Somatic Symptom and Related Disorders Flashcards

Somatic Symptom Disorders

• Physical symptoms may manifest as head, back, or chest pain, without any identifiable organic pathology.

• Characterized by distressing symptoms and an excessive or maladaptive response to health concerns, despite negative diagnoses and tests.

• SSRIs are used in treatment.

• Involves extreme worry and fear about the possibility of having a disease.

• SSRIs are used in treatment.

• Neurological symptoms manifest in the absence of a neurological diagnosis.

• Deficits are present in voluntary motor or sensory functions.

• The psychological and emotional expression of stress shown with physical symptoms.

Types of Disorders

• Somatic symptom disorder:

  • Patients experience authentic suffering and functional impairment.

  • Symptoms can be initiated, exacerbated, or maintained by biological, psychological, and sociocultural factors.

  • The target system is often gastrointestinal, but multiple systems can be involved.

  • Difficult to distinguish from physical disorders with organic causes.

• Illness anxiety disorder:

  • Symptoms may be mild or absent.

  • Intrusive thoughts about illness are hard to dismiss, even if the patient knows the fear is unrealistic.

  • Reassurance seekers frequently make medical appointments.

• Conversion disorder:

  • Examples include difficulty speaking or swallowing.

  • Thought to help resolve internal conflicts.

  • Emotional conflicts or stressors are channeled into physical symptoms.

• La belle indifference:

  • Apparent indifference to symptoms that seem serious to others and is considered a maladaptive defense mechanism.

  • Psychogenic complaints of pain, illness, or loss of physical function are related to repression of a conflict.

  • Individuals learn methods of communicating helplessness to manipulate others.

  • Patients focus on body sensations, misinterpret their meaning, and become alarmed.

  • Childhood events can result in lifelong somatization disorders.

Malingering

• Consciously motivated to deceive for material gain (monetary or otherwise) or to avoid work or punishment.

Factitious Disorder

• Consciously pretending to be ill to get emotional needs met and attain the status of “patient” (Munchhausen Syndrome).

• Patients truly believe in the presence of the symptoms, which are not fabricated or under voluntary control.

• Underlying psychological disorders might worsen the symptoms.

Psychological factors affecting medical condition

• Psychodynamic Theories

• Behavioral Theories

• Cognitive Theories

• Environmental Theories

Environmental factors

• Childhood trauma exposure accounts for negative outcomes across a variety of diagnoses in later life, including somatic symptoms.

• Fabricating an illness or exaggerating symptoms is done to become eligible for disability compensation, commit fraud against insurance companies, obtain prescription medications, or evade military service.

• Patients fabricate symptoms or self-inflict injury to assume a sick role.

• This results in disability and healthcare costs.

• It is a compulsion, and patients are skilled at making their symptoms appear real.

• Before taking a temperature, they may drink hot water to maintain the illusion, or even harm themselves to produce symptoms.

Factitious Disorder Imposed on Another

• A caregiver deliberately falsifies illness in a vulnerable dependent.

• The diagnosis is imposed on the perpetrator, not the victim.

• The purpose is to gain attention/excitement and perpetuate the relationship within the healthcare provider.

Biological Factors

• Somatic disorders tend to run in families.

• Twin studies show an increased risk of conversion disorder in monozygotic twin pairs.

• First-degree biological relatives of people with chronic pain disorders are more likely to have chronic pain, depressive disorder, and alcohol dependence.

Psychological Factors

• Psychodynamic theories:

  • Psychoanalytical theorists believe that psychogenic complaints of pain, illness, or loss of physical function are related to repression of a conflict.

• Behavioral theories:

  • Behaviorists suggest that people with somatic symptoms learn methods of communicating helplessness to manipulate others.

• Cognitive theories:

  • Cognitive theorists believe that the patient with somatic symptoms focuses on body sensations, misinterprets their meaning, and may become excessively alarmed by them.

Environmental factors:

• Childhood events result in lifelong problems, including somatization disorders.

• Childhood trauma exposure accounts for negative outcomes across a variety of diagnoses in later life, including multiple somatic symptoms.
  Implementation

• Stilted or scripted speech.

• Long-term interventions usually take place on an outpatient basis, as patients are seldom admitted to psychiatric care settings for somatic disorders.

• Focus on establishing a helping relationship with the patient.

• Effective coping skills include assertiveness training, cognitive reframing, problem-solving skills, and social supports.

• Patients who somatize often attribute their symptoms to physical problems and do not mention psychological symptoms.

• In cases of self-directed or other-directed factitious disorder, the nurse must consider safety.

• The nurse must share any information that may prevent a person or a vulnerable child from undergoing unnecessary surgery or treatments.

Treatment Modalities

• Individual Psychotherapy

• Cognitive Behavioral Therapy

• Dialectical Behavioral Therapy

• Group Psychotherapy

• Psychoeducation

• Psychopharmacology

Neurodevelopmental Disorders: Autism

Predisposing Factors

• Genetics.

• Neurological Implications.

• Prenatal and Perinatal Influences.

Persistent Deficits

• Deficits in social communication and social interaction across multiple contexts.

• Deficits in social-emotional reciprocity.

• Deficits in nonverbal communicative behaviors for social interaction.

• Deficits in developing, maintaining, and understanding relationships.

Social Communication Challenges

• Decreased sharing of interests with others.

