Somatoform and Sleep Disorders

1. Somatoform and Sleep Disorders Nursing 201

2. characterized • physical symptoms suggesting medical disease but without a demonstrable organic pathological condition or a known pathophysiological mechanism to account for them. • Somatoform disorders are more common • In women than in men • In those who are poorly educated • In those who live in rural communities • In those who are poor

3. Predisposing Factors • Theory of family dynamics • “Psychosomatic families” • Role modeling • Cultural and environmental factors • Low socioeconomic, occupational, and educational status • Genetic factors • Possible inheritable predisposition • Transactional Model of Stress/Adaptation • The etiology of somatization disorder is more likely influenced by multiple factors

4. Pain Disorder: Assessment • The predominantdisturbance in pain disorder is severe and prolonged pain that causes • Clinically significant distress • Impairment in social, occupational, or other areas of functioning • Even when an organic pathological condition is detected, the pain complaint may be evidenced by correlation of a stressful situation with onset of symptoms.

5. Nursing Process • Assessment: 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. • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

6. The disorder may be maintained by: • Primary gains: the symptom enables the client to avoid some unpleasant activity. • Secondary gains: the symptom promotes emotional support or attention for the client. • Psychodynamic theory • Symbolically expressing an intrapsychic conflict through the body • Behavior theory • Negative reinforcement results when the pain behavior prevents an undesirable phenomenon from occurring (i.e., provides relief from responsibilities for the client)

7. Theory of family dynamics • “Pain games” • Tertiary gain • Neurophysiological theory • Afferent pain fibers • Serotonin/endorphins • Neurophysiological theory • Afferent pain fibers • Serotonin/endorphins

8. Hypochondriasis: Assessment • Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease • Even in the presence of medical disease, the symptoms grossly exceed extent of pathological condition. • Anxiety and depression are common findings, and obsessive-compulsive traits frequently accompany the disorder.

9. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

10. Predisposing Factors • Psychodynamic theory • Ego-defense mechanism • Transformation of aggressive and hostile wishes toward others into physical complaints about self to others • Defense against guilt • Cognitive theory • Hypochondriasis arises out of perceptual and cognitive abnormalities. • Social learning theory • Somatic complaints are often reinforced when the sick role relieves the client of the need to deal with a stressful situation.

11. Past experience with physical illness • Previous experience can predispose to hypochondriasis. *Genetic influences • Transactional Model of Stress/Adaptation • The etiology of hypochondriasis is likely influenced by multiple factors.

12. Conversion Disorder: Assessment • A loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism • The client often expresses a relative lack of concern that is out of keeping with the severity of the impairment. This lack of concern is termed la belle indifference and may be a clue to the physician that the problem is psychological rather than physical.

13. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

14. Predisposing Factors • Psychoanalytical theory • Emotions associated with the traumatic event that the client cannot express because of moral or ethical unacceptabilityare “converted” into physical symptoms. • Familial factors • Findings suggest that conversion disorder occurs more often in relatives of people with the disorder. • Neurophysiological theory • Central nervous system involved. Excessive cortical arousal creating a negative feedback loop between the cerebral cortex and the brainstem reticular formation. • Behavioral theory • Learned through positive reinforcement from cultural, social, and interpersonal influences

15. Transactional Model of Stress/Adaptation • The etiology of conversion disorder is most likely influenced by multiple factors.

16. Body Dysmorphic Disorder: Assessment • Characterized by the exaggerated belief that the body is deformed or defective in some specific way • Common complaints involve imagined or slight flaws of face or head • Symptoms of depression and characteristics associated with OCD common in people with body dysmorphic disorder

17. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

18. Predisposing Factors • Etiology unknown • In some clients, belief is result of another more pervasive psychiatric disorder, such as schizophrenia, major mood disorder, or anxiety disorder • Classified as one of several monosymptomatic hypochondriacal syndromes • Defined as the fear of some physical defect thought to be noticeable to others although the client appears normal.

19. Sleep Disorders: Introduction • About 75 percent of adult Americans suffer from a sleep problem. • 69% of all children experience sleep problems • The prevalence of sleep disorders increases with advancing age • Sleep disorders add an estimated $28 billion to the national health care bill. • Common types of sleep disordersinclude insomnia, hypersomnia, parasomnias, and circadian rhythm sleep disorders

20. Sleep Disorders: Assessment • Insomnia • Difficulty falling or staying sleep • Hypersomnia (somnolence) • Excessive sleepiness or seeking excessive amounts of sleep • Narcolepsy: Similar to hypersomnia • Characteristic manifestation: Sleep attacks; the person cannot prevent falling asleep • Parasomnias • Nightmares, sleep terrors, sleep walking

21. Sleep terror disorder • Manifestations include abrupt arousal from sleep with a piercing scream or cry • Circadian rhythm sleep disorders • Shift-work type • Jet-lag type • Delayed sleep phase type

22. Nursing Process • Nursing Diagnosis • Planning/Implementation • Outcomes • Evaluation

23. Predisposing Factors • Genetic or familial patterns are thought to play a contributing role in primary insomnia, primary hypersomnia, narcolepsy, sleep terror disorder, and sleepwalking. • Various medical conditions, as well as aging, have been implicated in the etiology of insomnia. • Psychiatric or environmental conditions can contribute to insomnia or hypersomnia. • Activities that interfere with the 24-hour circadian rhythm hormonal and neurotransmitter functioning within the body predispose people to sleep-wake schedule disturbances.

24. Treatment Modalities • Somatoform disorders • Individual psychotherapy • Group psychotherapy • Behavior therapy • Psychopharmacology Sleep disorders • Relaxation therapy • Biofeedback • Pharmacotherapy

25. Primary hypersomnia/narcolepsy • Pharmacotherapy • CNS stimulants such as amphetamines • Parasomnias • Centers around measures to relieve obvious stress within the family • Individual or family therapy • Interventions to prevent injury