Psyche-for-ca2.pdf

DEFINITION

Psychiatric-Mental Health Nursing

• it is a specialized area of nursing practice that uses theories of human behavior as its scientific framework and requires the purposeful use of self as its art of expression. • involves the diagnosis and treatment of human responses to actual or potential mental health problems.

Understanding: MENTAL HEALTH and MENTAL ILLNESS

“the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age appropriate and congruent with local and cultural norms.”

Mental illness

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) defines mental disorder as: a syndrome characterized by clinically significant disturbance in an individual’s cognitions, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning.

Self-awareness • Process by which the nurse gains recognition of his or her own feelings, beliefs, and attitudes. • In nursing, being aware of one’s feelings, thoughts, and values is a primary focus.

PSYCHOTROPIC DRUGS

Psychosocial Theories and Therapy

Psychoanalytic Theories Sigmund Freud The father of psychoanalysis Psychoanalytic theory supports the notion that all human behavior is caused and can be explained EVERY BEHAVIOR HAS MEANING! Sexual impulses and desires motivate much human behavior. Personality is formed during the first six years of life

Psychoanalytic Theories Personality Components: Id, Ego, and Superego

Psychoanalytic Theories Level of Consciousness: Conscious; Preconscious and Unconscious

• Conscious • Preconscious *Freudian slip • Unconscious

Psychoanalytic Theories Freud’s Dream Analysis and Free Association

 Dream analysis  Free association

Psychoanalytic Theories Free Association

SNAKE BOOK FIRST CRUSH MAHAL MO? PLASTIC MAHAL KA BA? UMASA KA BA?EX BF/GF MOVIE FIRST HEARTBREAK BED COLOR FIRST LOVE

Psychoanalytic Theories Ego Defense Mechanisms

• Methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, or events.

Psychoanalytic Theories Ego Defense Mechanisms

• Denial- unconscious refusal to admit an unacceptable idea or behavior • Repression-unconscious and involuntary forgetting of painful ideas, events, and conflicts • Suppresion-conscious exclusion from aware-ness anxiety-producing feelings, ideas or situations

Psychoanalytic Theories Ego Defense Mechanisms

• Rationalization-conscious or unconscious attempts to make or prove that one’s feelings are justifiable • Intellectualization-consciously or uncons-ciously using only logical explanations without feelings or an affective component

Psychoanalytic Theories Ego Defense Mechanisms

• Dissociation-the unconscious separation of painful feelings and emotions from an unacceptable idea, situation, or object • Identification-conscious or unconscious attempt to model oneself after a respected person

Psychoanalytic Theories Ego Defense Mechanisms

• Introjection-unconsciously incorporating values and attitudes of others as if they were your own • Compensation-consciously covering up for weakness by overemphasizing or making up a desirable trait • Sublimation-consciously or unconsciously channeling instinctual drives into acceptable activities • Reaction formation-a conscious behavior that is exact opposite of an unconscious feeling

Psychoanalytic Theories Ego Defense Mechanisms

• Undoing-consciously doing something to counteract or make up for transgression or wrongdoing • Displacement-unconsciously discharging pent up feelings to a less threatening object • Projection-unconsciously or consciously blaming someone else for one’s difficulties or placing one’s unethical desire on someone else • Regression-unconscious return to an earlier and more comfortable developmental level

Psychoanalytic Theories Ego Defense Mechanisms

• Substitution-the replacement of a highly valued, unacceptable or unavailable object by a less valuables, acceptable, or available object • Conversion-expression of an emotional conflict through the development of physical symptom, usually sensorimotor in nature

Psychoanalytic Theories Ego Defense Mechanisms

• Fixation-Immobilization of portion of personality resulting from unsuccessful completion of task in a developmental stage • Resistance-Overt or covert antagonism toward remembering or processing anxiety-producing information

Psychoanalytic Theories Five Stages of Psychosexual Development

Psychoanalytic Theories Transference and Countertransference

 Transference  Countertransference

Developmental Theories Psychosocial Stages of Development

Erik Erikson (1902–1994) was a Germanborn psychoanalyst who extended Freud’s work on personality development across the life span while focusing on social and psychological development in the life stages.

Developmental Theories Psychosocial Stages of Development

In each stage, the person must complete a life task that is essential to his or her well-being and mental health. CRISIS

Developmental Theories Psychosocial Stages of Development

Developmental Theories Cognitive Stages of Development

Jean Piaget (1896–1980) explored how intelligence and cognitive functioning develop in children.

Developmental Theories Cognitive Stages of Development

Interpersonal Theories Interpersonal Relationships and Milieu Therapy

Harry Stack Sullivan (1892–1949) One’s personality involves more than individual characteristics, particularly how one interacts with others.

Interpersonal Theories Interpersonal Relationships and Milieu Therapy

He thought that inadequate or nonsatisfying relationships produce anxiety, which he saw as the basis for all emotional problems

Interpersonal Theories Therapeutic Nurse-Patient Relationship

Hildegard Peplau developed the concept of the therapeutic nurse– patient relationship

Interpersonal Theories Therapeutic Nurse-Patient Relationship

“The purpose of nursing is to educate and to be a maturing force to a patient, for him to get a new view of himself.”

Interpersonal Theories Therapeutic Nurse-Patient Relationship

1. 2. 3. 4.

Orientation phase Identification phase Exploitation phase Termination phase

Interpersonal Theories Roles of the Nurse in the Therapeutic Relationship

The primary roles she identified are as follows: • Stranger • Resource person • Teacher • Leader • Surrogate • Counselor

Interpersonal Theories Therapeutic Nurse-Patient Relationship

Anxiety as the initial response to a psychic threat. four levels of anxiety: mild, moderate, severe, and panic

Humanistic Theories Abraham Maslow: Hierarchy of Needs

Abraham Maslow (1921–1970) American psychologist who studied the needs or motivations of the individual.

Humanistic Theories Abraham Maslow: Hierarchy of Needs

CRISIS INTERVENTION CRISIS

A crisis is a turning point in an individual’s life that produces an overwhelming emotional response.

