MH Ch. 17 Somatic Symptom Disorders

somatization

expression of psychological stress through physical symptoms
-very complex disorder
-physical pain, paralysis, skin rashes

outpatient

setting which somatization is most commonly seen
-nurses need to utilize holistic approach

somatic symptom disorder, illness anxiety disorder, conversion disorder

somatic disorders

somatic symptom disorder

combination of distressing symptoms and a maladaptive response
-high level of functional impairment

one or more somatic Sx resulting in significant disruption of daily life

DSM-5 criteria for somatic Sx disorder

chest pain, fatigue, dizziness, headache, swelling, back pain, SOB, insomnia, abdominal pain, numbness

some of the symptoms to look out for with somatic symptoms disorder to help Dx

younger women, low socioeconomic status

demographic that somatic symptom disorder affect the most

low back pain

most common complaint with somatic symptom disorder

supportive care, avoid repeated tests and procedures, hypnotherapy, CBT, short term medication

treatment for somatic Sx disorder

hypochondriac

another name for illness anxiety disorder

illness anxiety disorder

thoughts of illness that are very hard to ignore, even when they know their fears are unrealistic

-Sx cause patient extreme worry and fear of possible disease

-often referred to psychiatrist but they refuse

chronic and relapsing

course of illness for illness anxiety disorder

doctor shopping

with illness anxiety disorder, get multiple opinions, multiple examinations, and multiple medication trials

anxiety disorders, depression, personality disorder

comorbidities with illness anxiety disorder

medications for anxiety or depression, ECT, CBT

treatment for illness anxiety disorder

functional neurologic disorder

another name for conversion disorder

conversion dsorder

patient exhibits neurological Sx but does not have a neurological Dx

-presence of deficits in voluntary motor or sensory functioning from channeling emotional conflicts or stressors into physical Sx

-patient truly believes in the presence of the Sx and that they are not fabricated or under voluntary control

paralysis, blindness, movement disorder, gait disorder, numbness, paresthesia, episodes that look like seizures

conditions that could be present with conversion disorder

cerebral activation

MRI can show abnormalities with this in patients with conversion disorder

la belle indifference

lack of emotional concern about symptoms which could happen with conversion disorder

Hx of abuse in childhood, depression, anxiety, PTSD, personality disorder

these can coincide with conversion disorder

coronary heart disease, cancer

depression can be a risk factor for these medical conditions

sensitivity to negativity, prone to catastrophic thinking, pessimistic (have no glass in the glass half full saying)

people who are more prone to somatic disorders may have these traits

characteristics of Sx, past history and childhood events, assess for anxiety, depression or past trauma, nutritional status, coping skills, quality of life, social support

complex assessment for somatic disorders
-requires complete documentation

patient health questionnaire

useful tool to understand the degree of somatization
-score of 15 or more considered severe
-stomach pain, chest pain, basic needs, Sx under control?

someone who helps or cares for them. risky behaviors (sedentary lifestyle, smoking)

assessment of psychosocial factors in the patient with a somatic disorder

secondary gains

benefits the patient gets from the Sx
-may get more attention from family if they are sick
-personal benefit leads to increased difficulty giving them up

establish therapeutic relationship, adress ways to help patient get needs met without resorting to somatization, establish all providers involved with patient (patient normally sees multiple), offer explanations and support during testing, do not imply Sx are not real, keep patient in contact with case manager, teach assertive communication

nursing interventions for the patient with somatic disorders

assertiveness traning

often identified as appropriate teaching for patients with somatization disorders
-give patients direct means of getting needs met (physical activity)
-decrease need for somatic Sx

factitious disorders

under conscious control, unlike with somatic disorders
-person likes to play patient
-deliberately and dramatically fabricate Sx to meet their attention needs
-illness physical or psychiatric

Munchausen syndrome

patient goes from one primary care provider to another
-have multiple tests and surgeries that are unnecessary
-multiple scars and very proud of them

Munchausen syndrome by proxy

caregiver deliberately feigns illness in a vulnerable dependent

malingering

condition that is related to factitious disorder that is a consciously motivated act to deceive based on the desire for material gain

-workers comp, fraud on insurance company

-usually report very vague Sx

Self compassion

a protective factor that fosters emotional resilience and is particularly relevant to the study of human adaptation to life adversity and stress
-tendency to be caring, warm, and understanding toward ourselves

Negative affectivity (neuroticism)

a dispositional tendency to experience unpleasant moods such as hostility, nervousness, and annoyance
-trait that is a genetic risk factor for somatic symptom disorder