1. Somatoform and Sleep Disorders
Nursing 201

2. characterized
physical symptoms suggesting medical disease but without a demonstrable organic
pathological condition or a known pathophysiological mechanism to account for them.
Somatoform disorders are more common
In women than in men
In those who are poorly educated
In those who live in rural communities
In those who are poor

3. Predisposing Factors Transactional Model of Stress/Adaptation
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

4. 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.

5. 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

6. 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)

7. “Pain games” Theory of family dynamics Tertiary gain
Neurophysiological theory
Afferent pain fibers
Serotonin/endorphins

8. 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.

9. Nursing Process Nursing Diagnosis Planning/Implementation Outcomes
Evaluation

10. Predisposing Factors Psychodynamic theory Cognitive 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.

11. 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.

12. 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.

13. Nursing Process Nursing Diagnosis Planning/Implementation Outcomes
Evaluation

14. Predisposing Factors Behavioral theory 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

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

16. 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

17. Nursing Process Nursing Diagnosis Planning/Implementation Outcomes
Evaluation

18. 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.

19. 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

20. 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

21. Circadian rhythm sleep disorders Shift-work type
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

22. Nursing Process Nursing Diagnosis Planning/Implementation Outcomes
Evaluation

23. 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.

24. Treatment Modalities Somatoform disorders Individual psychotherapy
Group psychotherapy
Behavior therapy
Psychopharmacology
Sleep disorders
Relaxation therapy
Biofeedback
Pharmacotherapy

25. 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