CRISIS INTERVENTION CRISIS

Maturational crises, sometimes called Developmental crises, are predictable events in the normal course of life, Ex: leaving home for the first time, getting married, having a baby, and beginning a career.

CRISIS INTERVENTION CRISIS

• Situational crises unanticipated or sudden events that threaten the individual’s integrity Ex: death of a loved one, loss of a job, and physical or emotional illness in the individual or family member.

CRISIS INTERVENTION CRISIS

• Adventitious crises, sometimes called social crises include natural disasters like floods, earthquakes, or hurricanes; war; terrorist attacks; riots; and violent crimes such as rape or murder.

CRISIS INTERVENTION CRISIS

Note that not all events that result in crisis are “negative” in nature. Crisis is described as self-limiting; usually exists for 4 to 6 weeks.

THERAPEUTIC RELATIONSHIPS

Therapeutic Relationship Therapeutic Nurse-Client Relationship

It is a helping and caring relationship in which both participants must recognize each other as unique and important human beings. It is also a relationship in which mutual learning occurs.

Therapeutic Relationship Therapeutic Nurse-Client Relationship

Components involved in establishing appropriate therapeutic nurse–client relationships: trust, genuine interest, acceptance, positive regard, self-awareness, and therapeutic use of self.

Therapeutic Communication

Which of the following is a concrete message? a. “Help me put this pile of books on Marsha’s desk.” b. “Get this out of here.” c. “When is she coming home?” d. “They said it is too early to get in.”

Therapeutic Communication THERAPEUTIC COMMUNICATION TECHNIQUES

Using Therapeutic Communication Techniques The choice of technique depends on the intent of the interaction and the client’s ability to communicate verbally.

Client: “I had an accident.” Nurse: “Tell me about your accident.” This is an example of which therapeutic communication technique?

a. Making observations b. Offering self c. General lead d. Reflection

“Earlier today you said you were concerned that your son was still upset with you. When I stopped by your room about an hour ago, you and your son seemed relaxed and smiling as you spoke to each other. How did things go between the two of you?” This is an example of which therapeutic communication technique? a. Consensual validation b. Encouraging comparison c. Accepting d. General lead

Therapeutic Communication Nontherapeutic Communication

Nontherapeutic Communication These responses cut off communication and make it more difficult for the interaction to continue.

“Why do you always complain about the night nurse? She is a nice woman and a fine nurse and has five kids to support. You’re wrong when you say she is noisy and uncaring.” This example reflects which nontherapeutic technique?

a. Requesting an explanation b. Defending c. Disagreeing d. Advising

When the client says, “I met Joe at the dance last week,” What is the best way for the nurse to ask the client to describe her relationship with Joe? a. “Joe who?” b. “Tell me about Joe.” c. “Tell me about you and Joe.” d. “Joe, you mean that blond guy with the dark blue eyes?”

Terms to know on assessment

BUILDING THE NURSE-CLIENT RELATIONSHIP:ASSESSMENT

CONTENT OF THE ASSESSMENT: Thought process and content

Circumstantial thinking: a client eventually answers a question but only after giving excessive unnecessary detail Delusion: a fixed false belief not based in reality Flight of ideas: excessive amount and rate of speech composed of fragmented or unrelated ideas

BUILDING THE NURSE-CLIENT RELATIONSHIP:ASSESSMENT

CONTENT OF THE ASSESSMENT: Thought process and content

Ideas of reference: client’s inaccurate interpretation that general events are personally directed to him or her, such as hearing a speech on the news and believing the message had personal meaning Loose associations: disorganized thinking that jumps from one idea to another with little or no evident relation between the thoughts Tangential thinking: wandering off the topic and never providing the information requested

BUILDING THE NURSE-CLIENT RELATIONSHIP:ASSESSMENT

CONTENT OF THE ASSESSMENT: Thought process and content

Thought blocking: stopping abruptly in the middle of a sentence or train of thought; sometimes unable to continue the idea Thought broadcasting: a delusional belief that others can hear or know what the client is thinking Thought insertion: a delusional belief that others are putting ideas or thoughts into the client’s head—that is, the ideas are not those of the client

BUILDING THE NURSE-CLIENT RELATIONSHIP:ASSESSMENT

CONTENT OF THE ASSESSMENT: Thought process and content

Thought withdrawal: a delusional belief that others are taking the client’s thoughts away and the client is powerless to stop it Word salad: flow of unconnected words that convey no meaning to the listener.

BUILDING THE NURSE-CLIENT RELATIONSHIP:ASSESSMENT

CONTENT OF THE ASSESSMENT: Thought process and content

ASSESSMENT OF SUICIDE OR HARM TOWARD OTHERS

 DUTY TO WARN

The client’s belief that a news broadcast has special meaning for him or her is an example of a. Abstract thinking b. Flight of ideas c. Ideas of reference d. Thought broadcasting

The client who believes everyone is out to get him or her is experiencing a(n) a. Delusion b. Hallucination c. Idea of reference d. Loose association

BUILDING THE NURSE-CLIENT RELATIONSHIP:ASSESSMENT

Judgment Ability to interpret one’s environment and situation correctly and to adapt one’s behavior and decisions accordingly Insight ability to understand the true nature of one’s situation and accept some personal responsibility for that situation

ANGER, HOSTILITY AND AGGRESSION

ANGER, HOSTILITY AND AGGRESSION

ANGER A normal human behavior A strong, uncomfortable, emotional response to a real or perceived provocation. Secondary emotion results when a person is frustrated, hurt, or afraid POSITIVE OR NEGATIVE

ANGER, HOSTILITY AND AGGRESSION

HOSTILITY verbal aggression An emotion expressed through verbal abuse, lack of cooperation, violation of rules or norms, or threatening behavior Person feels threatened or powerless Cause emotional harm to another

ANGER, HOSTILITY AND AGGRESSION

PHYSICAL AGGRESSION behavior in which a person attacks or injures another person or that involves destruction of property meant to harm or punish another person or to force someone into compliance

ANGER, HOSTILITY AND AGGRESSION

ONSET AND CLINICAL COURSE: Anger

CATHARSIS HYPOTHESIS Provides vent or release of anger

Habit forming Anger that is expressed inappropriately can lead to hostility and aggression.

