question

Know the types of Somatoform Disorders:

answer

• Somatization Disorder • Somatoform Pain Disorder • Hypochondriasis • Body Dysmorphic Disorder • Conversion Disorder

question

Know what Manual is used to diagnose somatoform disorders.

answer

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition(DSM-5), published by the American Psychiatric Association, is used to diagnoses mental conditions and by insurance companies to reimburse for treatment.

question

What is the definition of somatization Disorder?

answer

• the production of recurrent and multiple medical symptoms with no discernible organic cause. • Pain that is severe enough to disrupt a person's everyday life. • Long term (chronic) condition • Painful physical symptoms that involve more than one part of the body • No physical cause can be found for the pain • Pain is thought to be due to psychological issues.

question

Somatic symptom disorder...

answer

...occurs when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life. A person with somatic symptom disorder (SSD) is not faking his or her symptoms

question

How does it present? Age?

answer

• Interferes with relationships and work, and lead to many visits to different healthcare providers. • In the past, thought to be related to emotional stress. The pain was dismissed as being "all in their head" • Usually begins before age 30 and occurs more often in women than men. • More common in people with irritable bowel syndrome and chronic pain.

question

What are defining characteristics of somatization disorder?

answer

•The pain and other symptoms of this disorder are real, and are not created or faked on purpose (malingering). • Thorough medical examination, including laboratory and radiological evaluations to identify physical causes. • Psychological evaluation to identify related disorders If no physical cause is found to explain symptoms, somatoform pain disorder may be diagnosed

question

What s/s does this client complain of? *Stress often worsens the symptoms.* May have a hx of physical or sexual abuse • Nausea and/or vomiting • Pain during intercourse • Painful menstruation • Pain in legs or arms • Palpitations • Paralysis or muscle weakness • Sexual activity • Shortness of breath • Visual changes

answer

• Abdominal pain • Amnesia • Back pain • Bloating • Chest pain • Diarrhea • Difficulty swallowing • Dizziness • Headaches • Impotence • Joint pain

question

Define secondary gain. • Secondary gain is defined as the advantage that occurs secondary to stated or real illness.

answer

Transition into the sick role may have some incidental secondary gains for patients. Types of secondary gain include using illness for personal advantage, exaggerating symptoms, consciously using symptoms for gain, and unconsciously presenting symptoms with no physiological basis. These symptoms may contribute to the social breakdown syndrome and the patient's choice to remain in the sick role.

question

Cognitive behavioral therapy (talk therapy)

answer

• Cognitive reframing is a psychological technique that consists of identifying and then disputing irrational or maladaptive thoughts. Reframing is a way of viewing and experiencing events, ideas, concepts and emotions to find more positive alternatives.

question

From whom would this client seek treatment?

answer

medical doctor

question

Describe the treatment of Somatoform Disorders?

answer

• Maintaining a supportive relationship with only one primary care provider • To avoid repeating tests and procedures and polypharmacy. • These client's are at risk for addiction to pain relievers and sedatives. • Complications from surgery • Depression and anxiety

question

Tx of Somatoform Disorders • Psychotherapy • Chronic pain specialist

answer

• Cognitive behavioral therapy (talk therapy) • Cognitive reframing is a psychological technique that consists of identifying and then disputing irrational or maladaptive thoughts. Reframing is a way of viewing and experiencing events, ideas, concepts and emotions to find more positive alternatives.

question

What is the focus of treatment?

answer

• Goal: Help client learn to manage symptoms

question

Specific classifications of medications used?

answer

• Antidepressants-for pain and worry surrounding pain. • SSRI's • SNRI's • TCAs

question

Non-pharmacological interventions include?

answer

• Distraction techniques • Hot/cold applications • Hypnosis • Massage • Physical therapy • Stress reduction exercises

question

Explain what is Somatoform Pain Disorder? • Main symptom of somatoform pain disorder is chronic pain that lasts for several months and limits a client's work, relationships, and other activities. • Clients are often worried or stress about their pain. Thus, the cycle of pain and worry........

answer

• Pain that is severe enough to disrupt a client's everyday life. • Pain is like that of a physical disorder, but no physical cause is found. • The pain is thought to be due to a psychological problem.

question

How are Somatoform Pain disorders diagnosed?

