NUR 2488 MENTAL HEALTH EXAM 3 STUDY
GUIDE
Exam 3
Chapter 12
Somatoform Disorders- highest priority nursing interventions (table 12-3 &
12-4) & secondary gains
o Attempt to help the patient improve overall functioning through the
development of effective coping and communication strategies.
Through the use of identification and expression of emotions or
issues, patients no longer rely only on medical symptoms to
unconsciously display their needs.
o Highest priority: Shift focus from somatic symptoms to feelings.
o Secondary gains: benefits derived from the symptoms alone.
Ex: In the sick role, the patient is not able to perform normal
family, work, and social functions and receives extra attention
from loved ones. If a patient derives personal benefit from the
symptoms, relinquishing the symptoms is more difficult.
Hypochondriasis (Illness Anxiety Disorder)- signs/symptoms
o Patients with this disorder may or may not present with somatic
symptoms, and if they do, the symptoms are usually mild.
o Alarmed by the potential implications of any disorder than with the
disorder itself, and are alarmed with any new bodily sensations.
Patients can misinterpret normal physical sensations such as sweating,
abdominal cramping, or awareness of heartbeat as indicative of
disease. Have fears of having a serious disease.
o Exhibit high levels of anxiety and alarm about their health lasting at
least 6 months and may either excessively check for problems or
avoid medical care. It is important to consider other possible
diagnoses such as anxiety disorders.
Conversion Disorder- define and nursing interventions
o Presents with one or more symptoms of impaired motor or sensory
function.
o Causes significant distress to the patient and impaired social or
occupational functioning. Symptoms are further specified as
including weakness or paralysis, abnormal movement, swallowing or
speech difficulties, seizures or attacks, sensory loss or anesthesia, or
symptoms involving the senses (blindness or loss of smell).
, o Demonstrate lack of concern regarding the seriousness of
symptoms.
o Nursing interventions
Use a straight forward approach
Be supportive, yet ASSERTIVE with them
Pt independence is important, they need to be able to take care
of themselves.
Dissociative Fugue
o Often associated with dissociative amnesia, which is amnesia related
to a traumatic accident. Fugue is when the patient flees from their
normal life to another location and starts a new life.
o Gradually over time, memories of the original life may be triggered.
Patients can become confused and embarrassed when the amnesia
subsides and memory returns.
Body Dysmorphic Disorder- care plan, highest priority
o Includes preoccupation with an imagined "defective body part";
obsessional thinking (thinking they are ugly or deformed) and
compulsive behaviors (such as mirror checking, skin picking, or
excessive grooming); and impairment of normal social activities
related to academic or occupational functioning. Individuals with
BDD are frequently concerned with the face, skin, genitalia, thighs,
hips, and hair.
o Individuals with BDD have higher rates of suicidal ideation, suicide
attempts, and completed suicides than individuals who did not meet
criteria for BDD. The disorder is often kept secret for many years, and
the patient does not respond to reassurance. The pharmacological
agents of choice for treating people with BDD are SSRIs,
antidepressants, and clomipramine (tricyclic antidepressant) and
cognitive behavioral therapy. A second-generation antipsychotic
added to an SSRI may help in the more severe delusional form of
BDD.
Chapter 13
Personality Disorders- describe
o Personality disorders range from mild to moderate to severe based on
disturbances in functionality. Their relationships with others are
problematic, and they rarely reach their potential. They are often
socially isolated because of their rigidity, maladaptive coping skills,
, and control issues that complicate their interpersonal as well as
interactions with society.
o These patients can act bizarre, anxious, withdrawn, manipulative, or
violent, and their behaviors tend to alienate them from the population.
Because people with personality disorders are unaware that traits in
their own personality makeup are causing problems, they often blame
others for their difficulties or even deny they have a problem.
o Acknowledge manipulative behavior.
Borderline Personality- characteristics &nursing interventions
o Identify trigger situations and choose coping strategy.
o Feelings of anxiety, dysphonia, and irritability can be intense though
short lived.
o Poor impulse control is evidenced by recurrent suicide attempts, self-
mutilation, and other self-destructive behaviors. Chronic depression is
common.
o The use of the primitive defense mechanism of projected
identification is common in patients with BPD. This occurs when the
person projects on an undesirable aspect of the self.
o Individuals with BPD often exhibit patterns of high emotional
sensitivity, acute responsiveness, and slow return to normal as
"emotional dysregulation." This cycle may lead to feelings of
deadness, panic, and fury as well as self-mutilation and suicide-prone
behaviors. These are common responses to threats of separation or
rejection.
o People with BPD desperately seek relationships to avoid feelings of
abandonment and chronic feelings of emptiness. However, their
excessive demands, impulsive behavior, and/or uncontrolled anger
drives others away. Their relationships are stormy, marked by intense
neediness and lack of trust.
o When relationships end, the person with borderline personality
disorder is often left with feelings of deadness, panic, fury, and
intense abandonment. A person with BPD can experience dissociative
states under stress. Their frequent use of the defense of splitting not
only strains personal relationships but also creates turmoil in health
care settings.