ANGER, HOSTILITY AND AGGRESSION ONSET AND CLINICAL COURSE: HOSTILITY AND AGGRESSION triggering

sudden and unexpected

postcrisis

recovery

escalation

crisis

ANGER, HOSTILITY AND AGGRESSION

Intermittent Explosive Disorder rare psychiatric diagnosis characterized by discrete episodes of aggressive impulses that result in serious assaults or destruction of property. aggressive behavior the person displays is grossly disproportionate to any provocation or precipitating factor

ANGER, HOSTILITY AND AGGRESSION

Acting out an immature defense mechanism by which the person deals with emotional conflicts or stressors through actions rather than through reflection or feelings cannot handle intense feelings or deal with emotional conflict verbally

ABUSE AND VIOLENCE PSYCHIATRIC DISORDERS RELATED TO ABUSE AND VIOLENCE

Posttraumatic Stress Disorder (PTSD)

disturbing pattern of behavior demonstrated by someone who has experienced a traumatic event such as a natural disaster, a combat, or an assault. Symptoms occur 3 months or more after the trauma

ABUSE AND VIOLENCE

Posttraumatic Stress Disorder Three clusters of symptoms are present: • reliving the event • avoiding reminders of the event, and • being on guard, or experiencing hyperarousal.

Persistently reexperiences the trauma through memories, dreams, flashbacks, or reactions to external cues about the event and therefore avoids stimuli associated with the trauma.

ABUSE AND VIOLENCE

Posttraumatic Stress Disorder Medical Management Psychotherapy – Goal: Progressive Recapitulation of the Memory Pharmacology – Benzodiazipine, anti depressant Social Recreational – exercise program Nursing Management Promote the client’s safety. Develop trust. Help the client cope with stress and emotion. Grounding Technique – reminding the client that she in the present and she is safe. Help promote self esteem Establish social support – find people/activities in the community.

ABUSE AND VIOLENCE PSYCHIATRIC DISORDERS RELATED TO ABUSE AND VIOLENCE

Dissociation defense mechanism that helps a person protect his or her emotional self from recognizing the full effects of some horrific or traumatic event by allowing the mind to forget or remove itself from the painful situation or memory.

ABUSE AND VIOLENCE PSYCHIATRIC DISORDERS RELATED TO ABUSE AND VIOLENCE

Dissociative disorders Essential feature of a disruption in the usually integrated functions of consciousness, memory, identity, or environmental perception.

ABUSE AND VIOLENCE

Dissociative Disorders

Different types of dissociative disorders: • Dissociative amnesia • Dissociative fugue • Dissociative identity disorder • Depersonalization disorder

The ultimate goal of therapy for a client with dissociative disorder is: a. Integration of the personalities into one b. For the client to have the ability to switch from one personality to another voluntarily c. For the client to select which personality he or she wants to be the dominant self d. For the client to recognize that the various personalities exist

GRIEF AND LOSS

GRIEF AND LOSS

LOSS something valuable is gone Normal and essential in human life Grief refers to the subjective emotions and affect that are a normal response to the experience of loss.

Grieving also known as bereavement refers to the process by which a person experiences the grief. Anticipatory grieving people facing an imminent loss begin to grapple with the very real possibility of the loss or death in the near future Mourning outward expression of grief. rituals

GRIEF AND LOSS

Kubler-Ross’s Stages of Grieving

DABDA 1. Denial is shock and disbelief regarding the loss. 2. Anger may be expressed toward God, relatives, friends, or health care providers. 3. Bargaining occurs when the person asks God or fate for more time to delay the inevitable loss. 4. Depression results when awareness of the loss becomes acute. 5. Acceptance occurs when the person shows evidence of coming to terms with death.

GRIEF AND LOSS

Kubler-Ross’s Stages of Grieving

NURSING PRACTICE FOR PSYCHIATRIC DISORDERS

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Anxiety, Anxiety Disorders, and Stress-Related Disorders

Anxiety, Anxiety Disorders, and Stress-Related Disorders

ANXIETY *Vague feeling of dread or apprehension --it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms --unavoidable in life --serve many positive functions

Anxiety, Anxiety Disorders, and Stress-Related Disorders

FEAR feeling afraid or threatened by a clearly identifiable external stimulus that represents danger to the person.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

ANXIETY VS FEAR

Anxiety, Anxiety Disorders, and Stress-Related Disorders

ANXIETY DISORDERS Comprise a group of conditions that share a key feature of excessive anxiety with ensuing behavioral, emotional, cognitive, and physiologic responses.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

ANXIETY DISORDERS     

panic without reason, unwarranted fear of objects or life conditions, uncontrollable repetitive actions, re-experiencing of traumatic events, and unexplainable or overwhelming worry

----significantly impairs their daily routines, social lives, and occupational functioning

Anxiety, Anxiety Disorders, and Stress-Related Disorders

ANXIETY AS A RESPONSE TO STRESS Hans Selye identified the physiologic aspects of stress --labeled as the general adaptation syndrome three stages of reaction to stress: Alarm reaction stage Resistance stage Exhaustion stage

Anxiety, Anxiety Disorders, and Stress-Related Disorders

ANXIETY AS A RESPONSE TO STRESS Alarm reaction stage Preparation for defense/activation of the fight or flight response

Resistance stage Striving to adapt to stress within the person’s capabilities

Exhaustion stage Negative response to the stress that is too long or overwhelming resulting to inability to resist stress and depletion of body resources

The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as: a. Mild b. Moderate c. Severe d. Panic

Anxiety, Anxiety Disorders, and Stress-Related Disorders

OVERVIEW OF ANXIETY DISORDERS diagnosed when anxiety no longer functions as a signal of danger or a motivation for needed change becomes chronic and permeates major portions of the person’s life resulting in maladaptive behaviors and emotional disability

Anxiety, Anxiety Disorders, and Stress-Related Disorders

TREATMENT OF ANXIETY DISORDERS Positive reframing • means turning negative messages into positive messages.

Decatastrophizing • involves the therapist’s use of questions to more realistically appraise the situation

Assertiveness training • Techniques help the person negotiate interpersonal situations and foster self- assurance.

