Psychiatric Disorders Notes

Understanding Somatic and Dissociative Disorders

The Reality of Patient Experience

  • Patients with these disorders aren't faking; their experiences are genuine.

Somatic Symptoms and Stress Relief

  • Physical signs and symptoms of an illness serve to relieve stress by masking inner emotional turmoil.
  • Common stress can manifest as physical symptoms like headaches, diarrhea, or stomach upset.
  • The brain channels stress-related energy through the body, resulting in physical symptoms.
  • In psychiatric disorders, symptoms reduce anxiety, serving as the primary gain.
  • Primary Gain: Reduction of anxiety through physical symptoms.
  • Examples of normal stress outlets:
    • Migraines.
    • Irritable Bowel Syndrome (IBS) – stress affecting the GI system.

Defining Somatization

  • Somatization: Physical symptoms caused by stress in the absence of a diagnosable disease.
  • Formerly known as psychosomatic (connection between psychotic emotions and somatic physical symptoms).

Symptom Presentation

  • Symptoms suggest a medical condition, but no physical dysfunction exists.
  • Example: False seizures with normal EEG results, caused by psychological stress.
  • Patients may be unaware of the stressor causing the symptom,
  • The anxiety-reducing benefits are considered the primary gain.
  • Secondary Gain: Assuming a sick role (unintentional).

Characteristics of Emotionally-Based Disorders

  • Disorders are emotionally based without organic causes.
  • Patients are typically unaware of their emotional distress.
  • It is important that the patient is unable to figure out what their emotional distress is. They are clueless to it

Differentiating Somatization Disorder

  • Involves multiple organ systems.
  • Characterized by chronicity and early onset.
  • Absence of significant lab values.

Prevalence of Somatic Symptoms

  • 80% of people in the United States experience somatization.
  • Experiencing somatic symptom does not mean that a person has a psychiatric disorder.

Conversion Disorder

  • Involves sensory or motor functioning impairment.
  • Cause: Psychological conflict.
  • Example: Paralysis before deployment due to conflict about going into a fighting situation.
  • Indifference: Lack of concern about the problem (key sign).
  • Example: Sudden blindness to avoid identifying an assailant.
    *It is all about psychological conflict. That's why they can't see. So the brain's way of protecting you

Hypochondriasis

  • Intense fear or preoccupation with having a serious disease or medical condition.
  • Patients often doctor shop, seeking a diagnosis.
  • Convinced of having a disease despite negative test results.
  • Example of a man with pain in his leg being convinced he has Multiple Sclerosis.
  • Patients often think the worst.
  • The brain glitch: Patients are clueless as to what stressor that they're facing is anyway connected to the physical problem.

Axis I Disorders

  • Conversion disorder and hypochondriasis are classified as Axis I disorders.
  • Conversion and Hypochondriasis are psychiatric disorders.
  • Factitious disorders are also Axis I disorders.

Factitious Disorders

  • Purposely making oneself sick to gain attention or sympathy.
  • Patients may engage in harmful behaviors (e.g., drinking turpentine).

Factitious Disorder by Proxy

  • Causing sickness in someone under their care to gain recognition.
  • Creating the sickness in the individual they're taking care of, and then they rush in and save the person so they can get the recognition.
  • Motivated by seeking recognition and praise.
  • Both factitious disorders are hard to treat.

Malingering

  • Faking illness to gain something positive or avoid something negative.
  • Not a diagnosis, just a descriptive term.
  • Symptoms disappear when the motive is discovered and confronted.
  • Example: Faking mental illness to avoid prison.
  • Malingering to gain something positive or avoid something negative

Differentiating Malingering, Factitious Disorders, and Somatoform Disorders

  • Malingerers: External gain, deliberate, not a psychiatric disorder, resist procedures.
  • Factitious: Gain sick role, deliberate, psychiatric disorder, agree to procedures.
  • Somatoform: Psychiatric disorder, agree to procedures because they believe they are sick.

Treatment Approach

  • Rule out medical causes first.
  • Develop trust with the patient.
  • Address countertransference feelings.
  • Assess and intervene, even when aware of the patient's actions.
  • Explore the purpose of the symptom.
  • Minimize secondary gain.
  • Focus on the emotional impact of the symptom, not just the physical problem.
  • Help identify stressors and teach anxiety reduction techniques.

Anorexia Nervosa (Axis I)

  • Ongoing issue of food that can lead to psychological, social, and physical problems.
  • Anorexia means "loss of appetite".
  • Appetite is present; control is exerted by restricting eating.

Symptoms and Effects of Anorexia Nervosa

  • Disturbance of body image and issues with their appearance.
  • Patients perceive themselves as overweight, even when underweight.
  • The number one disorder that has the highest mortality rate in psychiatry.
  • High mortality rate due to starvation.
  • Control is regained by controlling eating habits.
  • Predominantly affects women, but increasingly seen in men.
  • Refusing to gain weight, losing control, and solving psychological problems.
  • It is a cultural thing.

Physical Manifestations of Anorexia

  • Amenorrhea (loss of menstruation) due to decreased body fat.
  • May develop unusual food-handling habits.
  • Electrolyte imbalances.
  • Blue fingertips (decreased blood flow).
  • Muscle wasting (from burning muscle for energy).
  • Edema (due to kidney retention of salt and water). The body is trying to compensate.
  • Osteoporosis (even in young patients).

