Chapter 17 - Somatic Symptom Disorders

A physician describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior?

Falsely claiming to have symptoms.

Experiencing symptoms that cannot be explained medically.

Experiencing symptoms that have a physiological basis.

Seeking medication to ease pain of psychological origin.

Falsely claiming to have symptoms.

Malingering is a consciously motivated act to deceive based on the desire for material gain. The symptoms described are nonexisting and so none of the other options are correct statements of behavior.

somatic symptom disorder

condition marked by excessive anxiety about physical symptoms with a medical or purely psychological origin example chest pain /numbness instead of help seeking for emotional distress (e.g., anxiety or depression)

No labs / tests can explain why,

S/s more than 6m.o

illness anxiety disorder

condition marked by intense preoccupation with the possibility of a serious undiagnosed illness -hypochondriac, cancer/thyroidism

-extreme worry or fear about the possibility

-obsessive as thoughts about illness may be intrusive and hard 1 to dismiss even when the pt's realize their fears are unrealistic

- may be care seeking or care-avoidant, may refuse mental hearth evaluation

-address @ early stage

-illness preoccupation present for over 6 mo.

conversion disorder

A rare somatoform disorder in which a person experiences very specific genuine physical symptoms for which no physiological basis can be found. neurological symptoms with no Neurological diagnosis

-some kind of trauma that causes distress

-emotional conflicts or stressors that are transfered to physical

S/s blindness, paralysis

- abnormal MRI shows abnormal pattern of cerebral activation

La belle indifference (Conversion Disorder)/ the grand indifference -

-Many pt's show a lack of emotional concern about often dramatic symptoms

- they don't feel distressed by about the disorder

-rule out all organic causes

- going to a MRI caused paralysis

- comormid psychiatric conditions include depression, anxiety, PTSD, or other somatic disorders, personality disorders

PHQ-15

Screening tool for somatic disorders

Somatic disorders implementation

-establish therapeutic relationships

- focus on strengths

- educate pt regarding treatment

- refer to support groups or systems

- teach effective coping skills assertiveness training

_

Six key elements for effective treatment somatic-disorders

1. Provide continuity of care - avoid doctor shopping, repeating labs and exams

2. Avoid unnecessary procedures

3. Provide frequent a brief regular visits W/o embarrassment or calling them out-

4 always conduct a physical exam. But not surgery

5. Avoid disparaging comments (it's an in your head)

6.. Set reasonable therapeutic goals

Monitor for doctor shopping

Facticious Disorder

intentionally producing psychological or physical symptoms without external motives

Nursing interventions somatic disorders Psychosocial interventions

Psychosocial interventions

- usually take place in the home or clinical settingsto develop

Effective coping skills

Nic:

- assertiveness training

-family involvement promotion

-Imit setting

- self awareness enhancement, and self-esteem enhancement

Nursing interventions somatic disorders - promotion of self-care

Activities

Pt's ability maybe impaired

-use of matter of fact approach to support the highest level of self-care activities

-pt having conversion disorders (paralysis, blindness, fatigue

An effective nursing approach is to support pt's while expecting

Them to support themselves. To reduce secondary dependence

- paralysis of arm to use otherarm

- blind person to eat clockwise on plate

- assertiveness training give pt's with somatic symptom disorders

A direct means at getting needs mets therefore decreasing

The need for somatic symptoms

- ROM exercises, walks → helps pt to feel in control

Health promotion of somatic disorders

- people who use somatizletion as a way of coping with anxiety tend to be less educated

-teaching basic info about bodily functions is necessary

Pictures, charts can be helpful preview with family

factitious disorder

-True Somatization disorders are not under the control of the client

-Rule out factitious disorders in which client deliberately fabricates symptoms or inflicts injury

-There is secondary gain-to assume our sick role

_-determine it conscious or unconscious, may be psychiatric or physiological

- avoid confrontation

Munchausen's

Factitious disorder imposed on self

- person may inject themselves with something or hurt themselves

-abdominal pain/headaches

_ admission to hospital is dramatic and description at illness using proper medical terminology

-Pt is often reluctant to speak to family members and friends or medical professionals

-Negative test results usually bring on new symptoms

- Doctor shopping occurs

Munchausen's By Proxy Syndrome

-Factitious disorder imposed on another person such as child or grandparent/parent

-cancer, burns, injuries

-The perpetrator does not do it for money but for attention with healthcare professionals

-Maybe a health care worker themselves

Malingering Disorder

* Symptoms:

*Patient consciously fakes a medical disorder to attain secondary gain (money, avoiding work, drugs). insurance fraud, avoid prison or

Military

Complaints cease after gain; avoids treatment.*

Which mental health disorder is an example of a somatoform disorder?