When assessing a client with anxiety, the nurse’s questions should be: a. Avoided until the anxiety is gone b. Open ended c. Postponed until the client volunteers information d. Specific and direct

The best goal for a client learning a relaxation technique is that the client will: a. Confront the source of anxiety directly b. Experience anxiety without feeling overwhelmed c. Report no episodes of anxiety d. Suppress anxious feelings

Which of the following would be the best intervention for a client having a panic attack? a. Involve the client in a physical activity. b. Offer a distraction such as music. c. Remain with the client. d. Teach the client a relaxation technique.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

PHOBIAS An illogical, intense, and persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

PHOBIAS There are three categories of phobias: • Agoraphobia • Specific phobia • Social phobia

Triskaidekaphobia Fear of FRIDAY the 13th

Anxiety, Anxiety Disorders, and Stress-Related Disorders

PHOBIAS Ophidiophobia Cynophobia Trypophobia Thanatophobia Atychiphobia Alektorophobia Aphenphosmphobia Gamophobia Hippopotomonstrosesquippedaliophobia

Anxiety, Anxiety Disorders, and Stress-Related Disorders

PHOBIAS Phobophobia Triskaidekaphobia Panophobia Podophobia Paraskevidekatriaphobia Somniphobia Apiphobia Koumpounophobia

Anxiety, Anxiety Disorders, and Stress-Related Disorders

Social PHOBIAS Aka social anxiety disorder the person becomes severely anxious to the point of panic or incapacitation when confronting situations involving people

Anxiety, Anxiety Disorders, and Stress-Related Disorders

OBSESSIVE–COMPULSIVE DISORDER Obsessions are recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function. Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

OBSESSIVE–COMPULSIVE DISORDER Common compulsions include the following: • Checking rituals • Counting rituals • Washing and scrubbing until the skin is raw • Praying or chanting • Touching, rubbing, or tapping • Hoarding items • Ordering • Exhibiting rigid performance • Having aggressive urges

Anxiety, Anxiety Disorders, and Stress-Related Disorders

OBSESSIVE–COMPULSIVE DISORDER REMEMBER! OCD is diagnosed only when these thoughts, images, and impulses consume the person or he or she is compelled to act out the behaviors to a point at which they interfere with personal, social, and occupational function.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

OBSESSIVE–COMPULSIVE DISORDER Behaviors are repetitive, meaningless, and difficult to conquer. The person understands that these rituals are unusual and unreasonable but feels forced to perform them to alleviate anxiety or to prevent terrible thoughts.

Anxiety, Anxiety Disorders, and Stress-Related Disorders

OBSESSIVE–COMPULSIVE DISORDER: INTERVENTION

Using Therapeutic Communication Teaching Relaxation and Behavioral Techniques Completing a Daily Routine Providing Client and Family Education

Obsessive compulsive disorder is BEST described by: a. Uncontrollable impulse to perform an act or ritual repeatedly: b. Persistent thoughts c. Recurring unwanted and disturbing thoughts alternating with a behavior. d. Pathological persistence of unwilled thought, feeling or impulse

To be more effective, the nurse who cares for persons with obsessive compulsive disorder must possess one of the following qualities: a. Compassion b. Consistency c. Patience d. Friendliness

SCHIZOPHRENIA

SCHIZOPHRENIA

SCHIZOPHRENIA Greek words: Skhizein = To split Phren = Mind Split mind Split personality

SCHIZOPHRENIA

NOT SPLIT MIND NOT SPLIT PERSONALITY

SCHIZOPHRENIA

BUT………….

SPLIT FROM REALITY

SCHIZOPHRENIA

SCHIZOPHRENIA Scattered or fragmented pattern of thinking that causes distorted and bizarre thoughts, perceptions, emotions, movements, and behavior.

SYNDROME disease process with many different varieties and symptoms

SCHIZOPHRENIA

Diagnosed in: late adolescence or early adulthood Rarely does it manifest in childhood Peak incidence of onset: Men- 15 to 25 years of age Women- 25 to 35 years of age

Prevalence: 1% of the total population

SCHIZOPHRENIA

Signs and Symptoms

1. Positive or hard symptoms/signs 2. Negative or soft symptoms/signs 3. Cognitive or Disorganized symptoms/signs

POSITIVE SYMPTOMS Acute onset A result in increased dopamine levels affecting the limbic areas of the brain Better prognosis

SCHIZOPHRENIA

POSITIVE OR HARD SYMPTOMS Ambivalence contradictory beliefs or feelings about the same person, event, or situation Associative looseness Fragmented or poorly related thoughts and ideas Delusions Fixed false beliefs that have no basis in reality

SCHIZOPHRENIA

POSITIVE OR HARD SYMPTOMS Echopraxia Imitation of the movements and gestures of another person whom the client is observing Flight of ideas Continuous flow of verbalization in which the person jumps rapidly from one topic to another Hallucinations False sensory perceptions or perceptual experiences that do not exist in reality

SCHIZOPHRENIA

POSITIVE OR HARD SYMPTOMS Ideas of reference False impressions that external events have special meaning for the person Perseveration Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic

When the client describes fear of leaving his apartment as well as the desire to get out and meet others, it is called: a. Ambivalence b. Anhedonia c. Alogia d. Avoidance

NEGATIVE SYMPTOMS Chronic onset Symptoms are essentially an absence of what should be A result in decreased dopamine levels in the mesocortical area of the brain Poor prognosis

SCHIZOPHRENIA

NEGATIVE OR SOFT SYMPTOMS Alogia Tendency to speak very little or to convey little substance of meaning (poverty of content) Anhedonia Feeling no joy or pleasure from life or any activities or relationships Apathy lack of interest, enthusiasm, or concern “I don’t care.”

