Podcast
Questions and Answers
A client consistently reports severe headaches and fatigue, significantly impacting their ability to work and socialize. Medical examinations reveal no organic cause. Which of the following conditions is MOST consistent with this presentation?
A client consistently reports severe headaches and fatigue, significantly impacting their ability to work and socialize. Medical examinations reveal no organic cause. Which of the following conditions is MOST consistent with this presentation?
- Conversion disorder
- Malingering
- Factitious disorder
- Somatic symptom disorder (correct)
What is the PRIMARY difference between primary and secondary gains in the context of somatic disorders?
What is the PRIMARY difference between primary and secondary gains in the context of somatic disorders?
- Primary gains are related to symptom relief, while secondary gains are related to social attention.
- Primary gains are associated with factitious disorder, while secondary gains are associated with somatic symptom disorder.
- Primary gains involve internal rewards, while secondary gains involve external rewards. (correct)
- Primary gains are conscious motivations, while secondary gains are unconscious.
Which nursing intervention is MOST appropriate when a client with somatic symptom disorder reports a new physical complaint?
Which nursing intervention is MOST appropriate when a client with somatic symptom disorder reports a new physical complaint?
- Matter-of-factly inform the client that the provider will be notified, without providing further reinforcement. (correct)
- Immediately reassure the client that the symptom is likely stress-related and not serious.
- Encourage the client to focus on the symptom and identify any potential triggers.
- Thoroughly investigate the new symptom, focusing extensively on its physical characteristics.
A client with a history of childhood trauma presents with sudden-onset blindness, despite neurological examinations revealing no organic cause. This client is MOST likely experiencing:
A client with a history of childhood trauma presents with sudden-onset blindness, despite neurological examinations revealing no organic cause. This client is MOST likely experiencing:
A patient is suspected of malingering. What behavior would MOST strongly suggest that this suspicion is correct?
A patient is suspected of malingering. What behavior would MOST strongly suggest that this suspicion is correct?
What is the PRIMARY motivation for a person with factitious disorder imposed on self to feign illness?
What is the PRIMARY motivation for a person with factitious disorder imposed on self to feign illness?
When caring for a client diagnosed with a somatic symptom disorder, what should be the nurse's INITIAL approach?
When caring for a client diagnosed with a somatic symptom disorder, what should be the nurse's INITIAL approach?
A mother consistently reports that her child is experiencing various medical symptoms, despite the child appearing healthy. After repeated medical evaluations, no physical basis for the symptoms is found, and there is evidence the mother is inducing some of the symptoms. This situation is MOST indicative of:
A mother consistently reports that her child is experiencing various medical symptoms, despite the child appearing healthy. After repeated medical evaluations, no physical basis for the symptoms is found, and there is evidence the mother is inducing some of the symptoms. This situation is MOST indicative of:
Which cognitive-behavioral technique is MOST useful in helping clients with somatic symptom disorder challenge their catastrophic interpretations of bodily sensations?
Which cognitive-behavioral technique is MOST useful in helping clients with somatic symptom disorder challenge their catastrophic interpretations of bodily sensations?
What is the recommended approach when presenting a diagnosis of conversion disorder to a client?
What is the recommended approach when presenting a diagnosis of conversion disorder to a client?
Which of the following statements BEST describes the role of genetics in the etiology of somatic symptom disorder?
Which of the following statements BEST describes the role of genetics in the etiology of somatic symptom disorder?
Which nursing intervention is MOST important to implement for a patient with Factitious Disorder?
Which nursing intervention is MOST important to implement for a patient with Factitious Disorder?
What is the MOST likely age of onset for psychogenic weakness or paralysis related to conversion disorder?
What is the MOST likely age of onset for psychogenic weakness or paralysis related to conversion disorder?
What is the BEST initial treatment for conversion disorder?
What is the BEST initial treatment for conversion disorder?
What percentage of perpetrators are mothers amongst Factitious Disorder Imposed on Others cases?
What percentage of perpetrators are mothers amongst Factitious Disorder Imposed on Others cases?
When a client is diagnosed with Somatic Symptom Disorder, what should the plan of care focus on?
When a client is diagnosed with Somatic Symptom Disorder, what should the plan of care focus on?
What is the lifetime prevalence of Somatic Symptom Disorder in the United States?
What is the lifetime prevalence of Somatic Symptom Disorder in the United States?