answer

• Thorough medical evaluation including laboratory and radiologic exam (MRI, CT, ultrasound, x-ray) is done to determine possible medical causes of pain. • Somatoform pain disorder diagnosis is made when these test do not reveal a clear source of the pain.

question

How do you treat somatoform pain disorders?

answer

• Psychotherapy • Cognitive behavioral therapy • To recognize what seems to make the pain worse • To develop ways to coping with the painful body sensations

question

What kinds of meds and classifications?

answer

• Prescription and nonprescription pain medications often do not work very well. These also can have side effects and carry a risk for abuse. • Antidepressants often help with both the pain and the worry surrounding the pain.

question

• Commonly used antidepressants include: • SSRIs • Fluoxetine (Prozac) • Sertraline (Zoloft) • Paroxetine (Paxil) • Fluvoxamine (Luvox) • Citalopram (Celexa) • Escitalopram (Lexapro)

answer

• SNRIs • venlafaxine (Effexor) • Desvenlafaxine (Pristiq) • Duloxetine (Cymbalta) • Ilnacipran (Dalcipran, Ixel, Savella) • TCAs

question

Non-pharmacological interventions include? • Some clients may not believe their pain is connected to emotional factors and may refuse these treatments.

answer

• Supportive measures that also can be helpful include: • Distraction techniques • Hot/cold applications • Hypnosis • Massage • Physical therapy • Stress reduction techniques

question

Possible complications of this disorder?

answer

• Addiction to pain meds • Complications from surgery • Depression and anxiety • Treatment by mental health care provider who is experienced with treating chronic pain has been shown to improve outcomes.

question

Explain what hypochondriasis is?

answer

• Type of mental illness • Classified as an anxiety disorder • Person has symptoms of medical illness, but the symptoms cannot be fully explained by an actual physical disorder. • Symptoms associated with hypochondriasis are not under the person's voluntary control, and can cause great distress and can interfere with normal functioning.

question

Who is at risk to get it? • Exact cause is unknown. Factors that might be involved in the development of the disorder include:

answer

• Hx of neglect/physical/sexual abuse • Hx of serious childhood illness • Poor ability to express emotions • Parent/close relative with the disorder • An inherited susceptibility for the disorder • Death of a loved one • Hx of an anxiety disorder

question

What are symptoms of hypochondriasis? • Can range from general complaints, such as pain or tiredness, to concerns about normal body functions, such as breathing or stomach noises. • Client's with hypochondriasis are not faking or lying about their symptoms; they truly believe they are sick.

answer

• Symptoms include: • Long-term intense fear/anxiety about having a serious disease of health condition • Worry about minor symptoms or bodily sensations mean you have a serious illness

question

What are symptoms of hypochondriasis? • Seeing physicians repeatedly • Frequent physician changes for 2nd, 3rd, 4th, or more opinions • Multiple diagnostic procedures (MRIs, EKGs, exploratory surgeries) • Obsessively doing health research • Then believing they have the disease after researching or hearing about it.

answer

• Obsessively assessing body for problems and frequently checking vital signs • Monitors for lumps, lesions, abnormalities, changes in BP and P and Temp.

question

What is the exact cause?

answer

unknown

question

What possible complications occur?

answer

These client's are at risk for addiction to pain relievers and sedatives. • Complications from surgery • Depression and anxiety

question

Describe treatment for hypochondriasis? • Primary treatment for hypochondriasis • Cognitive behavioral therapy may be the most effective. • Helps client recognize and stop behavior associated with anxiety, such as constant monitoring of body for problems

answer

• Exposure therapy • Client directly confronts health fears in a safe environment and learns skills to cope with the uncomfortable sensations.

question

Explain the types of therapy used in hypochondriasis?

answer

Psychological Counseling • Primary treatment for hypochondriasis • Cognitive behavioral therapy may be the most effective. • Helps client recognize and stop behavior associated with anxiety, such as constant monitoring of body for problems • Exposure therapy • Client directly confronts health fears in a safe environment and learns skills to cope with the uncomfortable sensations.

question

What kind of client education is used with hypochondriasis?

answer

•Known as psychoeducation • helps client better understand what hypochondriasis is, why the client has this and how to better cope with their health fears. •Compliance with treatment plan • Medication compliance is important • Increase activity • Helps manage symptoms such as depression, stress and anxiety • Avoid drugs and alcohol • Worsens symptoms and may interact with prescribed medications

question

Client Education cont'd

answer

• Do not physician shop • Create and maintain open and honest relationship with physician • Avoid excessive research • Internet research can increase stress and anxiety • Skip disease-of-the-week stories • The media is full of "overlooked" and "misdiagnosed" stories that will increase stress and anxiety.