SCHIZOPHRENIA

NEGATIVE OR SOFT SYMPTOMS

Blunted affect Restricted range of emotional feeling, tone, or mood Catatonia Psychologically induced immobility occasionally marked by periods of agitation or excitement

SCHIZOPHRENIA

NEGATIVE OR SOFT SYMPTOMS

Flat affect Absence of any facial expression that would indicate emotions or mood Lack of volition (avolition) Absence of will, ambition, or drive to take action or accomplish tasks

SCHIZOPHRENIA

CRITERIA FOR SCHIZOPHRENIA Diagnostic and Statistical Manual of Mental Disorders, 5th edition, Text Revision (DSM-V-TR) Describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and research

SCHIZOPHRENIA

CRITERIA FOR SCHIZOPHRENIA (DSM V-TR) Criteria A. At least TWO of the following characteristic symptoms: Delusion Hallucinations Disorganized speech Grossly disorganized or catatonic behavior Negative symptoms

SCHIZOPHRENIA

CRITERIA FOR SCHIZOPHRENIA (DSM V-TR) Criteria B. Social-occupational dysfunction: work, interpersonal, and self care functioning below the level achieved before onset Criteria C. Duration: continuous signs and symptoms of disturbance for at least 6 months

SCHIZOPHRENIA

CRITERIA FOR SCHIZOPHRENIA (DSM V-TR) Criteria D. Schizoaffective and mood disorders not present and not responsible for the signs and symptoms Criteria E. NOT CAUSED by substance abuse or general medical disorder

SCHIZOPHRENIA

TYPES OF SCHIZOPHRENIA

The diagnosis is made according to the client’s predominant symptoms: 1. 2. 3. 4. 5.

Paranoid type Disorganized type Catatonic type Undifferentiated type Residual type

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT 1. Persecutory/paranoid delusions involve the client’s belief that “others” are planning to harm the client or are spying, following, ridiculing, or belittling the client in some way Sometimes the client cannot define who these “others” are

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT 2. Grandiose delusions characterized by the client’s claim to association with famous people or celebrities, or the client’s belief that he or she is famous or capable of great feats. “I AM THE PRESIDENT OF THE PHILIPPINES!”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT 3. Religious delusions center around the second coming of Christ or another significant religious figure or prophet

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT 4. Somatic delusions generally vague and unrealistic beliefs about the client’s health or bodily functions.

Factual information or diagnostic testing does not change these beliefs.

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT 5. Referential delusions or ideas of reference involve the client’s belief that television broadcasts, music, or newspaper articles have special meaning for him or her.

SCHIZOPHRENIA

CLINICAL COURSE: ONSET development of signs and symptoms: abrupt or gradual DIATHESIS-STRESS MODEL a combination of biological and genetic vulnerabilities (DIATHESIS) Environmental stressors (STRESS) that contribute to the onset of schizophrenia

SCHIZOPHRENIA

ETIOLOGY: Biologic Theories Genetic Factors Genetics plays a role in mental illness  Identical twins have a 50% risk for schizophrenia that is, if one twin has schizophrenia, the other has a 50% chance of developing it as well

• Fraternal twins have only a 15% risk • one biologic parent with schizophrenia--15% risk • both biologic parents have schizophrenia--35% risk

SCHIZOPHRENIA

TREATMENT: Psychopharmacology The primary medical treatment for schizophrenia is psychopharmacology. Antipsychotic medications aka neuroleptics Decreasing psychotic symptoms Take note: They do not cure schizophrenia; rather, they are used to manage the symptoms of the disease. REVIEW OF ANTIPSYCHOTIC OR NEUROLEPTIC DRUG

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Motor Behavior: stereotypic behavior demonstrate seemingly purposeless gestures odd facial expressions such as grimacing psychomotor retardation a general slowing of all movements **Sometimes the client may be almost immobile, curled into a ball (fetal position).

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech exhibit an unusual speech pattern Clang associations ideas that are related to one another based on sound or rhyming rather than meaning. Example: “I will take a pill if I go up the hill but not if my name is Jill, I don’t want to kill.”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech Neologisms are words invented by the client. Example: “I’m afraid of grittiz. If there are any grittiz here, I will have to leave. Are you a grittiz?”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech Verbigeration stereotyped repetition of words or phrases that may or may not have meaning to the listener. Example: “I want to go home, go home, go home, go home.”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech Echolalia client’s imitation or repetition of what the nurse says. Example: Nurse: “Can you tell me how you’re feeling?” Client: “Can you tell me how you’re feeling, how you’re feeling?”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech Stilted language use of words or phrases that are flowery, excessive, and pompous. Example: “Would you be so kind, as a representative of Florence Nightingale, as to do me the honor of providing just a wee bit of refreshment, perhaps in the form of some clear spring water?”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech Perseveration persistent adherence to a single idea or topic and verbal repetition of a sentence, phrase, or word, even when another person attempts to change the topic.

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Speech Word salad combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener. Example: “Corn, potatoes, jump up, play games, grass, cupboard.”

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT DELUSIONS fixed, false beliefs with no basis in reality Types: 1. 2. 3. 4. 5. 6.

Persecutory/paranoid delusions Grandiose delusions Religious delusions Somatic delusions Referential delusions Nihilistic delusion

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Sensorium and Intellectual Processes Hallucinations false sensory perceptions, or perceptual experiences that do not exist in reality) involve the five senses and bodily sensations Distinct from illusion

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Hallucinations 1. 2. 3. 4. 5. 6. 7.

Auditory Visual Olfactory Tactile Gustatory Cenesthetic Kinesthetic

SCHIZOPHRENIA

NURSING PROCESS: ASSESSMENT Sensorium and Intellectual Processes DEPERSONALIZATION most extreme form of disorientation the client feels detached from her or his behavior

MOOD DISORDERS

Personality Disorders

Personality Disorders

Personality  refers to individual differences in characteristic patterns of thinking, feeling and behaving  the combination of characteristics or qualities that form an individual's distinctive character

Personality Disorders

Personality Traits How they think How they act How they behave

Can be harmful if those interfere with… PERSONAL LIFE WORK SOCIAL SETTING

Personality Disorders

Personality Disorder Psychological disorder marked by inflexible, disruptive, and enduring behavioral patterns that impair social and other functioning whether the sufferer recognizes that or not

Personality Disorders

Personality Disorder EGO-DYSTONIC aware they have a problem and tend to be distressed by their symptoms EGO-SYNTONIC NOT aware they have a problem and tend not to be distressed by their symptoms