The intentional act of exaggerating or falsifying an illness for personal gain is known as:
The intentional act of exaggerating or falsifying an illness for personal gain is known as:
In the context of treating somatic disorders, what is the PRIMARY focus of clinicians?
In the context of treating somatic disorders, what is the PRIMARY focus of clinicians?
Which of the following is the MOST appropriate nursing diagnosis for a client with a somatic disorder?
Which of the following is the MOST appropriate nursing diagnosis for a client with a somatic disorder?
Which action should the nurse AVOID when caring for a client with a somatic disorder?
Which action should the nurse AVOID when caring for a client with a somatic disorder?
What is the MOST important tool for the nurse to establish when caring for a client with a somatic disorder?
What is the MOST important tool for the nurse to establish when caring for a client with a somatic disorder?
A client with conversion disorder suddenly regains the ability to walk after several weeks of paralysis. Which nursing intervention is MOST appropriate at this time?
A client with conversion disorder suddenly regains the ability to walk after several weeks of paralysis. Which nursing intervention is MOST appropriate at this time?
What is the BEST approach for the nurse to take when a client with factitious disorder expresses anger and frustration toward the healthcare team?
What is the BEST approach for the nurse to take when a client with factitious disorder expresses anger and frustration toward the healthcare team?
Which factor is MOST likely to be present in the childhood history of a client with factitious disorder?
Which factor is MOST likely to be present in the childhood history of a client with factitious disorder?
What is the PRIMARY reason psychotherapy is recommended as the first-line treatment for factitious disorder?
What is the PRIMARY reason psychotherapy is recommended as the first-line treatment for factitious disorder?
What is the PRIMARY goal of gradually decreasing attention to clients' physical symptoms when dealing with someone with Somatic Symptom Disorder?
What is the PRIMARY goal of gradually decreasing attention to clients' physical symptoms when dealing with someone with Somatic Symptom Disorder?
What topic is MOST important to review with a client is receptive with Somatic Symptom Disorder?
What topic is MOST important to review with a client is receptive with Somatic Symptom Disorder?
What should a provider caring for a client with Conversion Disorder explain to the client regarding symptoms?
What should a provider caring for a client with Conversion Disorder explain to the client regarding symptoms?
Flashcards
Somatization
Somatization
Experiencing psychological distress through physical symptoms (e.g., headaches).
Primary Gains
Primary Gains
Internal benefits gained from being ill, such as avoiding stress or anxiety.
Secondary Gains
Secondary Gains
External advantages gained from being sick, like getting attention or avoiding responsibilities.
Malingering
Malingering
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Somatic Symptom Disorder
Somatic Symptom Disorder
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Conversion Disorder
Conversion Disorder
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Factitious Disorder
Factitious Disorder
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Factitious Disorder Imposed on Others
Factitious Disorder Imposed on Others
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Somatic Disorder Treatment Approach
Somatic Disorder Treatment Approach
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Cognitive Restructuring (ABCD method)
Cognitive Restructuring (ABCD method)
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Conversion Disorder Explanation
Conversion Disorder Explanation
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Study Notes
- Somatic disorders involve distressing physical symptoms that disrupt daily life without a detectable physical basis upon examination and testing.
Key Terms
- Somatization: Psychological distress experienced as physical symptoms like headaches or GI issues.
- Primary gains: Internal rewards from an illness, such as protection from stress and anxiety.
- Secondary gains: External rewards from an illness, such as being excused from work or receiving attention.
- Malingering: Intentionally exaggerating or falsifying an illness for personal gain.
Important Considerations
- Avoid hasty conclusions when patients report somatic symptoms.
- The absence of a detectable medical disease doesn't mean it does not exist. Medical diagnostic tools are not perfect.
- Even psychogenic symptoms are usually outside conscious control and are distressing to the client.
- Judgmental attitudes can be harmful to a therapeutic environment.
Relevant Nursing Diagnoses
- Anxiety
- Chronic pain
- Knowledge deficit
- Fear
- Impaired resilience
- Ineffective coping
- Ineffective denial
- Powerlessness
- Self-care deficit
Somatic Symptom Disorder
- Characterized by distressing and disruptive physical symptoms without a satisfying medical explanation.
- The client is preoccupied with physical problems.
- Insight varies, but some clients recognize they focus too much on physical sensations with extreme interpretations.
Epidemiology
- Estimated lifetime prevalence is 4% in the U.S., with higher rates in women.
- Typically starts in adolescence.
