Somatic Symptoms and Related Disorders
Somatic symptom disorder
A focus on somatic or physical symptoms such as pain. Clients report excessive concern, anxiety, fear, and preoccupation related to a condition. There is no clear medical cause for these symptoms.
Dissociation
Disconnecting from ones thoughts, feelings, or memories.
Cluster A
Odd eccentric behavior
Paranoid: Distrust
Schizoid: Emotional detachment
Schizotypal: Perception distortion, odd beliefs, magical thinking
Dysthymia
Mild depression
Suicide
Death caused by self-directed injurious behaviors
Illness Anxiety Disorder
Misinterpreting their symptoms and may seek extensive tx to relieve anxiety. Hypochondriac.
Dissociative identity disorder
Has 2 or more distinct personality states.
Cluster C
Anxious and fearful behavior
Avoidant: Lack close friends, avoid social activities, fear of criticism, anxiousness
Dependent: Extreme dependency in close relationships, excessive fear of separation
Obsessive Compulsive: Focuses on perfection, order, and control.
Depressive Disorders
Persistent sadness and loss of interest in activities.
Bipolar I
Reoccurring moods of mania, depression, and hypomania. At least one episode of mania. Is not better explained by another diagnosis.
Functional Neurological Symptom Disorder
Client may experience a motor weakness, tremors, reduced sensations, syncope, paralysis but when tested results in a negative finding.
What are some positive and negative dissociative symptoms
Positive: Depersonalization, Division or identity, Drealization
Negative: Lack of control, Lack of access to mental functions, Amnesia
Cluster B
Dramatic, erratic, and emotional behavior
Antisocial: Exploitation, manipulation, and deceit of others. No responsibility.
Borderline: Excessive emotional reactions. Frantic, dramatic, attention seeking, overly expressive. High risk of SI
Histrionic: Attention seeking, seductive
Narcissistic: Arrogant, need for constant admiration, lack of empathy
Signs and symptoms of Depression
Decreased mood
Decrease psychomotor (energy, movements, speech)
Insomnia/excessive sleep
Difficulty concentrating
Indecisiveness
Suicidal ideations
Anhedonia (loss of interest in activities)
Loss of appetite/weight gain
Hypomania
Mild form of mania
Difference between Factitious Disorder and Malingering Syndrome?
Factitious disorder falsifies their symptoms but with no reward for doing so.
Malingering Syndrome falsifies symptoms for personal gain (faking illness to get out of work)
What are some comorbidities for dissociative disorders
Anxiety
Bipolar disorder
Genetics
Substance use
What are some emotional deregulation ques
Angry outbursts
Unnecessary demands for attention
Increasing impulsive behaviors
Rigid thought process
Affective lability (rapid shifts in mood)
Occasional hallucinations
Suicide risk factors
Mental illness (depression, bipolar)
Genetics
Previous attempts
Trauma
Substance use
Financial struggles
Physical illness
Isolation
Access to lethal means
Signs of mania
Inflated self esteem
Poor judgment
Racing thoughts
Overspending
Hypersexual
Not sleeping well
Verbose speech (use of more words than necessary)
Fast speech
What are some ways we can care for someone with Somatic Symptom Disorder? What are some things we ask clients with Somatic Symptom Disorder?
Have you noticed any changes in your routine? Do these symptoms come and go do they stay constant? What are you doing when these symptoms present?
Validate symptoms (They are real symptoms but no medical cause)Assess safety (SI?)
Educate family that symptoms are real.
Encourage coping strategies.
What are some assessment questions and how would you care for someone with a dissociative disorder?
Can the pt remember recent or past evets?
Does the pt ever lose time or black out?
Pt safety is priority
Encourage CBT, DBT,
Encourage coping skills and grounding techniques (clapping hands, touching objects, counting, exercise)
What is the role of the nurse?
How would you help each cluster?
Highest priority is safety
Cluster A: May have trouble relating to others. The nurse can offer to help process feelings and emotions they wouldn’t otherwise share.
Cluster B: Nurse helps them process their needs while setting boundaries models good communication.
Cluster C: Decrease anxiety and suggest coping skills to empower clients.
Talking about hopelessness
Withdrawing from others
Sudden mood changes
Giving away possessions
Stating they will kill themselves
Obsessive thoughts or talking about death
Stating they feel trapped
Stating pain emotional or physical is unbearable
What are some Bipolar specifications
With anxious distress
With mixed features
With rapid cycling
With melancholic features
With atypical features
With mood-congruent psychotic features
With mood-incongruent psychotic features
With catatonia
With peripartum onset
With seasonal pattern