Personality Disorders

(DSM-V-TR) 10 DISORDERS 3 CLUSTERS Cluster A (odd-eccentric) “weird” Cluster B (dramatic, emotional, erratic) “wild” Cluster C (anxious, fearful) “worried”

Personality Disorders

CLUSTER A ODD ECCENTRIC

Personality Disorders

CLUSTER A: PARANOID PD – “Accusatory” Doubts trustworthiness of others or loyalty of friends and others Fear of confiding with others Suspicious, without justification, of spouse’s sexual partner’s fidelity Interprets remarks as demeaning or threatening

Personality Disorders

CLUSTER A: PARANOID PD -- “Accusatory” Holds grudges towards others Actions of others are seen as threat to self leading to hyper vigilance and extreme anxiety Often are humorless and serious

Personality Disorders

CLUSTER A: PARANOID PD -- “Accusatory” Interventions: a. Watch out for loss of control so involve them in formulating their own plan of care b. Help clients learn to validate ideas before taking into action

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? a. The client is overly dramatic after hearing the facts b. The client focuses on self to not become overanxious c. The client responds from a rational, objective point of view d. The client doesn’t spend time thinking about the information.

Personality Disorders

CLUSTER A: SCHIZOID PD- “aloof” Does not want to be involved in a relationship Emotionally distant Introversion and shyness Does not initiate conversations Blunted and emotional blunting

Personality Disorders

CLUSTER A: SCHIZOID PD- “aloof” Reality oriented but often fantasizes and day-dreams Choose solitary activities Little interest in sexual experience Indifference to praises and/or criticisms

Personality Disorders

CLUSTER A: SCHIZOID PD- “aloof” Interventions: a. Build trust and allow the client for expression of feelings b. Slowly and gradually involve the client to group activities

A client has a diagnosis of schizoid personality disorder. When assessing the client ‘s behavior would be:

a. b. c. d.

Rigid and controlling Dependent and submissive Detached and socially distant Superstitious and socially behavior

Personality Disorders

CLUSTER A: SCHIZOTYPAL PD- “awkward” Has ideas of reference Magical thinking and odd beliefs Unusual perceptual experiences, including body illusions Odd thinking and vague, stereotypical and overelaborate speech Suspicious

Personality Disorders

CLUSTER A: SCHIZOTYPAL PD- “awkward” Odd or eccentric appearance or behavior Few close relationships Excessive social anxiety

Personality Disorders

CLUSTER A: SCHIZOTYPAL PD- “awkward” Interventions: a. Offer support b. Involve activities like self care and social skills c. Low dose antipsychotic drug therapy

When caring for a client with a diagnosis of schizotypal PD, the nurse should: a. Set limits on manipulative behavior b. Encourage participation in group therapy c. Respect the client’s needs for social isolation d. Understand that seductive behavior is expected.

Personality Disorders

CLUSTER A Paranoid --- schizotypal and avoidant Schizotypal -- borderline

Cluster A --- Schizophrenia

CLUSTER B DRAMATIC-ERRATIC

Personality Disorders

CLUSTER B: ANTISOCIAL PD Deceitfulness (lying, cheating) Engages in illegal activities Aggressive Lack of guilt or remorse Irresponsible with work and finances Impulsive Disregard safety of self and other

Personality Disorders

CLUSTER B: ANTISOCIAL PD Interventions: a. Set consistent firm limits in a matter-of-fact nonjudgmental manner b. Assist in verbalization of feelings c. Use confrontation technique to manage manipulative or deceptive behavior d. Involve in group therapy

A 22-year-old male client diagnosed with antisocial personality disorder asks the nurse if he can have an additional smoke break because he's anxious. Which of the following responses would be best? a. "Well okay, I have a few minutes. I'll take you." b. "I'm sorry but I can't take you. I'm busy." c. "Smoking is harmful to your health. I don't want to contribute to your bad habits." d. "Clients are permitted to smoke at designated times. You'll have to follow the rules."

Personality Disorders

Cluster B: BORDERLINE PD Frantic avoidance of abandonment, real or imagined Unstable or intense interpersonal relationships Identity disturbances Impulsivity

Suicidal tendencies/Self mutilation

Personality Disorders

Cluster B: BORDERLINE PD Rapid mood shifts Splitting—”All good or all bad” Chronic feeling of emptiness Problems with anger Transient dissociative and paranoid symptoms

Personality Disorders

Cluster B: BORDERLINE PD Interventions: Promote client’s safety by instituting precautions on self-harm behaviors (no-self harm contract) Allow for verbalization of feelings Empathize with the client but be firm with boundaries Help the client to cope and control emotions

Personality Disorders

Cluster B: BORDERLINE PD Interventions: Cognitive restructuring Thought stopping Positive-self talk Decatastrophizing Structure the client’s activities in a way that boredom and feelings of emptiness are prevented

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? a. b. c. d.

Antisocial behavior Suspicious behavior Relationship problems Auditory hallucinations

Personality Disorders

CLUSTER B: NARCISSISTIC PD

Grandiose self-importance Fantasizes having unlimited power, success or brilliance Believes that he/she is unique and special Constant need for admiration

Personality Disorders

CLUSTER B: NARCISSISTIC PD Sense of entitlement Takes advantage of others for own benefit Lacks empathy Envious of others or others are envious of him/her arrogance

Personality Disorders

CLUSTER B: NARCISSISTIC PD Interventions: Gain cooperation of the client who may be critical and rude to the nurse Set limits on unacceptable behaviors Communicate clearly expectations

A client with a diagnosis of narcissistic personality has been given a day pass from the psychiatric hospital. The client is due to return

at 6pm. At 5pm the client telephones the nurse in charge of the unit and says “6 o’clock is too early. I feel like coming back at 7:30.” The nurse would be most therapeutic by telling the client to: a. b. c. d.

