Mental Health Nursing - Chapter 17 - Somatic symptom disorders

somatization

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

illness anxiety disorder

A psychiatric disorder that results in the misinterpretation of physical sensations as evidence of a serious illness.

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?

"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.

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

"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.

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 emotional distress is being expressed as a physical symptom." Conversion disorder is attributed to channeling of emotional conflicts or stressors into physical symptoms.

psychological factors affecting medical condition

A psychiatric classification that calls attention to how psychological factors may magnify and/or adversely affect medical conditions.

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

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.

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.

factitious disorder

A DSM-IV diagnosis marked by disease symptoms caused by deliberate efforts of a person to gain attention. Such actions may be repeated, even when the individual is aware of the hazards involved.

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 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.

Conversion disorder

An abnormality in which repressed emotional conflicts are changed into sensory, motor, or visceral symptoms with no underlying organic cause, such as blindness. Causal factors include a conscious or unconscious desire to escape from or avoid some unpleasant situation or responsibility or to obtain sympathy or some other secondary gain.

la belle indifference

An air of unconcern displayed by some patients toward their physical symptoms. It is believed the physical symptoms may relieve anxiety and result in secondary gains in the form of sympathy and attention given by others.

holistic approach

An approach to nursing care that emphasizes the interplay of biological, psychological, and sociocultural needs

secondary gain

An indirect benefit, usually obtained through an illness or debility. Such gains may include monetary and disability benefits, personal attention, or escape from unpleasant situations and responsibilities.

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

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.

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

Which statement about somatoform disorders is true?

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.

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

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.

Which mental health disorder is an example of a somatoform 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.

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

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

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.

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

Factitious disorders have a symptomatology that is actually controlled by the client. Factitious disorders, in contrast to other somatic disorders, are under conscious control.

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

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

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

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.

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

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.

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

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.

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?

La belle indifference La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety

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. 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.

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

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.

malingering

a consciously motivated act of fabricating an illness or exaggerating symptoms. This is 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. Reported pains are vague and hard for clinicians to prove or disprove (e.g., back pain, stomach ailments, headache, or toothache).

A class of medications commonly prescribed for somatic disorders is

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 sleep.