Dependent Personality- describe
o People with dependent personality disorder traits believe they are
incapable of surviving if left alone and have an excess need to receive
GUIDE
Exam 3
Chapter 12
Somatoform Disorders- highest priority nursing interventions (table 12-3 &
12-4) & secondary gains
o Attempt to help the patient improve overall functioning through the
development of effective coping and communication strategies.
Through the use of identification and expression of emotions or
issues, patients no longer rely only on medical symptoms to
unconsciously display their needs.
o Highest priority: Shift focus from somatic symptoms to feelings.
o Secondary gains: benefits derived from the symptoms alone.
Ex: In the sick role, the patient is not able to perform normal
family, work, and social functions and receives extra attention
from loved ones. If a patient derives personal benefit from the
symptoms, relinquishing the symptoms is more difficult.
Hypochondriasis (Illness Anxiety Disorder)- signs/symptoms
o Patients with this disorder may or may not present with somatic
symptoms, and if they do, the symptoms are usually mild.
o Alarmed by the potential implications of any disorder than with the
disorder itself, and are alarmed with any new bodily sensations.
Patients can misinterpret normal physical sensations such as sweating,
abdominal cramping, or awareness of heartbeat as indicative of
disease. Have fears of having a serious disease.
o Exhibit high levels of anxiety and alarm about their health lasting at
least 6 months and may either excessively check for problems or
avoid medical care. It is important to consider other possible
diagnoses such as anxiety disorders.
Conversion Disorder- define and nursing interventions
o Presents with one or more symptoms of impaired motor or sensory
function.
o Causes significant distress to the patient and impaired social or
occupational functioning. Symptoms are further specified as
including weakness or paralysis, abnormal movement, swallowing or
speech difficulties, seizures or attacks, sensory loss or anesthesia, or
symptoms involving the senses (blindness or loss of smell).
, o Demonstrate lack of concern regarding the seriousness of
symptoms.
o Nursing interventions
Use a straight forward approach
Be supportive, yet ASSERTIVE with them
Pt independence is important, they need to be able to take care
of themselves.
Dissociative Fugue
o Often associated with dissociative amnesia, which is amnesia related
to a traumatic accident. Fugue is when the patient flees from their
normal life to another location and starts a new life.
o Gradually over time, memories of the original life may be triggered.
Patients can become confused and embarrassed when the amnesia
subsides and memory returns.
Body Dysmorphic Disorder- care plan, highest priority
o Includes preoccupation with an imagined "defective body part";
obsessional thinking (thinking they are ugly or deformed) and
compulsive behaviors (such as mirror checking, skin picking, or
excessive grooming); and impairment of normal social activities
related to academic or occupational functioning. Individuals with
BDD are frequently concerned with the face, skin, genitalia, thighs,
hips, and hair.
o Individuals with BDD have higher rates of suicidal ideation, suicide
attempts, and completed suicides than individuals who did not meet
criteria for BDD. The disorder is often kept secret for many years, and
the patient does not respond to reassurance. The pharmacological
agents of choice for treating people with BDD are SSRIs,
antidepressants, and clomipramine (tricyclic antidepressant) and
cognitive behavioral therapy. A second-generation antipsychotic
added to an SSRI may help in the more severe delusional form of
BDD.
Chapter 13
Personality Disorders- describe
o Personality disorders range from mild to moderate to severe based on
disturbances in functionality. Their relationships with others are
problematic, and they rarely reach their potential. They are often
socially isolated because of their rigidity, maladaptive coping skills,
, and control issues that complicate their interpersonal as well as
interactions with society.
o These patients can act bizarre, anxious, withdrawn, manipulative, or
violent, and their behaviors tend to alienate them from the population.
Because people with personality disorders are unaware that traits in
their own personality makeup are causing problems, they often blame
others for their difficulties or even deny they have a problem.
o Acknowledge manipulative behavior.
Borderline Personality- characteristics &nursing interventions
o Identify trigger situations and choose coping strategy.
o Feelings of anxiety, dysphonia, and irritability can be intense though
short lived.
o Poor impulse control is evidenced by recurrent suicide attempts, self-
mutilation, and other self-destructive behaviors. Chronic depression is
common.
o The use of the primitive defense mechanism of projected
identification is common in patients with BPD. This occurs when the
person projects on an undesirable aspect of the self.
o Individuals with BPD often exhibit patterns of high emotional
sensitivity, acute responsiveness, and slow return to normal as
"emotional dysregulation." This cycle may lead to feelings of
deadness, panic, and fury as well as self-mutilation and suicide-prone
behaviors. These are common responses to threats of separation or
rejection.
o People with BPD desperately seek relationships to avoid feelings of
abandonment and chronic feelings of emptiness. However, their
excessive demands, impulsive behavior, and/or uncontrolled anger
drives others away. Their relationships are stormy, marked by intense
neediness and lack of trust.
o When relationships end, the person with borderline personality
disorder is often left with feelings of deadness, panic, fury, and
intense abandonment. A person with BPD can experience dissociative
states under stress. Their frequent use of the defense of splitting not
only strains personal relationships but also creates turmoil in health
care settings.
Dependent Personality- describe
o People with dependent personality disorder traits believe they are
incapable of surviving if left alone and have an excess need to receive