Depersonalization

Dissociative fugue

Conversion disorder

Dissociative identity disorder

Conversion disorder

Somatic disorders include conversion disorders that are functional neurological disorders. None of the other options are associated with this classification of mental health disorders.

When discussing somatic disorders from a cultural perspective, which statement is true?

Somatic disorders are rarely observed in males.

Somatic symptoms vary widely from culture to culture.

Underdeveloped countries rarely tolerate somatic disorders.

Secondary gain is seldom a factor in somatic disorders.

Somatic symptoms vary widely from culture to culture.

The type and frequency of somatic symptoms vary across cultures. Currently, none of the other options have been supported by research

Studies have shown a correlation between mental disorders and which medical condition?

Psoriasis

Asthma

Chronic renal failure

Cardiovascular disease

Cardiovascular disease

Studies in recent years have contributed to the growing body of evidence indicating a link between mental disorders and medical conditions such as cardiovascular disease and cancer. No such correlation has been proven between medical and any suggest psychiatric conditions

Which nursing diagnosis should be investigated for clients with somatoform disorders?

Deficient fluid volume

Self-care deficit

Ineffective coping

Delayed growth and development

Ineffective coping

Soma is the Greek word for "body," and somatization is the expression of psychological stress through physical symptoms. This information supports that clients generally demonstrate ineffecting coping of anxiety, loneliness, and risk of suicide. None of the other options are associated with somatoform disorders

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder?

Steering conversation away from the client's feelings

Conveying an interest in the client rather than in the symptoms

Encouraging the client to use benzodiazepines liberally

Encouraging the client to rely on the nurse to meet the client's needs

Conveying an interest in the client rather than in the symptoms

When the nurse focuses on the client rather than on the symptoms, the client's self-worth and coping skills are enhanced. The discussion related to client feelings is a major focus of therapy. Neither of the remaining options serves to help the client identify the causes of the illness and so would not serve as effective interventions.

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings?

Somatic disorder

Factitious disorder

Illness anxiety disorder

Conversion disorder

Illness anxiety disorder

Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic. This is not an accurate description of any of the other options.

Which statement made by a client would support the diagnosis of Illness anxiety disorder?

"I feel confused and disoriented."

"I feel as though I'm outside my body watching what is happening."

"I know I have cancer, but the doctors just cannot find it."

"I woke up one morning, and my left leg was paralyzed from the knee down."

"I know I have cancer, but the doctors just cannot find it."

Previously known as hypochondriasis, illness anxiety disorder results in the misinterpretation of physical sensations as evidence of a serious illness. People experience extreme worry and fear about the possibility of having a disease. None of the other statements accurately support this illogical fear of illness.

Which statement about somatoform disorders is true?

An organic basis exists for each group of disorders.

Nurses perceive clients with these disorders as easy to care for.

No relation exists between these disorders and early childhood loss or trauma.

Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Somatization disorders are believed to be responses to psychosocial stress, although the patient often shows no insight into the potential stressors. None of the other options accurately describe somatoform disorders

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff should implement which personal intervention?

Regularly discuss their feelings about the client during the unit's interprofessional care meetings.

Attend in-services that focus on the various aspects of somatic disorders.

Rotate care of the client among the entire nursing department staff to minimize the frustration.

Provide a unified approach to the client's behavior so as to manage and lessen the barr

Regularly discuss their feelings about the client during the unit's interprofessional care meetings.

It is helpful for health care workers, no matter the setting, to discuss responses to these patients in conferences with other health care members to allow for expression of feelings and, ultimately, to provide for consistent care. While the other options are appropriate, none are as staff oriented as the correct option

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved?

"I feel less anxiety than before."

"My memory is better than it was a month ago."

"I take my medications just as the physician prescribed."

"I don't think about my symptoms all the time as I used to."

"I don't think about my symptoms all the time as I used to."

This statement indicates that the client's preoccupation with the physical symptom has decreased, a highly desirable outcome. Neither medication adherence nor memory loss is associated with this disorder. The client would not acknowledge generalized anxiety as a symptom of their disorder.