question

Client Education cont'd

answer

• Resist the urge to "fixate" on the body • Maintain routine schedule exams with physician, seek physicians advise on which self-exams are reasonable for the client to perform themselves. • Join a support group • Allows client to connect with others who share common concerns, find out more about their condition and learn additional coping skills

question

Medications used?

answer

• Antidepressants may be helpful. • SSRIs • Fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) • TCAs • Clomipramine (Anafranil) and imipramine (Tofranil) • May be prescribed along with other medications if other psychological or physical conditions exists.

question

Explain Body Dysmorphic Disorder?

answer

• Chronic mental illness characterized by intense obsession of a minor or imagined flaw in appearance causing significant distress and ability to function in daily life. • Usually develops in adolescence. • Affects males and females

question

What are causes for BDD? • Specific cause is unknown, like many other mental illnesses, may result from a combination of causes such as:

answer

• Brain differences • Abnormalities in brain structure or neurochemistry may play a role • Genes • More common in clients whose biological family members also have the condition • Environment • Life experiences and culture may contribute

question

What are risk factors for BDD?

answer

• Risk factors for development of BDD • Biological relatives with BDD • Negative life experiences (childhood teasing) • Personality traits (low self-esteem) • Societal pressure or expectations of beauty • Comorbidity of another psychiatric disorder (anxiety or depression)

question

Complications related to BDD •Unnecessary medical procedures, esp. cosmetic surgery •Social phobia and social isolation •Lack of close relationships

answer

•Difficulty attending work or school •Low self-esteem •Repeated hospitalizations •Depressed mood or other mood disorders •Suicidal thoughts or behavior •Anxiety disorders •Obsessive-compulsive disorder •Eating disorders •Substance abuse

question

Treatment for BDD?

answer

Treatment • Psychological counseling • Client Education • Medications • Hospitalization

question

Psychological Counseling • Cognitive Behavioral Therapy • Focuses on

answer

•Understanding condition, feelings, thoughts, moods and behavior •Aiding client in stopping automatic negative thoughts and helps client to see themselves in a more realistic and positive way •Learning healthy behaviors, such as socializing with others.

question

Client Education • Compliance with treatment plan • Medication compliance is important • Increase activity • Helps manage symptoms such as depression, stress and anxiety. • Helps counteract side effect of weight gain with medications • Avoid drugs and alcohol • Worsens symptoms and may interact with prescribed medications

answer

• Join a support group • Allows client to connect with others who share common concerns, find out more about their condition and learn additional coping skills •Stay focused on goals •Recovery is an ongoing process. • Learn stress reduction techniques

question

Medications used and approved for BDD? • There are no medications specifically approved by the Food and Drug Administration (FDA) to treat BDD.

answer

• Antidepressants can be effective. • SSRIs • Antipsychotics added if client suffers related to body dysmorphic disorder

question

Define Conversion Disorder. • Also known as functional neurological symptom disorder.

answer

• Condition in which psychological stress is shown in physical ways. • Conditions starts as a mental or emotional crisis and converts to a physical problem. • S/S appear without underlying physical cause and client is powerless to control them.

question

What is functional neurological symptom disorder?

answer

• Condition in which psychological stress is shown in physical ways. • Conditions starts as a mental or emotional crisis and converts to a physical problem. • S/S appear without underlying physical cause and client is powerless to control them.

question

What is the cause of Conversion disorder? • Exact cause is unknown

answer

• Risk factors include • Recent significant stress or emotional trauma • Women are much more likely to develop conversion disorder • Pre-existing mental illness (mood/anxiety disorders, dissociative disorder, or certain personality disorders)

question

Symptoms of Conversion disorder?

answer

• Movement and senses typically affected. • Ability to walk, swallow, see or hear. • Vary in severity • May come and go OR be persistant • Prognosis better in younger children than in teens and adults • Immediate and appropriate management leads to better outcomes. • Symptoms appear suddenly after a stressful event or trauma, whether physical or psychological.