Patient Behavior and Nursing Interventions

  • They're sneaky.
  • Denial of the seriousness of the anorexia.
  • Patients may hide food or attempt to exercise in their rooms. The nurse always has to stay with them.
  • The nurse always has to stay with them. Because, you've gotta make sure that they're not hiding their food and they can't run to the washroom to purge
  • May need court-ordered treatment and feeding (NGT).
  • You have to, with these patients, be kind of a matter of fact, to the point, where let's say they eat and they get ready to get up go to the room. This is where you have to go to say, you can't go to your room now.

Bulimia Nervosa (Axis I)

  • Normal weight or slightly overweight individuals.

Cycle of Binging and Purging

  • Binge eating (consuming large amounts of calories in a short time).
  • They keep pushing it in and eating it and eating it and eating it till they gorge themselves because they've lost control
  • Purging is conducted to decrease the hate for themselves.
  • Purging methods include vomiting, laxatives, and diuretics.
  • Normal weight or slightly overweight, and you would never know that this person is calories in matter of minutes, and it could be anywhere from five to 20,000 calories.

Physical Complications of Bulimia

  • Electrolyte imbalances.
  • Arrhythmias.
  • Damage to the intestinal system.
  • Tooth decay due to stomach acid erosion, enamel on their cheek is eroding at the age of 17. The dentist is gonna automatically think anorexia or person.
  • Enlarged parotid glands.
  • Calluses on knuckles.
  • Body image disturbances.

Bulimia Patient Behavior

They're sneaky.

  • Guilt/shame after eating.
  • The person goes to the bathroom every time they eat.
  • The sign is the erosion. Of their enamel. And they need to go to your regular dentist

Bulimia Cycle

  • Dieting leads to hunger.
  • Hunger leads to anxiety.
  • Anxiety leads to binge eating to 5,000 to 20,000 calories in a sitting.
  • Binging leads to guilt.
  • Guilt leads to purging.
  • Purging leads to relief.
  • Then go back on the diet, and it repeats.

Other Eating Disorders

  • The disorders is an ongoing issue with food. So food is the issue because of something that happened during the process
  • Pica- eat Dirt, starch, or Clay, which is weird to most people but totally harmless

Pica

  • Eating non-nutritive substances.
  • Associated with iron or zinc deficiencies.
  • Texture may be a factor.
  • Complications can include intestinal blockage.

Rumination Disorder

  • Chewing and regurgitating food.
  • A form of self-soothing in some adults with mental illness.
    *They're gonna wanna chew up their meal and then throw it back up in their mouth, and then chew it.

Compulsive Overeating

  • Emotional pain leads to overeating and obesity.
  • Signs include eating when not hungry and eating alone.

NCLEX Focus Areas

  • Alcohol withdrawal.
  • Bipolar disorder.
  • Major depressive disorder.
  • Schizophrenia.
  • Personality disorders.

Dissociation

  • Interruption of waking consciousness.
  • Normal dissociation: Daydreaming.
  • Abnormal dissociation: Disruption of daily living.
  • Caused by deep-seated emotional trauma.
    *It's kinda where you just kinda leave for a minute and you kinda forget about something else, like you're doing here and I'm listening you, like, somewhere else.

Depersonalization Disorder (Axis I)

  • Detachment or disconnection from oneself.
  • Feelings of being robotic or outside one's body.
  • Blunted affect, dreamlike experiences, social withdrawal.
  • Social withdrawal and Classic thing that you hear is they're outside their body looking in
    You can see Depersonalization Disorder by itself or you can see it in association with other disorders

Dissociative Amnesia

  • Inability to remember personal information (not organic).
  • Attempt to avoid extreme stress.
  • Gaps in memory, especially regarding stressful events.
  • Triggers (sights, sounds, images) may cause emotional upset without conscious recall.
    *they might have clues where sights, sounds, and images can trigger emotional upset for them, but they don't know why

Dissociative Fugue

  • Sudden travel or wandering away from home, assuming a new identity.
  • Memory loss of the original identity; sudden traveling or wandering away from home is called a "Fugue State"
    *it's usually gonna be the result of something overwhelming, something stressful, or something traumatic. So they're kind of fleeing from home as a form of protection, but they don't know why they've done it.
  • Varies in duration but is eventually exited.

Dissociative Identity Disorder (DID, Multiple Personality Disorder, Split Personality) (Axis I)

  • These are all access one
  • Host: The original personality.
  • Alters: Split personalities formed after a traumatic event.

Characteristics of DID

  • Goal: Integrate all others personalities into This person in order for the person to live a more normal life. It is very difficult if not impossible
  • It's the only true treatment is psychoanalysis
  • Alters fight to be the dominant personality.
  • Physical ailments may vary among alters.
  • The dog is to get all these olders dissolved to this person to live. Some of the people who have these can actually switch
    . They do and that's just what you gotta know.
  • Each personality if there are medications that are prescribed for the patient, the medications often only work when that personality is present in that body.
  • Documented study of a person who was blind where are some personalities could see and some could not.