Somatic and Addictive Disorders

somatization

psychological and emotional expression of stress through physical symptoms

holistic approach to somatization

multidimensional interplay of biological, psychological, and sociocultural needs and its effects on somatization

somatic symptom disorder

characterized by a focus on somatic (physical) symptoms, such as pain or fatigue, to the point of excessive concern, preoccupation, and fear

one or more distressing symptoms lasting longer than 6 months

somatic symptom disorder

3 multiple choice options

excessive thoughts, anxiety and behaviors around symptoms, or health concerns without significant medical findings or health concerns

somatic symptom disorder

3 multiple choice options

clients are often resistant to seeking psychiatric assistance

somatic symptom disorder

3 multiple choice options

illness anxiety disorder

misinterprets physical manifestations as evidence of a serious disease process, which can lead to obsessive thoughts and fears about illness

preoccupation with having or acquiring serious illness for at least 6 months

illness anxiety disorder

3 multiple choice options

high anxiety about health, excessive health-related behaviors or maladaptive avoidance

illness anxiety disorder

3 multiple choice options

clients may be care-seeking or care-avoidance

illness anxiety disorder

3 multiple choice options

conversion disorder

neurological symptoms in the absence of a neurological diagnosis

presence of deficits in voluntary motor or sensory functions

conversion disorder

3 multiple choice options

clinical manifestations: conversion disorder

paralysis, blindness, movement disorder, gait disorder, numbness, paresthesia, loss of vision or hearing, episodes resembling epilepsy, la belle indifference (lack emotional concern about dramatic symptoms)

factitious disorder

consciously pretend to be ill to have their emotional needs met and achieve the status of patient; artificially, deliberately, and dramatically fabricate symptoms or self-inflict injury with the goal of assuming the sick role

malingering

a consciously motivated act of fabricating an illness or exaggerating symptoms; done for secondary gain to become eligible for such things as disability compensation, committing fraud against insurance companies, obtaining prescription medications, evading military service, or receiving a reduced prison sentence

factitious disorder by proxy

the client deliberately causes injury or illness to a vulnerable person

nursing interventions: factitious disorder by proxy

- keep careful, detailed records of visitation and events

- interact with patient frequently during visiting hours

- sitter in the room may be required

psychological factors affecting other medical conditions

a link between a client's psychological state and their physical condition

Freud's psychoanalytic theory

psychogenic complaints of pain, illness, or loss of physical function is a cover up for conflicted feelings and/or unwelcome experiences

behavioral theories

- communication of helplessness

- attention-seeking behavior.

cognitive theories

- negative, distorted, catastrophic thoughts

- focus on body sensations and misinterpret their meaning, responding with excessive

assessment of somatic disorders

- assess for nature, location, onset, characteristics, and duration of the symptom(s). ​

- explore past history of adverse childhood events. ​

- identify symptoms of anxiety, depression, and past trauma that may be contributing to somatic symptoms and ability to meet basic physical, and safety/security needs. ​

- determine current quality of life, social support, and coping skills including spirituality. ​

- identify any secondary gain that the patient is experiencing from symptom(s). ​

- explore the patient’s cognitive style and ability to communicate feelings and needs. ​

- assess current psychosocial and biological needs. ​

- screen for misuse of prescribed medication and substance use.

secondary gain

reward value of having a psychological or physical symptom, such as release from ordinary responsibilities

implementation for somatic disorders

- help patient to explore feelings​

- cognitive reframing

- establish therapeutic relationship​

- educate patient regarding treatment​

- refer to support groups or systems​

- teach effective coping​

- focus on strengths and reinforce skills

cognitive reframing

questioning client to determine other potential causes of feared disease

6 key elements for effective treatment of somatic disorders

1. provide continuity of care

2. avoid unnecessary procedures

3. provide frequent, brief, and regular visits

4. always conduct a physical exam

5. avoid disparaging comments

6. set reasonable therapeutic goals

psychosocial interventions for somatic disorders

- promotion of family involvement

- setting limits

- promotion of self-care activities

- assertiveness training

- self-esteem enhancement

pharmacological interventions for somatic disorders

- no FDA approved medications

- off label uses: TCAs, SSRIs, SNRIs

cognitive-behavioral therapy (CBT)

a popular integrative therapy that combines cognitive therapy (changing self-defeating thinking) with behavior therapy (changing behavior)

