Question Answered step-by-step Study: Conversion Disorder Carol has always been shy. Her parents… Study: Conversion Disorder Carol has always been shy. Her parents were concerned about this when Carol was a child and tried to bring her out of her shyness by involving her with other children, but they were not successful. Carol preferred to be alone and seemed to be perfectly content to be so. When Carol was in college, she took courses that she could study in solitude. The courses that required public participation often sent Carol into feelings of panic. She visited the student health center and the counseling center at the college. The student health center provided her with medication to help her through anxious times, and the counseling center tried to help her with coping strategies to get through the anxiety. When she graduated from college, Carol got a job in the research and development department of a pharmaceutical company. It was the perfect job for Carol. She was able to do her research without much interpersonal interaction with others. However, in the last year-and-a-half, the new supervisor has decided that every 6 months, each member of the research department staff will present his or her works individually to the board of trustees at their semi-annual meetings. Carol panicked the first time she heard this, but with the help of some anti-anxiety medication, she made it through the first presentation. When it was time for her second presentation, she woke up the morning of the meeting and was unable to speak. She presented herself at the emergency room, and her boss was notified of her hospitalization. She was released when nothing physiological could be found. Today is the day of Carol’s scheduled presentation. She has again awakened with the inability to make a sound. She has presented herself to the ER and does not appear to be very concerned about the problem. The admitting emergency room physician cannot find an organic reason for her aphonia. A psychiatrist is notified, and Carol is admitted to the psychiatric unit. Diagnosis: Conversion Disorder, Aphonia.What psychological conflict is Carol exhibiting?How would you treat Carol’s symptoms?Case Study: Somatic Symptom DisorderLois’s psychiatrist has admitted her to the psychiatric unit with a diagnosis of Somatic Symptom Disorder. Lois is 38 years old and has been seeing a psychiatrist off and on since she was 16 years old, when the family was deserted by her father. Lois was the oldest of five children. At that time, Lois was admitted to the hospital by the family physician for “abdominal pain.” No physical etiology was found, and the physician told Lois’s mother that Lois suffered from “nervous stomach.” Over the years, she has been treated on an outpatient basis or hospitalized for chest pain, abdominal pain, backaches, food intolerances, and fatigue. She has had a hysterectomy and a thyroidectomy. She is insisting at this time that she has a problem with her stomach that the doctor is not finding. She is very depressed and tells the nurse, “I can’t stand all this pain. I just can’t understand why the doctor can’t find my problem. I know I’m depressed, but that’s not causing my stomach pain. They need to keep looking for it.” The psychiatrist keeps reassuring Lois that no pathophysiology exists for her pain.What is the criteria for diagnosis for Somatic Symptom Disorder under the DSM 5 manual?What type of psychotherapy would help Loi’s condition?Why would an antidepressant work for Lois? Behaviors Associated with Somatic Symptom Disorders Identify the somatoform disorder associated with the behaviors listed below. Provide a primary nursing diagnosis for each.a. Somatic symptom disorder b. Factitious disorder c. Illness anxiety disorder d. Conversion disorder e. Psychological factors affecting medical condition 1. Fred is overweight, has diabetes, and recently had a mild heart attack. The doctor told him that he must make changes in his diet, or he will have another, more serious heart attack, from which he may not recover. Fred ignores his doctor’s advice, and says, “There’s not anything wrong with the way I eat!” The psychiatric home health nurse develops a care plan for Fred.Nursing diagnosis: _____________________________________________________________________ 2. Phyllis lives alone. She has no close relatives or friends, and she is very lonely. She presents to the emergency department with blood in her urine. She reports to the admitting nurse that she has had a rare bleeding disorder since childhood. On her third hospital day, she is recognized by a consulting physician from another hospital, who tells the nurse that Phyllis was seen for the same reason at his hospital just three weeks ago. A search of Phyllis’s belongings reveals a large container of anticoagulant medication. When she is questioned about it, she admits to having taken a large dose. She has been transferred to