• Difficulty appreciating their own and others’ emotions.

• Lack of eye contact.

• Lack of skill with using non-verbal gestures.

• Interpreting abstract ideas literally.

• Difficulty making or keeping friends.

Restricted and Repetitive Behaviors

• Inflexibility of behaviors, extreme difficulty coping with change.

• Being overly focused on niche subjects to the exclusion of others.

• Expecting others to be equally interested in those subjects.

• Difficulty tolerating changes in routine and new experiences.

• Sensory hypersensitivity.

• Stereotypical movements like hand flapping, rocking, spinning.

• Arranging things in a very specific manner.

Pharmacology

• 2’nd Gen Atypical Antipsychotics.

  • Risperidone

  • Aripiprazole

• SSRIs (off label).

  • Methylphenidate

  • Dexamphetamine

• Opioid antagonists.

  • Low-dose Naltrexone

Psychological Therapies

• ABA (Applied Behavior Analysis):

  • Uses principles of learning and behavior to increase positive behaviors and decrease negative or harmful ones

• EIBI (Early Intensive Behavioral Intervention)

• Early Start Denver Model.

• Social Skills Training.

Nursing Interventions

• Work with a child 1-1.

• Try to determine whether self-mutilative behavior occurs due to anxiety, protect them if it happens, and find out what causes the anxiety.

• Diversion or replacement activities and offer self to the child when anxiety levels rise.

• Provide with familiar objects such as toys or a blanket.

• Support attempts to interact with others.

• Give positive reinforcements.

• Assist the child in recognizing separateness during self-care activities, like dressing or feeding.

ADHD

Predisposing Factors

• Genetics.

• Prenatal, Perinatal, Postnatal - Premature birth, low birth weight, etc.

• Psychosocial Influences

• Anatomical Influences

• Environmental Influences - Cigarette smoke and lead.

• Must display 6 symptoms for inattentive AND hyperactive/impulsive, for a total of 12 potentially. (10 for 17+)

Symptoms:

• Inattention:

  • Overlook or miss details

  • Have difficulty sustaining attention during play or tasks

  • Not seem to listen when spoken to directly

  • Find it hard to follow through on instructions or finish schoolwork

  • Have difficulty organizing tasks

Pharmacology

• Drug holiday: patient only takes medication around school time or when focus is needed. All other days are not needed to be drugged up.

Other disorders

• Communication: language, speech sound, social communication

• Motor: stereotypic movement disorder, tic disorders

• Specific: Dyslexia, Dyscalculia, Dysgraphia

• Intellectual Disability

Oppositional Defiant Disorder

• A pattern of angry/irritable mood, always arguing and defiant, or even being vindictiveness lasting at least 6 months with at least 4 symptoms, exhibited during an interaction with at least one individual not a sibling.

Angry/Irritable Mood

• Losing temper often.

• Often touchy and easily annoyed.

• Angry and resentful.

Argumentative/Defiant

• Argues with authority figures often.

• Actively defies or refuses to comply with requests from authority figures.

• Often annoys others on purpose.

• Blames others for their own mistakes or misbehaviors.

Vindictiveness

• Spiteful or vindictive.

Intermittent Explosive Disorder

• A pattern of behavioral outbursts characterized by an inability to control one’s aggressive impulses. The aggression can be verbal or physical and is targeted towards other people, animals, property, or even oneself. At least 2x a week for 3 months.

• Can destroy rooms, break furniture, or damage expensive property. Will attack anyone who intervenes and often injures.

Stages

• Stage 1: Tension and arousal based on some environmental stimuli, such as someone driving too slowly, and followed by Stage 2: explosive behavior and aggression.

• Delayed consequences include feelings of regret, remorse, and embarrassment over the aggressive behavior. (NO REMORSE in Oppositional but remorse for this one).

• Significant issues with physical health: hypertension, diabetes, etc.

Conduct Disorder

• A repetitive and persistent pattern of behavior during which the basic rights of others or major age-appropriate societal norms/rules are violated. Must show at least 3 of the following 15 in the past year. Prior to age 10 for childhood, adolescents have no symptoms prior to age 10.

• Usually turns into antisocial or psychopathic tendencies. Extremely manipulative and charming, but are very cruel and sadistic when alone.

Aggression to Animals and People

• Bullies, threatens, or intimidates.

• Initiates physical fights.

• Used a weapon.

• Cruel to people/animals.

• Steal while confronting victims.

• Forcing someone into a sexual activity.

Destruction of Property

• Engaging in setting fires.

• Destroyed other people’s properties.

Deceitfulness or Theft

• Breaking into houses, buildings, or cars.

• Lies to obtain goods and favors.

• Stolen items without confrontation.

Serious Violation of Rules

• Stays out at night despite parental prohibition.

• Runs away from home overnight.

• Skips out on school.

Pyromania

• Repeated, deliberate fire-setting.

• People feel tension or excitement before setting a fire.

• Very interested in fire and matches.

Kleptomania

• Repeated failure to resist the urge to steal objects not needed for personal use or monetary values.

• The person experiences a buildup of tension before taking an object, and it followed by relief or pleasure following the theft.

Treatment Modalities

• Behavior therapy

• Family therapy

• Group therapy

• Psychodynamic therapy

Trauma-Related Disorders and Pharmacology

• Abuse/Assault

• Therapeutic Communication