Somatoform and Sleep Disorders

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Somatoform and Sleep Disorders

• Nursing 201

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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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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

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Pain Disorder Assessment

• The predominant disturbance 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.

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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

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• 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)

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

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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.

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

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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.

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• 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.

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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.

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

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Predisposing Factors

• Psychoanalytical theory
• Emotions associated with the traumatic event that
  the client cannot express because of moral or
  ethical unacceptability are 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

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

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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

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Nursing Process

• Nursing Diagnosis
• Planning/Implementation
• Outcomes
• Evaluation

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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.

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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