| Inadequate Sleep Hygiene | Engaging in behaviors not conductive to sleep or that interfere with sleep such as caffeine or nicotine at bedtime, excessive emotional or physical simulation prior to bedtime, daytime naps |
| Sleep Hygiene Interventions | Establish regular sleeping schedule. Avoid sleep deprivation. Do not eat large meals before bed. Avoid naps, exercise daily, minimize or eliminate caffeine and nicotine. Do not look at clock when in bed. Keep bedroom slightly cool, do not drink alcohol to induce sleep. Do not use bed for anything but sleep. Soft music/white noise |
| Melatonin | Produced by the pineal gland that influences the sleep-wake cycle and it is released during sleep. Serum levels are very low during waking hours |
| Sleep Disorders Related to Another Mental Disorder | Can either be hypersomnia or insomnia. Mood disorders, anxiety disorders, schizophrenia, and other psychotic disorders are often to blame. Treatment of the underlying mental disorder is indicated |
| Sleep Disorders Related to A General Medical Condition | May involve insomnia, hypersomnia, parasomnias, or a combination that are attributable to a medical condition. May result from degenerative neurological illnesses, CVD, endocrine conditions, viral and bacterial infections, coughing, ,or pain. Often improve with treatment of underlying medical condition or medication |
| Teaching Methods to Promote Relaxation, Rest, and Sleep | Biological (Pharmacotherapy), somatic interventions (cereve sleep system), psychological therapies (CBT-I, stimulus control) |
| Causes of Hypersomnolence | May be due to sleep regulation dysfunction in the brain |
| Pharmacotherapy | Generally, long-term sleeping pill use is discouraged because nonpharmacological treatments have shown superior efficacy in reducing insomnia. |
| Cognitive Behavioral Therapy for Insomnia (CBT-I) | uses educational, behavioral, and cognitive tools to target factors that perpetuate insomnia over time. |
| Stimulus Control | control is a behavioral intervention that involves sleep principles that decrease the negative associations between the bed and bedroom and strengthen the stimulus for sleep. |
| Sleep Latency | Time it takes to fall asleep |
| Sleep Continuity | Distribution of sleep and wakefulness across the sleep period |
| Sleep Fragmentation | Disruption of sleep stages |
| Sleep Efficacy | Ratio of sleep duration to time spent in bed |
| Too Much Sleep | Correlates with increased risk for stroke and childhood obesity |
| Irregular Sleep | Consequences include lower HDL cholesterol, higher waist circumference, increased BP, total triglycerides, and fasting glucose |
| Chronic Consequences of Sleep Loss | Cardiovascular Disease, Weight related issues, Metabolic syndrome, type 2 diabetes mellitus, colorectal cancer, all-cause mortality, safety issues, financial burden |
| Acute Consequences of Sleep Loss | Increased Stress responsivity, somatic pain, reduced quality of life, emotional distress, mood disorders, cognitive, memory, and performance deficits, and safety risks |
| Sleep Deprivation | The discrepancy between the number of hours of sleep one gets and the hours of sleep required for optimal functioning |
| Excessive Sleepiness | Subjective report to difficulty staying awake which may be serious enough to increase the risk for accident or injury |
| Sleep Drive | Homeostatic process that promotes sleep |
| Circadian Drive | Process that promotes wakefulness |
| Zeitgebers | Exogenous factors that help set our eternal clock to a 24 hour cycle (time-givers) |
| Master Biological Clock | Suprachiasmatic (SC) nucleus in the hypothalamus that regulates a host of functions |
| Basal Sleep Requirement | Amount of sleep necessary to feel fully awake and sustain normal levels of performance |
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