question

• S/S that affect movement may include:

answer

• Weakness or paralysis • Abnormal movement such as tremors or difficulty walking • Loss of balance • Difficulty swallowing or "a lump in the throat" • Seizures or convulsions • Episodes of unresponsiveness

question

• S/S that affect the senses may include:

answer

• Numbness or loss of touch sensation • Speech problems, such as inability to speak or slurred speech • Vision problems, such as double vision or blindness • Hearing problems or deafness

question

What health problems are commonly mistaken with Conversion disorder? • Conversion disorder can mimic a number of other health problems:

answer

• Myasthenia gravis-a muscle disorder • Guillain-Barre syndrome-immune system disorder • Neurologic disorders-Parkinson's disease, epilepsy • Stroke • Lupus • Spinal cord injury • HIV/AIDS

question

How do you diagnose Conversion disorder? • There are no standard diagnostic test for conversion disorder.

answer

Testing will depend on the S/S the client exhibits. • Physical assessment • Xrays and/or imaging procedures • EEG scan • The goal is to rule out any medical or neurological disease. • In the absence of medical or neurological findings, the diagnosis of Conversion disorder may be made.

question

• Treatment will depend on S/S and severity of the disorder. • Psychotherapy • Cognitive behavorial therapy

answer

• Physical therapy • May prevent complications of symptoms of paralysis or loss of mobility • Medication • Antianxiety ; antidepressants • Transcranial magnetic stimulation • Exciting brain activity by using weak electrical currents that are said to alter the brain's biochemistry. However, this is still in the early stages of consideration for treatment of conversion disorders. • Stress relieving techniques

question

How do you treat Conversion disorder?

answer

• For many clients symptoms of conversion disorder improve without treatment, especially after reassurance from the health care provider that their symptoms aren't caused by a serious underlying problem and after referral to a mental health professional for appropriate treatment.

question

Overview • Group of conditions in which physical pain and symptoms a person feels are related to psychological factors. •

answer

Symptoms cannot be traced to a specific physical cause. • Diagnostic test results are either within normal limits or do not explain the client's symptoms.

question

Overview cont'd • Clients who experience unexplained physical symptoms often cling to the belief that their symptoms have underlying physical cause, despite evidence to the contrary.

answer

• Clients may also dismiss any suggestion that psychiatric factors are playing a role in their symptoms. • A strong health care provider-client relationship is key to getting help with somatoform disorders.

question

Overview cont'd • Seeing a single provider with experience managing somatoform disorders can help cut down on unnecessary tests and treatments.

answer

• The focus of treatment is on improving daily functioning, not on managing symptoms. • Stress reduction is often an important part of getting better. • Counseling for family and friend may also be useful.

question

Types of Somatoform Disorders

answer

• Somatization Disorder • Somatoform Pain Disorder • Hypochondriasis • Body Dysmorphic Disorder • Conversion Disorder The Diagnostic and Statistical Manual of Mental Disorders, fifth edition(DSM-5), published by the American Psychiatric Association, is used to diagnoses mental conditions and by insurance companies to reimburse for treatment

question

Somatization Disorder • Pain that is severe enough to disrupt a person's everyday life. • Long term (chronic) condition

answer

• Painful physical symptoms that involve more than one part of the body • No physical cause can be found for the pain • Pain is thought to be due to psychological issues.

question

Symptoms • Abdominal pain • Amnesia • Back pain • Bloating • Chest pain • Diarrhea • Difficulty swallowing • Dizziness • Headaches • Impotence

answer

• Joint pain • Nausea and/or vomiting • Pain during intercourse • Painful menstruation • Pain in legs or arms • Palpitations • Paralysis or muscle weakness • Sexual activity • Shortness of breath • Visual changes *Stress often worsens the symptoms.* May have a hx of physical or sexual abuse

question

Symptoms cont'd • Interferes with relationships and work, and lead to many visits to different healthcare providers.

answer

• In the past, thought to be related to emotional stress. The pain was dismissed as being "all in their head" • Usually begins before age 30 and occurs more often in women than men. • More common in people with irritable bowel syndrome and chronic pain.

question

• Thorough medical examination, including laboratory and radiological evaluations to identify physical causes.

answer

• Psychological evaluation to identify related disorders If no physical cause is found to explain symptoms, somatoform pain disorder may be diagnosed.