substances that lead to use disorders

- alcohol

- caffeine

- cannabis

- hallucinogen

- inhalants

- opioids

- sedative-hypnotics

- stimulants

- tobacco

- gambling

addiction

compulsive, uncontrollable dependence on a chemical substance, habit, or practice to such a degree that either the means of obtaining or ceasing use may cause severe emotional, mental, or physiologic reactions

intoxication

the process of using a substance to excess

tolerance

when a person no longer responds to the drug in the way that the person initially responded

withdrawal

a set of physiological symptoms that occur when a person stops using a substance

caffeine intoxication symptoms

- restlessness

- nervousness

- flushed feeling

- GI upset

- tachycardia

caffeine withdrawal symptoms

- headache

- drowsiness

- irritability

- poor concentration

treatment for caffeine addiction

abstinence; resolves within a week

cannabis intoxication symptoms

- heightened senses

- depersonalization

- derealization

- delirium

cannabis withdrawal symptoms

- irritability/anger

- restless/anxiety

- depression

- GI upset/fever/chills/HA

treatment for cannabis addiction

- abstinence

- support therapies

- SSRIs

hallucinogen intoxication symptoms

- paranoia

- impaired judgement

- derealization

- pupil dilation

- tachycardia/tremors

- can cause medical emergency

hallucinogen withdrawal symptoms

- re-experiencing symptoms of use that can be distressing

- can last weeks, months, or years

treatment of hallucinogen addiction

- reassurance of safety

- benzodiazepines

- restraints

inhalants intoxication symptoms

- disinhibition

- euphoria

- illusions/hallucinations

- nystagmus

- N/V

- decreased reflexes

inhalants withdrawal symptoms

not considered under DSM-5

treatment of inhalant addiction

abstinence; resolves quickly

opioid intoxication symptoms

- constricted pupils

- drowsiness/slurred speech

- impaired memory and attention

- psychomotor retardation

- respiratory arrest

opioid withdrawal symptoms

- mood dysphoria/anxiety

- N/V/D

- diaphoresis

- hyperreflexia

treatment of opioid addiction

methadone program, medication assisted treatment (MAT)

stimulants intoxication symptoms

- elated, euphoric

- hypervigilant/anxious

- dilated pupils (short term)

- weight loss/confusion

- seizures

- chest pain/arrhythmias

stimulants withdrawal symptoms

- tiredness/insomnia

- vivid nightmares

- depression/suicidal

- paranoia/irritability

treatment of stimulants addiction

- inpatient (for amphetamine use)

- outpatient (for cocaine use)

- antipsychotics

- diazepam (Valium)

intoxication symptoms of sedatives, hypnotic, anti-anxiety med use disorder

- slurred speech

- impaired thinking

- incoordination

- nystagmus

- coma

withdrawal symptoms of sedatives, hypnotic, anti-anxiety med use disorder

- rebound hyperactivity

- tremors/insomnia

- anxiety/seizures

treatment of sedatives, hypnotic, anti-anxiety med use disorder

gradual reduction (taper)

overdose of of sedatives, hypnotic, anti-anxiety med use disorder is treated with

gastric lavage, activated charcoal

tobacco withdrawal symptoms

- irritability

- anxiety

- depression

- difficulty concentrating

- restlessness

- insomnia

treatment of tobacco addiction

- behavioral therapy

- bupropion (Zyban)

- clonidine (Catapres)

- varenicline (Chantix)

overdose

taking an excessive amount of a drug that leads to coma or death

medication assisted treatment (MAT)

strategy for treating substance use disorders that involves using medications and teaching a person how to handle cravings and avoid abusing the substance again

1st opioid use disorder (OUD) medication that can be prescribed in a doctor's office

buprenorphine/naloxone (Suboxone)

