122lecture2SomatoformandSleepDisordersstudent (1)

8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)

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Somatoform and Sleep

DisordersChapter 9


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Concepts of Somatoform and

Dissociative Disorders Somatoform disorders

Physical symptoms in absence of physiological cause

Associated with increased health care use May progress to chronic illness (sick role) behaviors

Dissociative disorders

Disturbances in integration of consciousness,memory, identify, and perception

Dissociation is unconscious mechanism to protectagainst overwhelming anxiety


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characterized physical symptoms suggesting medical disease

but withoutwithout a demonstrable organic

pathological condition or a knownpathophysiological mechanism to account forthem.

Somatoform disorders are more common

In women than in men In those who are poorly educated

In those who live in rural communities

In those who are poor


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Somatoform Disorders:

General Information Prevalence

Rate unknown; estimated that 38% of primary

care patients have symptoms with no medicalbasis

55% of all frequent users of medical care havepsychiatric problems

Comorbidity Depressive disorders, anxiety disorders, substance

use, and personality disorders common


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Somatization Disorder Diagnosis requires certain number of symptomsaccompanied by functional impairment

Pain: head, chest, back, joints, pelvis

GI symptoms: dysphagia, nausea, bloating,constipation

Cardiovascular symptoms: palpitations, shortness ofbreath, dizziness

Comorbidity

Anxiety and depression


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Hypochondriasis

Widespread phenomenon

1 out of 20 patients seek medical care

Misinterpreting physical sensations asevidence of serious illness

Negative physical findings does not affectpatients belief that they have serious illness

Cormorbidity

Depression, substance abuse, personalitydisorder


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Pain Disorder Diagnosed when testing rules out organic cause

for symptom of pain

Evidence of significant functional impairment

Suicide becomes serious risk for patients with

chronic pain

Typical sites for pain: head, face, lower back,and pelvis

Cormorbidity

Depression, substance abuse, personality disorder


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Body Dysmorphic Disorder

(BDD Patient has normal appearance or minor defect but is

preoccupied with imagined defective body part

Presence of significant impairment in function Typical characteristics

Obsessive thinking and compulsive behavior

Mirror checking and camouflaging

Feelings of shame Withdrawal from others

Cormorbidity

Depression, OCD, social phobia


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Conversion Disorder Symptoms that affect voluntary motor or

sensory function suggesting a physical

condition Dysfunction not congruent with functioning of

the nervous system

Patient attitude toward symptoms

Lack of concern (la belle indiffrence) ormarked distress


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Common symptoms

Involuntary movements, seizures, paralysis,

abnormal gait, anesthesia, blindness, and

deafness

Cormorbidity

Depression, anxiety, other somatoformdisorders, personality disorders


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Nursing Process:

Assessment Guidelines Collect data about nature, location, onset,

characteristics and duration of symptoms

Determine if symptoms under voluntary control

Identify ability to meet basic needs

Identify any secondary gains (benefits of

sick role) Identify ability to communicate emotional

needs (often lacking)

Determine medication/substance use


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Nursing Process: Diagnosis and

Outcomes Identification Common nursing diagnosis assigned

Ineffective coping

Outcomes identification

Overall goal: patient will live as normal life as

possible


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Nursing Process:

Planning and Implementation Long-term treatment/interventions usually

on outpatient basis

Focus interventions on establishing

relationship

Address ways to help patient get needs met

other than by somatization

Collaborate with family


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Nursing Communication Guidelines for

Patient with Somatoform Disorder

Take symptoms seriously

After physical complaint investigated, avoid

further reinforcement

Spend time with patient other than when

complaints occur

Shift focus from somatic complaints tofeelings


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Use matter-of-fact approach to patient

resistance or anger

Avoid fostering dependence

Teach assertive communication


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Treatment for Somatoform

Disorders Case management

Useful to limit health care costs

Psychotherapy

Cognitive and behavioral therapy

Group therapy helpful

Medications Antidepressants (SSRIs)

Short-term use of antianxiety medications

Dependence risk


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Nursing Process: Evaluation Important to establish measurable

behavioral outcomes as part of planning

process

Common for goals to be partially met

Patients with somatoform disorder have strong

resistance to change


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Sleep Disorders: Introduction About 75 percent of adult Americans suffer from a sleep

problem.

69% of all children experience sleep problems The prevalence of sleep disorders increases with

advancing age

Sleep disorders add an estimated $28 billion to the

national health care bill. Common types of sleep disorders include insomnia,

hypersomnia, parasomnias, and circadian rhythmsleep disorders


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Sleep Disorders: Assessment Insomnia

Difficulty falling or staying sleep

Hypersomnia (somnolence) Excessive sleepiness or seeking excessive amounts ofsleep

Narcolepsy: Similar to hypersomnia

Characteristic manifestation: Sleep attacks; the personcannot prevent falling asleep

Parasomnias Nightmares, sleep terrors, sleep walking


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Sleep terror disorder

Manifestations include abrupt arousal from

sleep with a piercing scream or cry

Circadian rhythm sleep disorders

Shift-work type

Jet-lag type

Delayed sleep phase type


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Nursing Process

Nursing Diagnosis

Planning/Implementation Outcomes

Evaluation


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Predisposing Factors Genetic or familial patterns are thought to play acontributing role in primary insomnia, primary

hypersomnia, narcolepsy, sleep terror disorder, and

sleepwalking.

Various medical conditions, as well as aging, have beenimplicated in the etiology of insomnia.

Psychiatric or environmental conditions can contribute toinsomnia or hypersomnia.

Activities that interfere with the 24-hour circadian rhythm

hormonal and neurotransmitter functioning within the body

predispose people to sleep-wake schedule disturbances.


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Treatment Modalities Somatoform disorders

Individual psychotherapy

Group psychotherapy Behavior therapy

Psychopharmacology

Sleep disorders

Relaxation therapy

Biofeedback

Pharmacotherapy


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Primary hypersomnia/narcolepsy

Pharmacotherapy

CNS stimulants such as amphetamines

Parasomnias

Centers around measures to relieve obvious stress

within the family Individual or family therapy

Interventions to prevent injury

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