question

Treatment

answer

• Goal: Help client learn to manage symptoms • This is accomplished by: • Maintaining a supportive relationship with only one primary care provider • To avoid repeating tests and procedures and polypharmacy. • These client's are at risk for addiction to pain relievers and sedatives. • Complications from surgery • Depression and anxiety

question

Treatment

answer

• Psychotherapy • Chronic pain specialist • Cognitive behavioral therapy (talk therapy) • Cognitive reframing is a psychological technique that consists of identifying and then disputing irrational or maladaptive thoughts. Reframing is a way of viewing and experiencing events, ideas, concepts and emotions to find more positive alternatives. • Antidepressants-for pain and worry surrounding pain. • SSRI's • SNRI's • TCAs

question

Treatment cont'd • Some client's refuse to believe their pain is connected to emotional factors and refuse antidepressants and psychotherapy.

answer

• Non-pharmacological interventions include: • Distraction techniques • Hot/cold applications • Hypnosis • Massage • Physical therapy • Stress reduction exercises

question

Somatoform Pain Disorder

answer

• Pain that is severe enough to disrupt a client's everyday life. • Pain is like that of a physical disorder, but no physical cause is found. • The pain is thought to be due to a psychological problem.

question

Cause • Client's seem to experience painful sensations in a way that increases their pain level.

answer

• Pain and worry creates a cycle that is hard to break. • As health care providers learn more about the mind - body connection, there is more evidence that emotional well-being affects the way in which pain is perceived.

question

Symptoms • Main symptom of somatoform pain disorder is chronic pain that lasts for several months and limits a client's work, relationships, and other activities.

answer

• Clients are often worried or stress about their pain. Thus, the cycle of pain and worry........

question

Diagnosis • Thorough medical evaluation including laboratory and radiologic exam (MRI, CT, ultrasound, x-ray) is done to determine possible medical causes of pain.

answer

• Somatoform pain disorder diagnosis is made when these test do not reveal a clear source of the pain.

question

Treatment • Psychotherapy

answer

• Cognitive behavioral therapy • To recognize what seems to make the pain worse • To develop ways to coping with the painful body sensations

question

try to encourage a multi-disciplined approach

answer

hopefully pt will eventually "buy-in" to idea that pain might be mental illness symptom

question

• Medication

answer

• Prescription and nonprescription pain medications often do not work very well. These also can have side effects and carry a risk for abuse. • Antidepressants often help with both the pain and the worry surrounding the pain.

question

Medication cont'd • Commonly used antidepressants include: • SSRIs • Fluoxetine (Prozac) • Sertraline (Zoloft) • Paroxetine (Paxil) • Fluvoxamine (Luvox) • Citalopram (Celexa) • Escitalopram (Lexapro)

answer

• SNRIs • venlafaxine (Effexor) • Desvenlafaxine (Pristiq) • Duloxetine (Cymbalta) • Ilnacipran (Dalcipran, Ixel, Savella) • TCAs

question

Medications cont'd • Some clients may not believe their pain is connected to emotional factors and may refuse these treatments.

answer

• Supportive measures that also can be helpful include: • Distraction techniques • Hot/cold applications • Hypnosis • Massage • Physical therapy • Stress reduction techniques • Clients with this disorder may benefit from

question

Possible Complications

answer

• Addiction to pain meds • Complications from surgery • Depression and anxiety • Treatment by mental health care provider who is experienced with treating chronic pain has been shown to improve outcomes.

question

Hypochondriasis • Type of mental illness • Classified as an anxiety disorder • Person has symptoms of medical illness, but the symptoms cannot be fully explained by an actual physical disorder.

answer

• Symptoms associated with hypochondriasis are not under the person's voluntary control, and can cause great distress and can interfere with normal functioning.

question

Causes of Hypochondriasis • Exact cause is unknown. Factors that might be involved in the development of the disorder include:

answer

• Hx of neglect/physical/sexual abuse • Hx of serious childhood illness • Poor ability to express emotions • Parent/close relative with the disorder • An inherited susceptibility for the disorder • Death of a loved one • Hx of an anxiety disorder

question

Symptoms of Hypochondriasis • Can range from general complaints, such as pain or tiredness, to concerns about normal body functions, such as breathing or stomach noises. • Client's with hypochondriasis are not faking or lying about their symptoms; they truly believe they are sick.

