Somatoform and Sleep Disorders

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Somatoform and Sleep Disorders

• Chapter 9

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Concepts of Somatoform and Dissociative Disorders

• Somatoform disorders
• Physical symptoms in absence of physiological
  cause
• Associated with increased health care use
• May progress to chronic illness (sick role)
  behaviors
• Dissociative disorders
• Disturbances in integration of consciousness,
  memory, identify, and perception
• Dissociation is unconscious mechanism to protect
  against overwhelming anxiety

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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

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Somatoform Disorders General Information

• Prevalence
• Rate unknown estimated that 38 of primary care
  patients have symptoms with no medical basis
• 55 of all frequent users of medical care have
  psychiatric problems
• Comorbidity
• Depressive disorders, anxiety disorders,
  substance use, and personality disorders common

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Somatization Disorder

• Diagnosis requires certain number of symptoms
  accompanied by functional impairment
• Pain head, chest, back, joints, pelvis
• GI symptoms dysphagia, nausea, bloating,
  constipation
• Cardiovascular symptoms palpitations, shortness
  of breath, dizziness
• Comorbidity
• Anxiety and depression

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Hypochondriasis

• Widespread phenomenon
• 1 out of 20 patients seek medical care
• Misinterpreting physical sensations as evidence
  of serious illness
• Negative physical findings does not affect
  patients belief that they have serious illness
• Cormorbidity
• Depression, substance abuse, personality disorder

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Pain Disorder

• Diagnosed when testing rules out organic cause
  for symptom of pain
• Evidence of significant functional impairment
• Suicide becomes serious risk for patients with
  chronic pain
• Typical sites for pain head, face, lower back,
  and pelvis
• Cormorbidity
• Depression, substance abuse, personality disorder

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Body Dysmorphic Disorder (BDD

• Patient has normal appearance or minor defect but
  is preoccupied with imagined defective body part
• Presence of significant impairment in function
• Typical characteristics
• Obsessive thinking and compulsive behavior
• Mirror checking and camouflaging
• Feelings of shame
• Withdrawal from others
• Cormorbidity
• Depression, OCD, social phobia

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Conversion Disorder

• Symptoms that affect voluntary motor or sensory
  function suggesting a physical condition
• Dysfunction not congruent with functioning of the
  nervous system
• Patient attitude toward symptoms
• Lack of concern (la belle indifférence) or marked
  distress

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• Common symptoms
• Involuntary movements, seizures, paralysis,
  abnormal gait, anesthesia, blindness, and
  deafness
• Cormorbidity
• Depression, anxiety, other somatoform disorders,
  personality disorders

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Nursing Process Assessment Guidelines

• Collect data about nature, location, onset,
  characteristics and duration of symptoms
• Determine if symptoms under voluntary control
• Identify ability to meet basic needs
• Identify any secondary gains (benefits of sick
  role)
• Identify ability to communicate emotional needs
  (often lacking)
• Determine medication/substance use

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Nursing Process Diagnosis and Outcomes
Identification

• Common nursing diagnosis assigned
• Ineffective coping
• Outcomes identification
• Overall goal patient will live as normal life as
  possible

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Nursing Process Planning and Implementation

• Long-term treatment/interventions usually on
  outpatient basis
• Focus interventions on establishing relationship
• Address ways to help patient get needs met other
  than by somatization
• Collaborate with family

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Nursing Communication Guidelines for Patient with
Somatoform Disorder

• Take symptoms seriously
• After physical complaint investigated, avoid
  further reinforcement
• Spend time with patient other than when
  complaints occur
• Shift focus from somatic complaints to feelings

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• Use matter-of-fact approach to patient resistance
  or anger
• Avoid fostering dependence
• Teach assertive communication

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Treatment for Somatoform Disorders

• Case management
• Useful to limit health care costs
• Psychotherapy
• Cognitive and behavioral therapy
• Group therapy helpful
• Medications
• Antidepressants (SSRIs)
• Short-term use of antianxiety medications
• Dependence risk

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Nursing Process Evaluation

• Important to establish measurable behavioral
  outcomes as part of planning process
• Common for goals to be partially met
• Patients with somatoform disorder have strong
  resistance to change

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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 disorders include insomnia,
  hypersomnia, parasomnias, and
  circadian rhythm
  sleep disorders

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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

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• 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

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

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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.

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Treatment Modalities

• Somatoform disorders
• Individual psychotherapy
• Group psychotherapy
• Behavior therapy
• Psychopharmacology
• Sleep disorders
• Relaxation therapy
• Biofeedback
• Pharmacotherapy

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• 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