8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
1/24
Somatoform and Sleep
DisordersChapter 9
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
2/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
3/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
4/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
5/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
6/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
7/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
8/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
9/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
10/24
Common symptoms
Involuntary movements, seizures, paralysis,
abnormal gait, anesthesia, blindness, and
deafness
Cormorbidity
Depression, anxiety, other somatoformdisorders, personality disorders
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
11/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
12/24
Nursing Process: Diagnosis and
Outcomes Identification Common nursing diagnosis assigned
Ineffective coping
Outcomes identification
Overall goal: patient will live as normal life as
possible
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
13/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
14/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
15/24
Use matter-of-fact approach to patient
resistance or anger
Avoid fostering dependence
Teach assertive communication
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
16/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
17/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
18/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
19/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
20/24
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
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
21/24
Nursing Process
Nursing Diagnosis
Planning/Implementation Outcomes
Evaluation
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
22/24
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.
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
23/24
Treatment Modalities Somatoform disorders
Individual psychotherapy
Group psychotherapy Behavior therapy
Psychopharmacology
Sleep disorders
Relaxation therapy
Biofeedback
Pharmacotherapy
8/8/2019 122lecture2SomatoformandSleepDisordersstudent (1)
24/24
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
Top Related