SOMATIC_SYMPTOMS_AND_RELATED- Final (2).pptx

a pptx describing somatic symptoms disorder and the nursing interventions to it

1. Somatic Symptom and Related Disorders

2. Content Introduction. Common characteristics of somatoform disorders. Classifications of somatoform disorders. Etiology. Nursing management of clients with somatoform disorders Nurses’ reactions and feelings.

3. The term "soma" is the Greek word for body. Somatic can be defined as the expression of psychological stress through physical symptoms. In other words, psychological conflicts are converted into bodily symptoms, and the person reacts with somatic rather than psychic manifestations.

4. Common characteristics of somatoform disorders

5. Classifications of Somatic Disorders

6. Somatic symptom disorder (SSD) is a syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health-care professionals.

7. Somatic symptoms Disorder Individuals are convinced that symptoms are related to organic pathology and reject the role of stress. S ymptoms are frequently exaggerated, dramatic, and vague . Common complaints include headache, fatigue, abdominal, back, and chest pains. Clients tend to seek relief through over-medicating with prescribed analgesics or anti-anxiety agents. Symptoms are associated with impairment in social and occupational functioning and excessive medical help-seeking behavior . (Doctor shopping) Drug abuse and dependency are common complications. Anxiety, depression, and suicidal behaviors are common.

8. Illness Anxiety Disorder Previously known as hypochondriasis , Illness anxiety disorder may be defined as an unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease.

9. No organic pathology can be detected. Individuals with illness anxiety disorder are extremely conscious of bodily sensations and changes and may become convinced that a rapid heart rate indicates they have heart disease or that a small sore is skin cancer. They are profoundly preoccupied with their bodies and are aware of even the slightest change in feeling or sensation. Their response to these small changes, however, is usually unrealistic and exaggerated Some individuals with illness anxiety disorder have a long history of ― doctor shopping ‖ and are convinced that they are not receiving the proper care. Depression and OCD are common.

10. Conversion Disorder (Functional Neurological Symptom Disorder) Conversion disorder is a loss of or change in body function (Voluntary motor and /or sensory pathways) that cannot be explained by any known neurological disorders

11. Conversion Disorder Sudden deficits in sensory and/or motor function that suggest a neurological disorder but are associated with psychological factors. N eurological evaluation reveals intact sensory pathways. It involves feelings show inappropriate lack of concern (Labelle indifférence ). There is most likely a psychological component involved in the initiation, Exacerbation, or perpetuation of the symptom, although it may or may not be obvious or identifiable

12. Conversion Disorder Examples include paralysis, aphonia (inability to produce voice), seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, A nosmia (inability to perceive smell), and loss of pain sensation.

13. Factitious Disorder Factitious disorder involves conscious, intentional feigning of physical or psychological symptoms. Individuals with factitious disorder pretend to be ill to receive emotional care and support commonly associated with the role of patient. Even though the behaviors are deliberate, there may be an associated compulsive element that diminishes personal control. Sometimes called: Munchausen syndrome

14. What is malingering behavior? a client who is malingering makes a conscious attempt to deceive others by pretending to have false or exaggerated symptoms to meet external benefits.

15. Etiology of Somatoform Disorders

16. Biological theories

17. Neuro-cognitive and neurotransmitters: Due to faulty perceptions and incorrect assessments of body sensations Deficiency in serotonin and endorphins lead the person to perceive incoming pain stimuli as being more intense .

18. Genetic theory: Twins studies have shown an increased prevalence of hypochondriasis among identical twins. F irst-degree relatives of pain disorder clients have an increased likelihood for the same disorder.

19. Sociocultural Theory

20. Sociocultural theory: The incidence of somatoform disorder is higher among individuals from lower socio-economic groups ( rural than urban and those with little education ). Conversion disorder was originally thought to be a disorder affecting women exclusively but now is found to occur in men, although to a lesser degree.

21. Psychodynamic theory: "Freud" believed that psychogenic complaints of pain, illness, or loss of physical function were related to the repression of a conflict (usually of an aggressive or sexual nature) and the transformation of anxiety into a physical symptom symbolically related to the conflict.

22. Behavioral theory S omatoform disorders are learned ways of communicating helplessness . Symptoms are learned through positive reinforcement of sick roles from cultural, social, and interpersonal influences.

23. Family dynamics theory: In psychosomatic families, there appears to be: A marked deficiency in the abilities of the family members to openly express emotions , A failure to resolve conflicts verbally , and The denial of psychological problems in general. S omatization may be interpreted as a maladaptive way to communicate psychological needs within psychosomatic families.

24. Treatment Modalities: For patients manifesting paralysis , blindness, or severe fatigue, an effective nursing approach is to support patients while expecting them to feed, bathe, or groom themselves (e.g., the patient who demonstrates paralysis of an arm can be expected to eat using the other arm). To encourage the patient experiencing blindness to feed himself, he can be told what numbers on an imaginary clock the food is located on the plate. These strategies are effective in reducing secondary gain. Promotion of Self-Care Activities In general, interventions involve the use of a matter-of-fact approach to support the highest level of self-care the patient is capable of.

