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Nursing 1111

Somatoform and Dissociative Disorders Ch. 15

Somatization Disorder Multiple somatic symptoms that cannot be explained medically; Vague, dramatized, or exaggerated symptoms; Pain in multiple sites; multiple physician; Anxiety & depression w/ suicide common; Symptoms present before age 30
What does somatoform disorders different from? Malingering; Factitous disorder; Psychosomatic illness
Malingering Intentionally producing symptoms to achie e and environmental goal
Factitious disorder Fabrication of symptoms or self-inflicted injury to assume the sick role
Psychosomatic illness A general medical condidion affected by stress or psychological factors
These are behaviors not disorders Malingering, Factitious disorder, Psychosomatic illness
Somatoform Disorders Conversion; Hypochondriasis; Somatization disorder; Pain disorder; Body dysmorphic disorder
Dissociative Disorders Amnesia; Fugue; Dissociative identity disorder; Depersonalization
Pain Disorder Severe prolonged pain that impairs social or occupational functioning; Diagnostic testing rules out organic cause; Psychological issues causes the pain or affects the severity or maintenance; Usual sites of pain: head, face, lower back pelvis
Pain Disorder Presence of pain provides primary, secondary and/or tertiary gain; Depression, suicide & substance abuse are common
Pain Disorder Nursing Care: Assess physical status; Note pain episodes- duration, intensity, and factors influencing onset; Use distraction to manage pain, Reinforce non pain behaviors and interactions; Teach effective coping strategies; Explore meaning pain (client)
Hypochondriasis Belief that one has a serious disease in spite of negative medical findings; Misinterpretation of physical sensations; Preoccupation causes impaired social and occupational functioning; Depression or anxiety disorders common; Repeat doctor shopping; 6 mon
Hypochandriasis Something is there, could be be a mole & client believes it is cancerous
Hypochandriasis Nursing Care: Thorough physical assessment; Limit focus on physical complaints; Encourage discussion of feelings; Convey acceptance, unconditional regard & non-judgemental attitude
Conversion Disorder Loss or change in body function as result of psychological conflict or extreme stress; Symptoms affect voluntary motor or sensory function such as involuntary movements, abnormal gait, anesthesia, blindness, deafness, paralysis, or seizures
Conversion Disorder La bell indiffererence; Primary gain; Secondary gain; symptoms resolve within a few weeks
Conversion Disorder Common rape victim
Conversion Disorder Comorbidities: Major depression, Dissociative disorder, Personality disorder
Somatization Disorder Comorbidities: Major depression, Panic disorder, Personality disorder, Substance dependence
Hypochondriasis Comorbidities: Depressive disorder, Anxiety disorder, Other somatoform disorders
Pain Disorder Comorbidities: Anxiety disorder, Depressive disorder, Substance dependence
Body dysmorphic Disorder Comorbidities: Major depression Obsessive-compulsive disorder, Social phobia
Primary gain Avoid conflicts
Secondary gain Avoids uncomfortable situation
Conversion Disorder Nursing Care: Thorough physical; look for primary &secondary gains; Avoid judgement; Encourage verbalization of feelings; Teach adaptive coping
Body Dysmorphic Disorder Preoccupation with an imagined defective body part; Exaggerated belief that body is deformed or defective; Delusional thinking (true)
Body Dysmorphic Disorder Depression & Obsessive-compulsive behavior are common; Meay seek medical intervention to "fix" the perceived problem ( will actually have surgery to fix)
Body Dysmorphic Disorder Nursing Care: Assess client's perception of body image; Help them see reality; Encourage expression of fears; Teach adaptive coping; Support groups may be helpful
Somatoform D/O Treatment: May avoid psychiatric referrals or fail to persist with treatment; Pharmocological; Behavior and psychotherapy helpful if client will attend
Pharmocological for Somatoform D/O Hard to get them into treatment because it makes them face their fear and feelings.
