Somatoform and Sleep Disorders

Nursing 201

characterized

• physical symptoms suggesting medical disease but withoutwithout 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

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

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.

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

• 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)

• Theory of family dynamics

– “Pain games”– Tertiary gain

• Neurophysiological theory– Afferent pain fibers– Serotonin/endorphins

• Neurophysiological theory– Afferent pain fibers– Serotonin/endorphins

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.

Nursing Process

• Nursing Diagnosis

• Planning/Implementation

• Outcomes

• Evaluation

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.

• 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.

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.

Nursing Process

• Nursing Diagnosis

• Planning/Implementation

• Outcomes

• Evaluation

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

• Transactional Model of Stress/Adaptation– The etiology of conversion disorder is most

likely influenced by multiple factors.

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

Nursing Process

• Nursing Diagnosis

• Planning/Implementation

• Outcomes

• Evaluation

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.

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

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

• 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

Nursing Process

• Nursing Diagnosis

• Planning/Implementation

• Outcomes

• Evaluation

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.

Treatment Modalities

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

• 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