25. Treatment Modalities: These patients have many questions about illnesses, symptoms, and treatments. Emphasize positive healthcare practices and minimize the effects of serious illness. Patients with SSD should focus on ―staying healthy instead of focusing on their illnesses. Avoid reinforcing physical symptoms but help patients to identify activities that meet their psychological and spiritual needs, such as going to pray, and managing stress, which are important in maintaining a healthy balance. Psycho-education Health teaching is useful throughout the nurse–patient relationship.

26. Treatment Modalities Psychotherapy: Individual Psychotherapy The goal of psychotherapy is to help clients develop healthy and adaptive behaviors , encourage them to move beyond their somatization, and manage their lives more effectively without resorting to somatic behaviour.

27. Treatment Modalities Psychotherapy: Group Psychotherapy It may be helpful for somatic symptom disorders because it provides a setting where clients can: share their experiences of illness, Learn to verbalize thoughts and feelings, and Be confronted by group members and leaders when they reject responsibility for maladaptive behaviors.

28. Treatment Modalities Psychotherapy: Behaviour Therapy It is more likely to be successful in instances when secondary gain is prominent . Behavioral therapy focuses on teaching the caregiver to reward the client’s autonomy, self-sufficiency, and independence . This process becomes more difficult when the client is very regressed, and the sick role is well established.

29. Treatment Modalities Psychotherapy: Assertiveness training The use of assertiveness techniques gives patients a direct means of getting their needs met and thereby decreases the need for somatic symptoms. Also, helps the clients to learn how to express their emotions.

30. Nursing Management

31. Assessing presence of secondary gains: The nurse might identify a number of secondary gains the client may be receiving from the symptoms. These can include: Secondary gain is any benefit or support that a person obtains from the environment as a result of his/ her illness. 1. Getting out usual responsibilities. 2. Getting extra attention. 3. Manipulating others in the environment. 4. Fulfilment of dependency needs. 5. Financial gain from insurance, worker‘s compensation, or sick benefits.

32. One way to identify the presence of secondary gains is to ask the client questions such as: "What can’t you do now that you used to be able to do?" or "How has this problem affected your life?”

33. Assessing cognitive style: Exploring the client‘s cognitive style may be helpful in distinguishing between hypochondriasis and somatization disorder. The client with hypochondriasis exhibits more anxiety and an obsessive attention to detail, along with a preoccupation with the fear of serious illness. The client with somatization disorder is often rambling and vague about the details of his or her many symptoms and may give a poor or vague history . .

34. Assessing the ability to communicate emotional needs: Often, clients with somatic disorder have difficulty communicating their emotional needs. The somatic symptom may be used as a means of communicating emotional needs. Psychogenic blindness or hearing loss may be saying symbolically, ―I can‘t face this situation.

35. Assessing dependence on medication: Individuals experiencing many somatic complaints often become dependent on medication to relieve pain or anxiety, or to induce sleep. It is important that the nurse assess the types and amounts of medication being used by the client.

36. Possible nursing diagnoses Ineffective individual coping Impaired social interaction Ineffective family coping Self-esteem disturbance

37. Ineffective individual coping may be related to: Repressed anxiety. Unmet dependency needs. Psychological conflicts/stressors. Ineffective use of adaptive coping strategies.

38. Ineffective individual coping (cont.) Evidenced by: Verbalization of physical complaints in the absence of any pathophysiological evidence. Total focus on the self and physical symptoms. Verbalizes continued need to seek medical assistance in spite of physician’s reassurance "doctor shopping". Denies correlation between physical symptoms and psychological conflicts/stressors. Demonstrate excessive dramatic or exaggerated behavior when describing perceived physical signs and symptoms.

39. Ineffective individual coping (cont.) Goal: The client will demonstrate adaptive coping mechanism with anxiety without resorting to physical symptoms.

40. Nursing interventions Review all current laboratory and diagnostic results with the client in clear terms to maintain assurance that possibility of organic pathology is clearly ruled out. After physical complaints have been investigated, avoid further reinforcement. Recognize and accept that the physical complaint is real to the client . Identify secondary gains that the physical symptoms are providing for the client.

41. Nursing interventions (cont.): Initially, fulfill client’s most urgent dependency needs, but gradually withdraw attention to physical symptoms. Listen actively to the client’s verbalizations of fears and anxieties without encouraging or focusing on physical symptoms or dysfunction. Redirect the focus of communication when ever the client begins to ruminate about physical symptoms. Assist the client to associate onset of physical symptoms with stressful events.

42. Nursing interventions (cont.): Discuss with the client alternative coping strategies to reduce anxiety in accordance with client’s capabilities and lifestyle: Deep breathing techniques. Relaxation exercises. Physical activities (walking, running,.. etc). Teach client assertive communication. Praise the client for using adaptive behaviours to manage anxiety rather than resorting to physical symptoms.

43. Other possible nursing diagnoses Impaired social interaction Ineffective family coping Self-esteem disturbance

44. Nurses’ reactions and feelings Nurses and other healthcare workers often find working with clients with somatic disorders difficult and unsatisfying. Anger may arise when staff members find themselves dealing with a client who uses somatic symptoms to manipulate the environment and the people in the environment. It is helpful to remember that the symptom the client is experiencing is very real to him or her, even though the objective data do not support a physiologic basis.

45. Nurses’ reactions and feelings Staff may experience feelings of helplessness over not being able to "make the client realize" that his or her symptom has no organic basis. Setting goals that have staged outcomes (small, attainable steps) can help the nurse avoid feelings of helplessness.