Etiology
- Childhood Factors: Raised in environments where emotions are suppressed or experienced abuse and neglect.
- Psychological Factors:
- Psychodynamic theory: Physical symptoms may express unconscious emotions.
- Behavioral theory: Positive reinforcement of somatic complaints (primary and secondary gains).
- Cognitive-behavioral theory: Incorrect assumptions about health lead to misinterpreting normal sensations as catastrophic.
- Biological Factors: Some genetic influence, but not strong.
Effective Treatments
- General Approach: Focus on caring and conservative symptom management.
- Reassure the client that their concerns are being heard and understood.
- Patient-centered care is key.
- Psychotherapy: Psychoeducation and relaxation training.
- Pharmacotherapy: Antidepressants for comorbid anxiety, depression, and OCD.
Nursing Interventions
- Create a therapeutic alliance using empathy and unconditional positive regard.
- Take concerns seriously but avoid arguing or denying experiences.
- Perform careful assessments and explain test results thoroughly.
- Gradually shift attention from physical symptoms to psychological stressors and alternative coping strategies.
- Address new symptoms matter-of-factly without reinforcement.
- Encourage verbalization of emotions.
- Provide relevant psychoeducation, including stress effects, hypersensitivity, and relaxation techniques like diaphragmatic breathing or CBT cognitive restructuring.
Conversion Disorder
- Neurological symptoms (e.g., seizures, paralysis) that lack medical explanation cause distress or impairment.
Epidemiology
- Incidence is 0.004-0.012%.
- More common in females.
- Average onset is 39 years for psychogenic weakness/paralysis and 27 years for nonepileptic seizures.
Etiology
- Often follows traumatic life events, converting stressors into physical disabilities to keep the conflict unconscious.
Effective Treatments
- Difficult to treat with a poor prognosis.
- Form a therapeutic alliance and present the diagnosis delicately.
- Explain symptoms are real, frame symptoms as a "software" problem rather than a "hardware" problem.
- Psychotherapy: Psychoeducation, cognitive restructuring, desensitization, relaxation techniques; hypnosis may help.
- Pharmacotherapy: Antidepressants if psychotherapy isn't enough or for comorbid conditions.
Nursing Interventions
- Create a therapeutic alliance using empathy and unconditional positive regard.
- Take concerns seriously but avoid arguing or denying experiences.
- Perform careful assessments and explain test results thoroughly.
- Gradually shift attention from physical symptoms to psychological stressors and alternative coping strategies.
- Address new symptoms matter-of-factly without reinforcement.
- Encourage verbalization of emotions.
- Provide relevant psychoeducation, including stress effects, hypersensitivity, and relaxation techniques like diaphragmatic breathing or CBT cognitive restructuring.
Factitious Disorder
- Consciously pretending to have an illness.
Factitious Disorder Imposed on Self (Munchausen Syndrome)
- Enjoyment of the sick role and being cared for, which is the primary motivation.
- These clients often become skilled at navigating the medical system.
Factitious Disorder Imposed on Others (Munchausen Syndrome by Proxy)
- Deceiving others about the health of someone under their care, potentially causing harm.
Epidemiology
- Factitious Disorder Imposed on Self: Lifetime prevalence is hard to determine due to deception. One Italian study estimated the lifetime prevalence to be 0.1%. Incidence rate is approximately 1% in clinical settings. Rates are highest in women. The average age of onset is 30-50 years.
- Factitious Disorder Imposed on Others: 0.53% of hospitalized children are victims. Over 95% of perpetrators are mothers.
Etiology
- Etiology is unknown.
- Many clients experienced childhood abandonment or abuse. They use sickness as a way to receive care.
Effective Treatments
- Prognosis is poor.
- Present diagnosis compassionately and inform all care team members.
- Assess for comorbid psychiatric illnesses. Base treatment on objective findings.
- Avoid overlooking genuine illnesses.
- Psychotherapy: CBT is recommended, but clients are often resistant.
- Pharmacotherapy: Antidepressants or antipsychotics are sometimes tried but are usually not beneficial.
Nursing Interventions
- Monitor your feelings to avoid acting inappropriately.
- Create a therapeutic alliance using empathy and unconditional positive regard.
- Avoid ignoring or overlooking genuine medical problems.
- Monitor the client to prevent self-injury and remove dangerous items from the room.
- Encourage the development of communication skills, positive coping skills, and social support.
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