Mental Health Exam 3 STUDY GUIDE.

Mental Health Exam 3 STUDY GUIDE. Exam 3 Key Concept Guide (Modules 7, 8, & 9) Exam 3 Key Concept Guide (Modules 7, 8, & 9) Chapter 12 – Somatoform Disorders  Somatoform Disorders o Defined as experiencing physical symptoms as a result of psychological stress (no physical explanation for the pain). Commonly found in patients with Depression & Anxiety & Drug Abuse. Symptoms cause significant distress in one’s life. o Most common in women, poor educated, non-whites, living in rural areas o Factitious & Malingering Disorders needed to be r/o before patient can be diagnosed with Somatoform Disorder o “Doctor Shopping” is common (they want a pill for every symptom they have) o Common Symptoms: TMJ, Teeth Grinding @ night, Hypertension, Tension H/A o Nursing Interventions:  GOAL: To get feelings OUT, so the symptoms aren’t there anymore  Offer explanations during testing to reduce anxiety  Assess if patient can meet Basic Human Needs and Safe & Security  Assess for Triggering event/trauma/crisis (ex: divorce,  Avoid further reinforcement (ex: taking vitals each time the patient complains of chest palpitations. This is negative reinforcement.)  NEVER state that their symptoms aren’t real....to the patient they are real.  Focus on things other than their symptoms, such as their interests, favorite things to do during the holidays, etc.  Be straightforward when the patient is angry to avoid power- struggles o Nursing Assessment should include:  Patient’s level of ability to voluntarily control symptoms  Results of patient’s diagnostic laboratory tests  Patient’s limitations in carry out activities of daily living  Secondary Gains (associated with Somatoform Disorders) o Benefits the patient receives because of their symptoms:  Extra attention  Freedom from responsibilities (family duties, social events)  Financial Rewards (disability, PTO, FLMA) o Nurse can identify if this is present by asking 2 questions: 1. What abilities have you lost since the development of your symptoms? 2. How has this problem affected your life?  Hypochondriasis - signs/symptoms o Signs:  Person sincerely believes they have a devastating health condition (ex: “my headaches, so I must have terminal brain cancer”)  Usually have Anxiety or Depressive Disorder as well  Symptoms:  Severe distress/preoccupation with health causes issues w/social life, relationships, work, etc.  Symptoms are exacerbated during times of stress  May or may not have somatic symptoms  Example Patient Scenario: “Mark lost his wife to colon cancer last year. He saw his doctor recently and sincerely believes he has Colon Cancer, regardless that the diagnostic testing does not show he does. He has stopped seeing his friends/family and when asked why he stays home, he states, “I am resting my liver.”  Conversion Disorder o Most common Somatic Symptom Disorder (elderly & women highest risk) o Symptoms are due to stress, insomnia, loss of control/loss of grip on their lives o Symptoms:  Patient has motor/sensory deficits, but no medical illness to prove why (Ex: blindness, abnormal gait, seizures, paralysis, can’t move a limb, deafness, anesthesia)  Patient may show lack of emotional concern: “La Belle Indifference”  Patient wants medical care, but not really concerned about their symptoms o Nursing interventions  Treat with Behavioral Therapy, Family Therapy, hypnosis & anxiolytics  Dissociative Amnesia o Inability to recall important personal information (DOB, SSN, Name, etc) o Veterans most commonly have this. o “Baby Brain”, postpartum (can’t remember things due to stress) o Example Scenario: “Lady found wondering in a park, disheveled and malnourished. She has no idea how she got there or what happened. After identified by her parents, it is found that she just broke up with her boyfriend of 6 years”.  Derealization o Walking into your own home, yet everything looks distorted, strange and dream-like. o Persistent & recurrent  Depersonalization o Time moves slow, in a dream/fog, detachment from body o Usually preceeded by severe stress (Ex: Mother was just told by her son that he is homosexual and also that he is HIV positive).  Dissociative Fugue o Sudden, unexpected travel from current location to another and unable to recall one’s identity or where they came from (Amnesia)