A class of medications commonly prescribed for somatic disorders is

mood stabilizers.

antidepressants.

anxiolytics.

antipsychotics.

anxiolytics.

Primary care providers prescribe anxiolytic agents for patients who seem highly anxious and concerned about their symptoms. Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety or to induce slee

Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder?

13-year-old male

23-year-old female

33-year-old male

43-year-old female

23-year-old female

The predominance of women with somatization is significant. It has been proposed that women are more aware of their bodily sensations, have different health-seeking behaviors when faced with physical and psychological distress, and use more health care services than men. In particular, young women aged 16 to 25 are more likely to receive a somatic diagnosis than men or older individuals

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder?

Potential for violence

Level of confusion

Dependence on medication

Personal identity disturbance

Dependence on medication

Many clients with somatoform disorder have received prescription medication for anxiety or pain relief and may have developed dependence. Assess not only for what the client has taken, but also for amounts and length of time over which the drugs have been prescribed. None of the other options are routinely associated with somatoform disorders.R

A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of what process?

Regression

Depersonalization

La belle indifference

Dissociative amnesia

La belle indifference

La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety. Such indifference is not observed in any of the other options

The primary difference between a factitious disorder and other somatic disorders is described in which statement?

Factitious disorders respond well to confrontation as a primary therapeutic technique.

Factitious disorders have a symptomatology that is actually controlled by the client.

Factitious disorders have their origins in depression and anxiety.

Factitious disorders are always self-directed.

Factitious disorders have a symptomatology that is actually controlled by the client.

Factitious disorders, in contrast to other somatic disorders, are under conscious control. None of the other statements accurately describe these disorders

Somatic symptom disorder

A psychiatric disorder characterized by a combination of distressing symptoms and an excessive or maladaptive response or associated health concerns without significant physical findings and medical diagnosis.

somatozation

A process whereby a mental event is expressed in a body disorder or physical symptom. Examples include peptic ulcers and asthma.

Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder?

"A combination of antianxiety and antidepressant therapy is the most effective therapy."

"Aversion therapy is often used because in effect you are punishing yourself by not being able to walk."

"Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome."

"Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

"Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

CBT is the most consistently supported treatment for the full spectrum of somatic disorders. All the other options are incorrect and do not describe the most used and effective therapy for this disorder

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective?

Client will walk unassisted within 1 week.

Client will return to a pre-illness level of functioning within 2 weeks.

Client will be able to state two new effective coping skills within 2 weeks.

Client will assume full self-care within 3 weeks.

Client will be able to state two new effective coping skills within 2 weeks.

4

An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe. In the other options, the time frames of these outcomes are unrealistic

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder?

Utilizing many different therapeutic strategies or modalities for enhanced coping

Involving every member of the family as well as the patient in treatment

Incorporating spirituality and religion into treatment

Considering all dimensions of the patient, including biological, psychological, and sociocultural

Considering all dimensions of the patient, including biological, psychological, and sociocultural

It is important to use a holistic approach in nursing care so that we may address the multidimensional interplay of biological, psychological, and sociocultural needs and its effects on the somatization process. All nurses need to be aware of the influence of environment, stress, individual lifestyle, and coping skills of each patient. The other options do not explain the concept of holistic care.

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering?

A court date this week for drunk driving

Was adopted at the age of 5 years

A history of physical abuse by his stepfather

A history of oppositional-defiant disorder

Raised primarily in a single parent household

A court date this week for drunk driving

Malingering is a process of fabricating an illness or exaggerating symptoms to gain a desired benefit or avoid something undesired, such as to obtain prescription medications, evade military service, or evade legal action. It is more common in men, those who have been neglected or abused in childhood, and those who have had frequent childhood hospitalizations. Adoption is not known to be a causative factor in malingering. A history of oppositional-defiant disorder is not known to a causative factor in malingering. Being raised in a single parent home is not known to be a causative factor in malingering.

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?"

"Your legs don't work because your brain is screwed up."

"Your emotional distress is being expressed as a physical symptom."

"You are making up your symptoms as a cry for help."

"You are overly anxious about having a severe illness."

Your emotional distress is being expressed as a physical symptom."

Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms. Telling the patient her brain is "screwed up" is unprofessional and does not give any useful education. Symptoms of conversion disorder are not within the patient's voluntary control. Being overly anxious about having a severe illness describes illness anxiety disorder.