Pain Disorder Suicide is a serious risk in clients with chronic pain: the rate is nine times higher than regular population
Body Dysmorphic Disorder There is no relief of symptoms; The disorder is chronic and the response to treatment is limited.
La belle indifference Lack of emotional concern about the symptoms
Conversion Disorder The course of this disorderis related to its acuity; in cases with acute onset during stressful events, remission rate is high; in cases with a more gradual onset, the disorder is not readily treated
Dissociative Disorders Dissociative Amnesia; Dissociative Fugue; Dissociative Identity Disorder (DID); Depersonalization Disorder
Dissociative Disorders DSM-IV-TR
Somatoform Disorders DSM-II-TR
Dissociative Disorders Disturbances in the normally well integrated continuum of consciousnes, memeory, identity, and perception
Dissociative Amnesia Inability to recall important personal information; Begins abruptly; Usually related to a traumatic event; Client is aware of memory loss and is alert before and after incident; Not related to substances or medical condition
Dissociative Amnesia Types Localized; Selective; Generalized
Localized Unable to recall events from a certain period
Selective Unable to recall portions of events from a certain period
Generalized Unable to recall information about their entire life
Dissociative Amenesia Nursing Care: Secure safe environment; Obtain as much information as possible; Dont pressure client to remember experiences allow them to process info at their own pace; Expose client to simuli that should remind the client of pleasant past experiences
Dissociative Amnesia Encourage client to talk about recent stressors
Dissociative Fugue Sudden unexpected travel from home; Inability to recall personal identity; May assume a new identity; Evidence of secondary gain is clear
Dissociative Fugue Nursing Care: Safe environment; low stimuli; Redirect violence; Grive tranquilizing meds. (Valum, Zanax); Explore traumatice experiences (when calm); Teach effective coping; Refer to community support
Dissociative Fugue Usually lives simple lives; Usually precipitated by a traumatic event;
Dissociative Identity Disorder Multiple Personality Disorder
Dissociative Identity Disorder (blank)
Dissociative Identity Disorder 2 or more distinct personalitites are present and periodically take control of client's behavior; Unable to consistently recall personal information; May or may not be aware of alter ego; Not due to substances or a medical condition
Dissociative Identity Disorder These alter-egos are created for protection
Dissociative Identity Disorder Predisposing Factors: Biological capacity for dissociation; Threatening environment present as personality developed; History of severe trauma or abuse in childhood; Lack of nurturing or recovery from the abuse
Dissociative Identity Disorder Nursing Care: Assure safety, assess suicidal intent and supervise closely; Provide structure and reassure client of safety; Establish a trusting relationship; Explore each personality and the role it plays.
Dissociative Identity Disorder Nursing Care: Know that excessive switching between alters is result if trigger similar to past trauma
Dissociative Identity Disorder Assist client to accept and integrate personalities into one; Teach grounding techniques to convey "not going away" -Safe place, -Ice in hands, -Wrapping self in blanket, -Counting
Dissociative Identity Disorder Provide coping skills such as: -Relapse prevention, -Journaling
Depersonalization Disorder Temporary sense of unreality; Parts of body feel unreal, sense of detachment from the environment; Derealizaiton may occur- altered perceptions w/ people automatic; Client is aware of perceptual distortions
Depersonalization Disorder Accompanied by anxiety, depression, fear of going insane, obsessive thoughts, somatic complaints; Client is aware of perceptual distortions
Causes of Depersonalization Disorder Neurophysicological: Brain, Tumors, Epilepsy, Drug Intoxication (LSD), Severe Sensory Deprivation; Conflicts within ego structure that protects one fromn trauma; multiple
Cause of Depersonaliztion Disorder Multiple Causes: Stress increases & Person uses Repression to Deal with it
Common Treatments Amobarital (Truth Serum) helps client recall memories; Psychotherapy; Hypnosis
Created by: keystudent