Return immediately, to demonstrate control Return on time or restrictions will be imposed Come back at 6:45, as a compromise to set limits Come back as soon as possible or the police will be sent

Personality Disorders

CLUSTER B: HISTRIONIC PD

Needs to be the center of attention Displays sexually seductive or provocative behaviors Shallow and rapidly shifting emotions Uses physical appearance to draw attention

Personality Disorders

CLUSTER B: HISTRIONIC PD Uses speech to impress others but is lacking in depth Dramatic expression of emotions Easily influences by others Exaggerates degree of intimacy with others

Personality Disorders

CLUSTER B: HISTRIONIC PD Interventions: a. Give feedback on the appropriate manner of dressing and nonverbal behavior b. Teach and model/role play appropriate social skills with the client

Personality Disorders

CLUSTER B BORDERLINE --- antisocial, schizotypal and avoidant Schizotypal -- borderline

Cluster B --- Mood disorder

CLUSTER C ANXIOUS-FEARFUL

Personality Disorders

CLUSTER C: DEPENDENT PD

Unable to make decisions without much advise and reassurance Needs to be responsible for important areas of life Seldom disagrees with others because of fear of loss of support or approval

Personality Disorders

CLUSTER C: DEPENDENT PD Problem with initiating projects or doing things on own because of little self confidence Performs unpleasant task to gain support from others Anxious or helpless when alone because of fear of being unable to care for self

Personality Disorders

CLUSTER C: DEPENDENT PD Urgently seeks another relationship for support and care after a close relationship ends Preoccupied with fear of being alone to care for self

Personality Disorders

CLUSTER C: DEPENDENT PD Interventions: Help client to express feelings of grief and loss over the end of the relationship while fostering autonomy and self-reliance Help clients identify strengths and needs Cognitive restructuring techniques may be beneficial

Personality Disorders

CLUSTER C: DEPENDENT PD Interventions: Provide assistance in daily functioning Refrain from giving advise about problems or making decisions for clients even if the client may ask the nurse Teach problem solving and decision making skills Provide support and positive feedback

Which of the following information must be included for the family of a client diagnosed with dependent personality disorder?

a. b. c. d.

Address coping skills Explore panic attacks Promote exercise programs Decrease aggressive outbursts

Personality Disorders

CLUSTER C: AVOIDANT PD

Avoid occupations involving interpersonal contact due to fear of rejection or disapproval Distant from others unless sure of being accepted or liked

Lacks intimate relationship due to fear of shame or ridicule

Personality Disorders

CLUSTER C: AVOIDANT PD Fear of criticisms or rejections in social institutions Inhibited and feels inadequate in new interpersonal situations

Believes that he/she is socially inept, unappealing, or inferior Very reluctant to take risks

Personality Disorders

CLUSTER C: AVOIDANT PD Interventions: Explore with the client possible self-aspects, positive responses from others, and possible reasons for self-criticisms Teach social skills and help them practice it within the safety of nurse-client relationship

Personality Disorders

CLUSTER C: AVOIDANT PD Interventions: Help client to practice self-affirmation and positive talk Assist in the use of decatastrophizing and reframing to enhance self-worth

Personality Disorders

CLUSTER C: OBSESSIVE-COMPULSIVE PD Preoccupied with details, rules, lists, organizations Perfectionism that interferes with task completion Too busy working to have friends or leisure activities Over conscientious and inflexible

Personality Disorders

CLUSTER C: OBSESSIVE-COMPULSIVE PD Unable to discard worthless or worn-out objects Others must do things his or her way in work-or task-related activity Reluctant to spend and hoards money Rigid and stubborn

Personality Disorders

CLUSTER C: OBSESSIVE-COMPULSIVE PD Interventions: Help clients view decision making and completion of projects from a different perspective Help clients tolerate less-than-perfect work Help client set goals with specific deadlines to meet Help client to accept or tolerate less-than-perfect work or decisions

Personality Disorders

A 38-year-old mother with obsessive compulsive PD has become immobilized by her elaborate hand washing and walking rituals. The nurse recognizes that the basis for OCPD is often feeling of: a. Anger b. Remorse c. Inadequacy d. Hopelessness

Personality Disorders

CLUSTER C DEPENDENT --- and avoidant

Cluster C ---anxiety disorder substance abuse disorder

CHAPTER 17 SUBSTANCE ABUSE

EATING DISORDERS

EATING DISORDERS CATEGORIES OF EATING DISORDERS AND RELATED DISORDERS

1. Anorexia Nervosa 2. Bulimia Nervosa

EATING DISORDERS

1. Anorexia Nervosa A life-threatening eating disorder characterized by the client’s:  refusal or inability to maintain a minimally normal body weight,  intense fear of gaining weight or becoming fat,  significantly disturbed perception of the shape or size of the body, and  steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists

 85% or less of that expected for their age and height

EATING DISORDERS

Anorexia Nervosa: Onset and Clinical Course  Begins between 14 and 18 years of age.  Clients often deny they have a negative body image or anxiety regarding their appearance.  They are very pleased with their ability to control their weight and may express this.  A profound sense of emptiness is common.

EATING DISORDERS

Symptoms of Anorexia Nervosa  Fear of gaining weight or becoming fat even when severely underweight  Body image disturbance  Amenorrhea  Depressive symptoms such as depressed mood, social withdrawal, irritability, and insomnia  Preoccupation with thoughts of food  Feelings of ineffectiveness

EATING DISORDERS

Symptoms of Anorexia Nervosa  Inflexible thinking  Strong need to control environment  Limited spontaneity and overly restrained emotional expression  Complaints of constipation and abdominal pain  Cold intolerance  Lethargy  Emaciation

EATING DISORDERS

Symptoms of Anorexia Nervosa      

Hypotension, hypothermia, and bradycardia Hypertrophy of salivary glands Elevated BUN (blood urea nitrogen) Electrolyte imbalances Leukopenia and mild anemia Elevated liver function studies

The nurse is working with a client with anorexia nervosa. Even though the client has been eating all her meals and snacks, her weight has remained unchanged for 1 week. Which of the following interventions is indicated? a. Supervise the client closely for 2 hours after meals and snacks. b. Increase the daily caloric intake from 1,500 to 2,000 calories. c. Increase the client’s fluid intake. d. Request an order from the physician for fluoxetine.