3 multiple choice options

buprenorphine/naloxone (Suboxone)

decreases feelings of craving and can be effective in maintaining compliance

given only in a clinic for opioid use disorder

methadone

methadone

used to decrease the painful symptoms of opiate withdrawal, also blocks the euphoric effects of opiate drugs

the only MAT that can be safely used during pregnancy

methadone

3 multiple choice options

taken daily for a minimum of 12 months

methadone

3 multiple choice options

first line treatment for opioid use disorder (OUD) and alcohol use disorder (AUD)

naltrexone

3 multiple choice options

naltrexone

binds to endorphin receptors and blocks effects of opioids and cravings of alcohol

treatment lasts for 3-4 months

naltrexone

3 multiple choice options

risk of taking pill form of naltrexone daily

reduces tolerance for opioids, increasing the risk of overdose

requirements for a client with AUD to begin naloxone

must have withdrawn from alcohol, must maintain sobriety

IM vivitrol q28 days for OUD

must wait at least 7 days from last opioid use for short-acting and 10-14 days after long-acting

drug only for alcohol use disorder (AUD)

disulfiram/Antabuse

3 multiple choice options

disulfiram/Antabuse

blocks enzyme involved in processing alcohol which creates severe discomfort and is a deterrent to drinking

side effects of disulfiram/Antabuse

SEVERE nausea/vomiting, chest pain, tachycardia, flushing, dizziness

important consideration for disulfiram/Antabuse

never use with any alcohol containing products (mouthwash, deodorant, hand sanitizer, perfume, etc.)

tobacco cessation options

- patches

- lozenges

- gum

- hypnosis

- medications: bupropion (Zyban, Wellbutrin), varenicline (Chantix)

bupropion (Zyban, Wellbutrin)

NDRI antidepressant that decreases nicotine craving and manifestations of withdrawal

varenicline (Chantix)

a nicotinic receptor agonist that promotes the release of dopamine to simulate the pleasurable effects of nicotine; reduces cravings for nicotine as well as the severity of withdrawal manifestations; reduces the incidence of relapse by blocking the desired effects of nicotine

Narcan (naloxone)

reverses respiratory depression secondary to opioid overdose

legally intoxicated blood alcohol concentration (BAC)

0.08% (80 mg/dL)

3 multiple choice options

blood alcohol concentration (BAC) that can indicate acute toxicity and/or death

0.40% (400 mg/dL)

3 multiple choice options

systemic effects of alcohol use disorder (AUD)

- peripheral neuropathy

- alcoholic myopathy and cardiomyopathy

- esophagitis, gastritis, pancreatitis

- alcoholic hepatitis

- cirrhosis of the liver

- leukopenia

- thrombocytopenia

- cancer (head and neck)

minor alcohol withdrawal symptoms (6-8 hours after)

N/V, shaky, jitters, HA, mild perceptual changes

moderate alcohol withdrawal symptoms (8-10 hours after)

- psychotic and/or perceptual symptoms begin (hallucinations)

- can lead to seizures, delirium, or unconsciousness

treatmtent of moderate alcohol withdrawal

ativan, librium

severe alcohol withdrawal symptoms (12-24 hours after)

generalized and tonic-clonic seizures

treatment of severe alcohol withdrawal

diazepam (Valium)

delirium tremens (alcohol withdrawal delirium)

a medical emergency that may occur within 72 hours of withdrawal; causes delusions, hallucinations, and physiologic problems and puts the patient at a danger to self

nursing interventions: delirium tremens (alcohol withdrawal delirium)

- prevention

- monitor vital signs

- notify provider of changes

SBIRT

screening, brief intervention, and referral to treatment

- included in routine wellness screenings

- reduces risk drinking and related harms

- promotes safer drinking

- increase help-seeking among individuals who need it

AUDIT

alcohol use disorders identification test

CAGE

4 questions to identify alcohol abuse

CAGE-AID

screen for all types of substance abuse; adjusted to Include drugs

T-ACE

tolerance, annoyance, cut down, eye-opener; identifies risk of drinking during pregnancy

implementation for substance abuse disorders

- achieve psychological stability​

- provide an empathetic, supportive environment​

- promoting safety and sleep: first-line interventions​

- reintroduce good nutrition and hydration​

- support for self-care (hygiene)​

- exploring harmful thoughts and spiritual distress

care continuum for substance abuse

- detoxification (detox)

- rehabilitation

- halfway houses

- other housing

- partial hospitalization

- intensive outpatient (IOP) treatment

- outpatient treatment

- Alcoholics Anonymous (AA)

- relapse prevention

transtheoretical stages of change theory

a psychological theory that describes how people progress through distinct stages when attempting to change a behavior

precontemplation stage

stage of change in which people are unwilling to change their behavior

contemplation stage

stage of change in which people are considering changing behavior in the next 6 months