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Chapter 6 Textbook Notes - Somatoform Disorders.docx

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PSYC 235
Christopher Bowie

Chapter 6 – Somatoform Disorders -Individuals may be preoccupied with their health or appearance becomes so great that it dominates their lives. Their problems fall under the general heading of somatoform disorders. - There is usually no identifiable medical condition causing the physical complaints. - People may experience periodically sight alternations, or detachments, in consciousness or identity, and they are known as dissociative experiences or dissociation. For a few people, these experiences are so intense and extreme that they lose their identity entirely and assume a new one, or they lose their memory or sense of reality and are unable to function. These are dissociative disorders. SOMATOFORM DISORDERS In each of the 5 somatoform disorders, individuals are pathologically concerned with the appearance or functioning of their bodies. 1) Hypochondriasis 2) Somatization Disorder 3) Conversion Disorder 4) Pain Disorder 5) Body Dysmorphic Disorder HYPOCHONDRIASIS CLINICAL DESCRIPTION - In hypochondriasis, severe anxiety is focused on the possibility of having a serious disease. The threat seems so real that reassurance from physicians does not seem to help. The individual is preoccupied with bodily symptoms, misinterpreting them as indicative of illness or disease. Almost any physical sensation may become the basis for concern for individuals. Some may focus on normal bodily functions such as heart rate or perspiration, or very minor abnormalities like a cough. - Hypochondriasis shares many features with the anxiety and mood disorders (particularly panic disorder) and they are frequently comorbid with hypochondriasis; That is, if the individuals with hypochondriacal disorder have additional diagnoses, these are likely to be anxiety or mood disorders. - Individuals who fear developing a disease, and therefore avoid situations they associate with contagion, are different from those who are anxious they actually have a disease. Individuals who have only marked fear of developing a disease are classified as having an illness phobia. Individuals who mistakenly believe they currently have a disease are diagnosed with hypochondriasis. Individuals with high disease conviction are more likely to misinterpret physical symptoms and display higher rates of checking behaviours and trait anxiety. Both disorders are common among people to have, as well as patients with panic disorder, because they both have similar symptoms. - Although both disorders include characteristic concern with physical symptoms, patients with panic disorder typically fear immediate symptom-related catastrophes that may occur during the few minutes they are having a panic attack. Individuals with hypochondrical concerns, on the other hand, focus on long-term process of illness and disease (Ex. AIDS, breast cancer, etc) Chapter 6 – Somatoform Disorders TREATMENT - A PREVENTION - Proper medical care for illnesses and therapeutic drug monitoring can play a significant role in preventing delirium. A broad spectrum of interventions (education, support, reorientation, anxiety-reduction, preoperative medical assessment) may be moderately effective in preventing delirium in surgical patients. DEMENTIA Dementia is the cognitive disorder that include a gradual deterioration of brain functioning that affects judgment, memory, language, and other advanced cognitive processes. Dementia is caused by several medical conditions and by the abuse of drugs and alcohol that cause negative changes in cognitive functioning. Some of these conditions (such as infection or depression) can cause dementia, although it is often reversible through treatment of the primary condition. Although delirium and dementia can occur together, dementia has a gradual progression as opposed to deliriums acute onset; people with dementia are not disoriented or confused in early stages. Like delirium, however, dementia has many causes, including a variety of insults to the brain such as stroke (which destroys blood vessels), the infectious diseases of syphilis and HIV, severe head injury, the introduction of certain toxic or poisonous substances, and diseases such as Parkinson’s, Huntington’s, and the most common cause of dementia, Alzheimer’s disease. CLINICAL DESCRIPTION - In the initial stages, memory impairment is seen as an inability to register ongoing events. - Diana couldn’t find her way home b/c Visuospatial skills are impaired among people with dementia. Agnosia - the inability to recognize and name objects, is one of the most familiar symptoms. Facial agnosia - the inability to recognize familiar faces - Perhaps because victims of dementia are aware that they are deteriorating mentally, emotional changes often occur as well. Common side effects are delusions (irrational beliefs), depression, agitation, aggression, and apathy. - Cognitive functioning continues to deteriorate until the person requires almost total support to carry out day-to-day activities. Ultimately, death occurs as the result of inactivity combined with the onset of other illnesses such as pneumonia. - Results suggest that dementia is a relatively common disorder among older adults, and the chances of developing it increase rapidly after the age of 75. - Five classes of dementia based on etiology have been identified: o Dementia of the Alzheimer’s type o Vascular dementia o Dementia due to other general medical conditions o Substance-induced persisting dementia o Dementia due to multiple etiologies o Dementia not otherwise specified DEMENTIA OF THE ALZHEIMER’S TYPE Chapter 6 – Somatoform Disorders - The DSM diagnostic criteria for dementia of the alzheimer’s type include multiple cognitive deficits that develop gradually and steadily. This includes impairment of memory, orientation, judgment & reasoning. The inability to integrate new information results in failure to learn new associations. They forget important events and lose objects. Their interest in nonrountine activities narrows. They tend to lose interest in others and thus, become socially isolated. As the disorder progresses, they can become agitated, confused, depressed, anxious, or even combative. Many of these difficulties become more pronounced late in the day – referred to as “sundowner syndrome” – maybe resulting from fatigue or a disturbance in the brains bio clock. - People with dementia of the Alzheimer’s type also display one or more other cognitive disturbances, including aphasia (difficulty with language), apraxia (impaired motor functioning), agnosia (failure to recognize objects), or difficulty with activities such as planning, organizing, sequencing, or abstracting info. One example of the language difficulties experienced by people with Alzhiemer’s disease is anomia (problems with naming objects). - A simplified version of a mental status exam, called the Mini Mental State Examination, is used to assess language and memory problems. This simple exam has been shown to be quite accurate in identifying people with dementia. When detecting dementia and Alzheimer’s disease, the clock-drawing subtest of the Clock Test is used to supplement the mental status exam. - Approximately 50% of cases of dementia are found to be the result of Alzheimer’s disease. Those with the least amount of formal education are more likely to develop dementia than those with more education. The cerebral reserve hypothesis suggests that the more synapses a person develops throughout life, the more neuronal death must take place before obvious signs of dementia. Mental activity that occurs with education builds up this reserve of synapses and serves as a protective factor in the development of the disorder. Both skill development & the changes in the brain with education may contribute to how quickly the disorder progresses. - Alzheimer’s disease may be more prevalent among women. Women tend to live longer and likely to experience Alzheimer’s and other diseases. Women lose the hormone estrogen, as they grow older, so perhaps it is protective against the disease. VASCULAR DEMENTIA - The word vascular refers to blood vessels. When the blood vessels in the brain are blocked or damaged and no longer carry oxygen and other nutrients to certain areas of brain tissue, damage results. Many people survive strokes, but one potential long-term consequence is dementia. - DSM lists criteria for vascular dementia the memory and other cognitive disturbances that are identical to those for dementia of the Alzheimer’s type. However, certain neurological signs of brain tissue damage, such as abnormalities in walking & weakness in limbs, are observed in many people with vascular
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