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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21 Somatic Symptom Illnesses

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Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21 Somatic Symptom Illnesses Slide 2 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Symptom Illnesses Psychosomatic: connection between mind (psyche) and body (soma) Hysteria: multiple physical complaints with no organic basis Proposal by Freud that people can convert unexpressed emotions into physical symptoms Somatization: transference of mental experiences, states into body symptoms Slide 3 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Symptom Illnesses (cont.) Three central features Physical complaints suggest major medical illness but have no demonstrable organic basis Psychological factors and conflicts seem important in initiating, exacerbating, maintaining symptoms Symptoms or magnified health concerns are not under patients conscious control Slide 4 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Somatic Symptom Illnesses Somatic symptom illness: multiple physical symptoms combination of pain, GI, sexual, pseudoneurologic symptoms Conversion disorder: unexplained sensory or motor deficits associated with psychological factors; typically involves significant functional impairment; la belle indifference Slide 5 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Somatic Symptom Illnesses (cont.) Pain disorder: pain unrelieved by analgesics; psychological factors influencing onset, severity, exacerbation, maintenance Illness anxiety disorder (hypochondriasis): disease conviction or disease phobia Slide 6 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Onset and Clinical Course Symptoms usually onset in adolescence or early adulthood All either chronic or recurrent Patients go from one physician or clinic to another, or see multiple providers at once, to obtain relief of symptoms Slide 7 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A patient with a somatic symptom illness is able to voluntarily control the symptoms. Slide 8 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer False Rationale: The symptoms of somatic symptom illness are not under the patients voluntary control. Slide 9 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Related Disorders Malingering: intentional false or grossly exaggerated symptoms; external incentives as motivation Factitious disorder: intentional symptoms to gain attention (Munchausens syndrome = imposed upon self) Munchausens syndrome by proxy = imposed upon others Slide 10 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Related Disorders (cont.) Malingering and factitious disorders: willful control of symptoms; somatic symptom illnessesno voluntary control over symptoms Slide 11 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology Psychosocial theories Internalization Primary gains: direct external benefits of being sick provide relief of anxiety, conflict, distress Secondary gains: person receives internal or personal benefits from others because one is sick. Slide 12 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Etiology (cont.) Biologic theories: Differences in regulation, interpretation of stimuli Slide 13 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural Considerations Variable in frequency, meaning across cultures (see Table 21.1) Dhat (men in India) Koro (Southeast Asia) Falling-out episodes Hwa-byung (Korean folk syndrome) Shenjing shuariuo (China) Slide 14 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment Symptom management, improvement in quality of life Antidepressants for accompanying depression: SSRIs (see Table 21.2) Pain clinic referral for disorder Involvement in therapy groups Slide 15 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Symptom Illnesses and Nursing Process Application Assessment Investigation of physical health status; screening (se Box 21.1) History: usually detailed medical history; distress about health status (except patient with conversion disorder who displays la belle indifference) General appearance, motor behavior Mood, affect: labile; exaggerated emotions Slide 16 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Is the following statement true or false? A patient with a factitious disorder develops symptoms primarily for attention. Slide 17 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Factitious disorder occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. Slide 18 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Symptom Illnesses and Nursing Process Application (cont.) Assessment (cont.) Thought process, content: focus on symptoms Sensorium, intellectual processes Judgment, insight Self-concept: focus on physical self Roles, relationships: problems Physiologic, self-care concerns (Box 21.2) Slide 19 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Symptom Illnesses and Nursing Process Application (cont.) Data analysis/nursing diagnoses Outcome identification Identify relationship between stress and physical symptoms Verbally express emotions/feelings Establish and follow a daily routine Demonstrate alternate ways to deal with stress, anxiety, and other feelings Demonstrate healthy behaviors regarding rest, activity, and nutritional intake Slide 20 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Somatic Symptom Illnesses and Nursing Process Application (cont.) Intervention Provide health teaching: improved health behaviors Help express emotions: journaling; limiting time spent on physical complaints Teach coping strategies Emotion-focused coping strategies Problem-focused coping strategies Evaluation Slide 21 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Community-Based Care Appropriate referrals, such as pain clinic for patients with pain disorder Information about community support groups Pleasurable activities or hobbies Slide 22 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Which of the following would be an example of a problem-focused coping strategy? A. Progressive relaxation B. Deep breathing C. Interaction role-playing D. Guided imagery Slide 23 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Interaction role-playing Rationale: Interaction role-playing is an example of a problem-focused coping strategy. Progressive relaxation, deep breathing, and guided imagery are emotion-focused coping strategies. Slide 24 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Health Promotion Assist patients to deal directly with emotional issues Assist patients to continue gaining knowledge about themselves, their emotional needs Slide 25 Copyright 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Self-Awareness Issues Deal with feelings of frustration. Be realistic about small successes. Validate patients feelings. Deal with feeling that patient could do better if he tried.

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