the psychiatric unit.Nursing diagnosis: ____________________________________________________________________ 3. Franklin is assigned to secure a contract for his company. The boss tells Franklin, “If we don’t get this contract, the company may have to fold.” When Franklin wakes up on the morning of thenegotiations, he is unable to see. The doctor in the ER has ruled out organic pathology. Franklin is transferred to the psychiatric unit.Nursing diagnosis: ____________________________________________________________________ 4. Sarah has had what she calls a “delicate stomach” for years. She has sought out many physicians with complaints of nausea and vomiting, abdominal pain, bloating, and diarrhea. No organic pathology can be detected. She has been admitted to the psychiatric unit and says to the nurse, “This is ridiculous. I don’t belong here with these crazy people. I need to be on the medical floor!”Nursing diagnosis: ____________________________________________________________________ 5. John’s father died of a massive myocardial infarction when John (now age 34) was 15 years old. The two of them were playing basketball at the time. Since then, John becomes panicky when he feels his heart beating faster than usual. He takes his pulse several times a day and gets a physical exam several times a year. He has been referred to the psychiatric nurse practitioner in the mental health clinic.Nursing diagnosis ____ Behaviors Associated with Dissociative Disorders Identify which dissociative disorder is associated with the behaviors listed below. a. Localized amnesia d. Dissociative amnesia with dissociative fugue b. Selective amnesia e. Dissociative identity disorder c. Generalized amnesia f. Depersonalization-derealization disorder 1. A young man is brought into the emergency department by the police. He does not know who he is or anything at all about his life. 2. A young man is brought into the emergency department by the police. He gives his identity and home address (which is several hundred miles away) to the admissions clerk. He tells the nurse he is very frightened, because he doesn’t know when or how he came to be in this place. 3. Sandra is a clerk in an all-night convenience store. Three nights ago, the store was robbed at gunpoint, and Sandra was locked in a storage compartment for several hours until the manager was contacted by passersby who reported the robbery. She has been unable to recall the incident until just today, when details began to emerge. She is now able to report the entire event to the authorities. 4. Sam is a salesman for a leading manufacturing company. His job requires that he make presentations for large corporations that are considering Sam’s company product. Sam is up for promotion and realizes that the outcomes of these presentations will weigh heavily on whether or not he gets the promotion. Lately, he has been worried that he is going insane. Each time he is about to make a presentation, his thinking becomes “foggy,” his body feels lifeless, and he describes the feeling as being somewhat “anesthetized.” These episodes sometimes last for hours and are beginning to interfere with his performance. 5. Melody’s husband complained of severe chest pain. Melody called the ambulance and accompanied her husband to the hospital. He died of a massive myocardial infarction in the emergency department.With the help of family and friends, Melody made arrangements for the memorial service and the burial. Now that it is all over, Melody is able to remember only certain aspects about what has occurred since her husband first experienced the severe pain. She remembers the doctor telling her that her husband was dead, but she cannot remember attending the funeral service. 6. Margaret explains to the nurse that during the last year, she has had periods of time for which she cannot account. She has been attending college, and she finds pages of notes in her notebook that she cannot recall writing. Her roommate recently recounted an incident that took place when they were supposedly out together, for which Margaret has no recall. Recently, she was hospitalized when her roommate found her unconscious in their room with an empty bottle of sleeping pills beside her. She tells the nurse she has no memory of taking the pills.1. Past experience with serious or life-threatening physical illness, either personal or that of a close family member, can predispose an individual to what somatic symptom disorder? 2. In an individual with dissociative identity disorder, what most commonly precipitates transition from one personality to another? 3. Conversion symptoms most commonly occur in an individual for what reason? 4. Somatic symptom and dissociative disorders are the physical/behavioral responses to what unconscious phenomenon? Health Science Science Nursing Share QuestionEmailCopy link Comments (0)
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