All but which of the following are initial goals for treating the severely malnourished client with anorexia nervosa?

a. Correction of body image disturbance b. Correction of electrolyte imbalances c. Nutritional rehabilitation d. Weight restoration

A teenaged girl is being evaluated for an eating disorder. Which of the following would suggest anorexia nervosa? a. Guilt and shame about eating patterns b. Lack of knowledge about food and nutrition c. Refusal to talk about food-related topics d. Unrealistic perception of body size

A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to: a. b. c. d.

manipulate her husband. gain control of one part of her life. commit suicide. live up to her mother's expectations.

EATING DISORDERS

2. BULIMIA NERVOSA called bulimia is an eating disorder characterized by recurrent episodes (at least twice a week for 3 months) of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising **clients’ bulimic weight is in the normal range

EATING DISORDERS BULIMIA NERVOSA: Onset and Clinical Course

Begins in late adolescence or early adulthood; 18 or 19 years old Binge eating frequently begins during or after dieting. Between binging and purging episodes, clients may eat restrictively, choosing salads and other low-calorie foods.

EATING DISORDERS

Symptoms of Bulimia Nervosa  Recurrent episodes of binge eating  Compensatory behavior such as self-induced vomiting, misuse of laxatives, diuretics, enema or other medications, or excessive exercise  Self-evaluation overly influenced by body shape and weight  Usually within normal weight range, possibly underweight or overweight

EATING DISORDERS

Symptoms of Bulimia Nervosa  Restriction of total calorie consumption between binges, selecting low-calorie foods while avoiding foods perceived to be fattening or likely to trigger a binge  Depressive and anxiety symptoms  Possible substance use involving alcohol or stimulants  Swollen salivary gland in the cheeks (chipmunk face-PATHOGNOMONIC SIGN)

chipmunk facePATHOGNOMONIC SIGN

RUSSELL’S SIGN

EATING DISORDERS

Symptoms of Bulimia Nervosa Loss of dental enamel Chipped, ragged, or moth-eaten appearance of teeth Increased dental caries Menstrual irregularities Dependence on laxatives Esophageal tears

EATING DISORDERS

Symptoms of Bulimia Nervosa Fluid and electrolyte abnormalities Metabolic alkalosis (from vomiting) or metabolic acidosis (from diarrhea) Mildly elevated serum amylase levels

The nurse is evaluating the progress of a client with bulimia. Which of the following behaviors would indicate that the client is making positive progress? a. The client can identify calorie content for each meal. b. The client identifies healthy ways of coping with anxiety. c. The client spends time resting in her room after meals. d. The client verbalizes knowledge of former eating patterns as unhealthy.

A client with bulimia is learning to use the technique of selfmonitoring. Which of the following interventions by the nurse would be most beneficial for this client? a. Ask the client to write about all feelings and experiences related to food. b. Assist the client to make out daily meal plans for 1 week. c. Encourage the client to ignore feelings and impulses related to food. d. Teach the client about nutrition content and calories of various foods.

SOMATOFORM DISORDERS

SOMATOFORM DISORDERS

SOMATOFORM DISORDERS

Psychosomatic convey the connection between the mind (psyche) and the body (soma) in states of health and illness. The mind can cause the body to create physical symptoms or to worsen physical illnesses. Real symptoms can begin, continue, or be worsened as a result of emotional factors.

SOMATOFORM DISORDERS

HYSTERIA “wandering uterus” Refers to multiple physical complaints with no organic basis;

the complaints are usually described dramatically.

SOMATIZATION

SOMATOFORM DISORDERS

Somatization Transference of mental experiences and states into bodily symptoms.

SOMATOFORM DISORDERS

Somatoform Disorders can be characterized as the presence of physical symptoms that suggest a medical condition without a demonstrable organic basis to account fully for tHEM

SOMATOFORM DISORDERS

Five specific somatoform disorders 1. 2. 3. 4. 5.

Somatization disorder Conversion disorder Pain disorder Hypochondriasis Body dysmorphic disorder

SOMATOFORM DISORDERS

Somatization disorder Briquet's syndrome Characterized by multiple physical symptoms that cannot be explained medically includes a combination of pain and gastrointestinal, sexual, and pseudoneurologic symptoms begins by 30 years of age

SOMATOFORM DISORDERS

Conversion Disorder conversion reaction involves unexplained, usually sudden deficits in sensory or motor function (e.g., blindness, paralysis). These deficits suggest a neurologic disorder but are associated with psychologic factors. An attitude of la belle indifference—key feature

SOMATOFORM DISORDERS

Pain disorder Primary physical symptom of pain Unrelieved by analgesics Affected by psychologic factors in terms of onset, severity, exacerbation, and maintenance

SOMATOFORM DISORDERS

Hypochondriasis Preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions.

SOMATOFORM DISORDERS

Body dysmorphic disorder Preoccupation with an imagined or exaggerated defect in physical appearance thinking one’s nose is too large or teeth are crooked and unattractive.

SOMATOFORM DISORDERS

ONSET AND CLINICAL COURSE somatization disorder and body dysmorphic adolescence Conversion between 10 and 35 years of age Pain disorder and hypochondriasis can occur at any age

SOMATOFORM DISORDERS

RELATED DISORDERS: Malingering

Intentional production of false or grossly exaggerated physical or psychologic symptoms; motivated by external incentives such as avoiding work, evading criminal prosecution, obtaining financial compensation, or obtaining drugs. have no real physical symptoms or grossly exaggerate relatively minor symptoms.

SOMATOFORM DISORDERS

RELATED DISORDERS: Factitious disorder Munchausen syndrome Person intentionally produces or feigns physical or psychologic symptoms solely to gain attention. Person may even inflict injury on themselves to receive attention.

SOMATOFORM DISORDERS

RELATED DISORDERS: Factitious disorder Munchausen syndrome by proxy occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a “hero” for saving the victim

SOMATOFORM DISORDERS RELATED DISORDERS: Body identity integrity disorder (BIID)

This condition is also known as amputee identity disorder and apotemnophilia or “amputation love.” Term given to people who feel alienated from a part of their body and desire amputation.

SOMATOFORM DISORDERS

ETIOLOGY Primary gains are the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress. Secondary gains are the internal or personal benefits received from others because one is sick, such as attention from family members and comfort measures

SOMATOFORM DISORDERS

ETIOLOGY Biologic Theories AMPLIFICATION

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