answer

• Symptoms include: • Long-term intense fear/anxiety about having a serious disease of health condition • Worry about minor symptoms or bodily sensations mean you have a serious illness

question

Symptoms cont'd • Seeing physicians repeatedly • Frequent physician changes for 2nd, 3rd, 4th, or more opinions • Multiple diagnostic procedures (MRIs, EKGs, exploratory surgeries) • Obsessively doing health research • Then believing they have the disease after researching or hearing about it. •

answer

Obsessively assessing body for problems and frequently checking vital signs • Monitors for lumps, lesions, abnormalities, changes in BP and P and Temp.

question

Diagnosis • DSM-5 criteria:

answer

The client has• A preoccupation, lasting for a least six months, of having a serious illness based on bodily symptoms • Worry about this preoccupation • Difficulty in social life, work or other daily routines.

question

Treatment

answer

• Psychological counseling • Client Education • Medications

question

Psychological Counseling • Primary treatment for hypochondriasis • Cognitive behavioral therapy may be the most effective.

answer

• Helps client recognize and stop behavior associated with anxiety, such as constant monitoring of body for problems • Exposure therapy • Client directly confronts health fears in a safe environment and learns skills to cope with the uncomfortable sensations

question

Client Education •Known as psychoeducation • helps client better understand what hypochondriasis is, why the client has this and how to better cope with their health fears. •Compliance with treatment plan

answer

• Medication compliance is important • Increase activity • Helps manage symptoms such as depression, stress and anxiety • Avoid drugs and alcohol • Worsens symptoms and may interact with prescribed medications

question

Client Education cont'd • Do not physician shop • Create and maintain open and honest relationship with physician • Avoid excessive research • Internet research can increase stress and anxiety • Skip disease-of-the-week stories • The media is full of "overlooked" and "misdiagnosed" stories that will increase stress and anxiety. • Resist the urge to "fixate" on the body •

answer

Maintain routine schedule exams with physician, seek physicians advise on which self-exams are reasonable for the client to perform themselves. • Join a support group • Allows client to connect with others who share common concerns, find out more about their condition and learn additional coping skills

question

Medications • Antidepressants may be helpful. .

answer

• SSRIs • Fluoxetine (Prozac), fluvoxamine (Luvox), and paroxetine (Paxil) • TCAs • Clomipramine (Anafranil) and imipramine (Tofranil) • May be prescribed along with other medications if other psychological or physical conditions exists

question

Body Dysmorphic Disorder

answer

• Chronic mental illness characterized by intense obsession of a minor or imagined flaw in appearance causing significant distress and ability to function in daily life. • Usually develops in adolescence. • Affects males and females

question

Causes • Specific cause is unknown, like many other mental illnesses, may result from a combination of causes such as:

answer

• Brain differences • Abnormalities in brain structure or neurochemistry may play a role • Genes • More common in clients whose biological family members also have the condition • Environment • Life experiences and culture may contribute

question

Causes cont'd • Risk factors for development of BDD • Biological relatives with BDD

answer

• Negative life experiences (childhood teasing) • Personality traits (low self-esteem) • Societal pressure or expectations of beauty • Comorbidity of another psychiatric disorder (anxiety or depression)

question

Symptoms • Preoccupation with appearance with extreme self-consciousness

answer

• Frequent self-examinations in mirror OR avoidance of mirrors altogether. • Strong belief that an abnormality or defect in appearance makes them ugly. • Avoidance of social situations • Frequent cosmetic procedures with little satisfaction

question

Symptoms cont'd • May obsess over any part of the body • Body feature focus may change over time • Most commonly focuses on

answer

• Face • Nose • Complexion • Wrinkles • Acne/other blemishes • Hair • Skin and vein appearance • Breast size • Muscle size and tone • genitalia

question

Complications related to BDD

answer

•Unnecessary medical procedures, esp. cosmetic surgery •Social phobia and social isolation •Lack of close relationships •Difficulty attending work or school •Low self-esteem •Repeated hospitalizations •Depressed mood or other mood disorders •Suicidal thoughts or behavior •Anxiety disorders •Obsessive-compulsive disorder •Eating disorders •Substance abuse

question

Diagnosis • DSM-5 criteria: The client is

answer

• Extremely preoccupied with an imagined defect or a minor flaw in appearance • So preoccupied with appearance that is causes significant distress or problems in social life, work, school or other areas of life.

