MHN Somatic

• Somatization


  When mental or psychological factors cause physical symptoms such as headache or diarrhea
• Somatic Symptom and Related Disorders


  • Characterized by the presence of physical symptoms that suggest a medical symptom without a demonstrable organic basis to account fully for them
  • The client focuses on the physical signs and symptoms and is unable to control the S/S
  • The anxiety is redirected into a somatic concern
  • The client may unconsciously use somatization for secondary gains, such as increased attention and decrease responsibilities

  
• Somatic Symptom Disorders


  • Somatic Symptom Disorder (formerly known as "Somatization Disorder" or "Somatoform Disorder)
  • Illness Anxiety Disorder (known as Hypochondriasis)
  • Conversion Disorder (Functional Neurologic Disorder)
  • Factitious Disorder

  
• Somatic Symptom Disorder


  • Characterized by persistent WORRY OR COMPLAINTS regarding physical illness without supportive physical findings
  • Multiple, recurrent somatic complaints (fatigue, backache, nausea, menstrual cramps) over the years
  • The client focuses on the physical S/S and is not able to control the S/S. The physical S/S ↑ with psychosocial stressors
  • No organic etiology for these complaints but client is totally convinced that their symptoms are related to organic pathology
  • Patients with somatic system disorders go from physician to physician trying to establish a physical cause for their symptoms
  • When a psychological basis is suggested and a referral for counseling is offered, these patients reject both
  • Patient is resistant to accepting psychiatric help

  
• Client suffers from anxiety, depression, and suicidal thoughts
• Secondary gain


  People are nicer and more caring. Nobody expects anything of you. Your partner doesn't leave you. People make more of an effort to spend time with you
• Secondary gains


  • Miss work
  • Avoid military duty
  • Obtain financial compensation
  • Obtain drugs
  • Avoid a jail sentence
  • Avoid house hold chores
• Some families have difficulty expressing emotions openly and resolving conflicts verbally; when this occurs, the child may become ill, and a shift in focus is made from the open conflict to the child's illness, leaving unresolved the underlying issues that the family cannot confront openly
• Chronic, with symptoms beginning age 30
• Anxiety and depression are frequently manifested
• Assessment


  • Pain symptoms
  • Gastrointestinal symptoms
  • Sexual symptoms
  • Pseudoneurologic symptoms
  • Denial of emotional problems
  • Signs of anxiety
  • Fear
  • Low self esteem
  • Secondary gain – increased attention and decreased responsibilities
• People with SSD are not faking their symptoms
• Complaints chronic but fluctuating
• Somatic complaints may involve any other organ system
• Distress from symptoms significantly affects daily functioning. Symptoms of anxiety and depression
• History of seeking medical attention for many years
• May have the tendency to seek relief through overmedicating with prescribed analgesics or antianxiety agents
• Common complications: Drug abuse and dependence
• Suicide results are associated with overmedication
• Nursing Diagnosis


  • Chronic pain
  • Ineffective coping
  • Self-care deficit
• Management


  • Stress reduction
  • Counseling for family and friends
  • Cognitive behavioral therapy
  • Psychotherapy (talk therapy)
  • Antidepressant or anti-anxiety medications
• Major nursing care plan goals

  • The client will identify the relationship between stress and physical symptoms
  • The client will verbally express emotional feelings
  • The client will follow an established daily routine
  • The client will demonstrate alternative ways to deal with stress, anxiety, and other feelings
  • The client will demonstrate healthier behaviors regarding rest, activity, and nutritional intake
• Nursing interventions


  • Health teaching
  • Expression of emotional feelings
  • Coping strategies
• Illness Anxiety Disorder/ Hypochondriasis

  Excessively PREOCCUPIED with having or acquiring a serious undiagnosed illness
• Causes of Illness Anxiety Disorder

  • Childhood trauma, such as child abuse or neglect
  • Extreme stress
  • Health anxieties or other anxiety disorders in the family
  • Childhood illness
  • Mental health issues, such as anxiety or depression
  • Trauma, such as rape or physical or emotional abuse
• Symptoms of Illness Anxiety Disorder

  • Anxiety
  • Frequent somatic complaints – unrealistic and exaggerated
  • Fatigue and insomnia complaints
  • Difficulty expressing feelings
  • Avoiding people or places due to worry about catching an illness
  • Constantly researching diseases and symptoms
  • Exaggerating symptoms and their severity
  • High level of anxiety about personal health
  • Obsession with normal body functions, such as heart rate
  • Oversharing symptoms and health status with others
  • Repeatedly checking for signs of illness, such as taking blood pressure or temperature
  • Extensive use of home remedies or non-prescription medication
  • Repeatedly visiting the doctor in spite of repeated reassurance & normal test results
  • Long history of DOCTOR SHOPPING – they are convinced that they are not receiving proper care
• Treatment and Management of Illness Anxiety Disorder

  • Establish a firm therapeutic alliance with the patient
  • Exercise – to increase psychological wellbeing, improves mood and reduce tension
  • Relaxation Exercise
  • Close collaboration among all clinician to prevent investigative duplication
• Nursing Interventions for Illness Anxiety Disorder

  • Rule out presence of actual disease
  • Focus on anxiety, not physical symptom
  • Set limits on amount of time spent with client
  • Reduce anxiety by providing diversionary activities
  • Avoid negative response to client's demands by discussing in staff conferences
  • Provide client with correct information
• Conversion Disorders/Hysteria


  A physical symptom or deficit suggesting loss or altered body function related to psychological conflict or need

  
• Symptoms of conversion disorder usually occur after experiencing a stressful event, living through a natural disaster, going through a horrible divorce, or having a medical emergency
• Most common conversion symptoms

  • Motor – paralysis, tremors, gait abnormalities, abnormal limb posturing
  • Sensory – altered or absent skin sensation, Blindness, Deafness

  
• Symptoms are beyond the conscious control of the client and are directly related to conflict
• The development of physical symptoms reduces anxiety
• Has no organic cause
• La belle indifference


  A condition in which the person is unconcerned, DO NOT WORRY with symptoms caused by a conversion disorder

  
• Assessment of Conversion Disorder

  • La belle indifference
  • Physical limitation or disability
  • Feelings of guilt, anxiety or frustration
  • Low self-esteem and feeling of inadequacy

  
• Nursing Diagnoses for Conversion Disorder

  • Chronic low self-esteem
  • Impaired social interaction
  • Unexpressed anger or conflict
  • Aphonia- inability to produce voice
  • Secondary gain
• Most symptoms resolve within a week
• Nursing Interventions for Conversion Disorder

  • Focus on anxiety reduction, not physical symptom
  • Use matter of fact (not showing emotion especially when talking about exciting or upsetting things) acceptance of symptoms
  • Encourage client to discuss
  • Do not provide secondary gain by being too attentive
  • Provide diversionary activities
  • Encourage expression of feelings

  
• Factitious Disorder


  A serious mental disorder in which someone deceives others by appearing sick, by purposely getting sick or by self-injury