question

Treatment

answer

• Psychological counseling • Client Education • Medications • Hospitalization

question

Psychological Counseling • Cognitive Behavioral Therapy • Focuses on

answer

•Understanding condition, feelings, thoughts, moods and behavior •Aiding client in stopping automatic negative thoughts and helps client to see themselves in a more realistic and positive way •Learning healthy behaviors, such as socializing with others.

question

Client Education

answer

• Compliance with treatment plan • Medication compliance is important • Increase activity • Helps manage symptoms such as depression, stress and anxiety. • Helps counteract side effect of weight gain with medications • Avoid drugs and alcohol • Worsens symptoms and may interact with prescribed medications

question

Client Education

answer

• Join a support group • Allows client to connect with others who share common concerns, find out more about their condition and learn additional coping skills •Stay focused on goals •Recovery is an ongoing process. • Learn stress reduction techniques

question

Medications • There are no medications specifically approved by the Food and Drug Administration (FDA) to treat BDD.

answer

• Antidepressants can be effective. • SSRIs • Antipsychotics added if client suffers related to body dysmorphic disorder

question

Conversion Disorder • Also known as functional neurological symptom disorder. • Condition in which psychological stress is shown in physical ways. • Conditions starts as a mental or emotional crisis and converts to a physical problem.

answer

• S/S appear without underlying physical cause and client is powerless to control them.

question

Causes • Exact cause is unknown • Risk factors include

answer

• Recent significant stress or emotional trauma • Women are much more likely to develop conversion disorder • Pre-existing mental illness (mood/anxiety disorders, dissociative disorder, or certain personality disorders)

question

Symptoms • Movement and senses typically affected.

answer

• Ability to walk, swallow, see or hear. • Vary in severity • May come and go OR be persistant • Prognosis better in younger children than in teens and adults • Immediate and appropriate management leads to better outcomes. • Symptoms appear suddenly after a stressful event or trauma, whether physical or psychological.

question

Symptoms cont'd • S/S that affect movement may include:

answer

• Weakness or paralysis • Abnormal movement such as tremors or difficulty walking • Loss of balance • Difficulty swallowing or "a lump in the throat" • Seizures or convulsions • Episodes of unresponsiveness

question

Symptoms cont'd • S/S that affect the senses may include:

answer

• Numbness or loss of touch sensation • Speech problems, such as inability to speak or slurred speech • Vision problems, such as double vision or blindness • Hearing problems or deafness

question

Diagnosis • There are no standard diagnostic test for conversion disorder.

answer

Testing will depend on the S/S the client exhibits. • Physical assessment • Xrays and/or imaging procedures • EEG scan

question

Diagnosis cont'd • Conversion disorder can mimic a number of other health problems:

answer

• Myasthenia gravis-a muscle disorder • Guillain-Barre syndrome-immune system disorder • Neurologic disorders-Parkinson's disease, epilepsy • Stroke • Lupus • Spinal cord injury • HIV/AIDS

question

Diagnosis cont'd • The goal is to rule out any medical or neurological disease.

answer

• In the absence of medical or neurological findings, the diagnosis of Conversion disorder may be made.

question

Treatment

answer

• For many clients symptoms of conversion disorder improve without treatment, especially after reassurance from the health care provider that their symptoms aren't caused by a serious underlying problem and after referral to a mental health professional for appropriate treatment.

question

Treatment cont'd • Treatment will depend on S/S and severity of the disorder.

answer

• Psychotherapy • Cognitive behavorial therapy • Physical therapy • May prevent complications of symptoms of paralysis or loss of mobility • Medication • Antianxiety ; antidepressants • Transcranial magnetic stimulation •

question

Treatment cont'd • Treatment will depend on S/S and severity of the disorder.

answer

Exciting brain activity by using weak electrical currents that are said to alter the brain's biochemistry. However, this is still in the early stages of consideration for treatment of conversion disorders. • Stress relieving techniques

question

Secondary Gain • Secondary gain is defined as the advantage that occurs secondary to stated or real illness. Transition into the sick role may have some incidental secondary gains for patients.

answer

Types of secondary gain include using illness for personal advantage, exaggerating symptoms, consciously using symptoms for gain, and unconsciously presenting symptoms with no physiological basis. These symptoms may contribute to the social breakdown syndrome and the patient's choice to remain in the sick role.

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