Presentation on somatoform & sleep disorder, psychiatric nursing/mental health nursing.

1. Presented by,
Ms. Harshitha
M.Sc (N)

3. Somatization Disorder :
The process by which psychological needs are expressed in the
form of physical symptoms. Somatization is thought to be
associated with repressed anxiety.
Somatization disorder is a syndrome of multiple somatic symptoms
that cannot be explained medically and are associated with
psychosocial distress and long-term seeking of assistance from
healthcare professionals.

4. Predisposing factors :
• Theory of family dynamics
• Cultural and environmental factors
• Genetic factors

6. Pain Disorder :
The essential feature of pain disorder is severe and prolonged pain
that causes clinically significant distress or impairment in social,
occupational, or other important areas of functioning (APA, 2000).
Additional psychological implications may be supported by the facts
that (1) appearance of the pain enables the client to avoid some
unpleasant activity [primary gain] and (2) the pain promotes
emotional support or attention that the client might not otherwise
receive [secondary gain].

7. Predisposing factor
• Psychodynamic Theory
• Behavioral Theory
• Theory of family dynamics
• Neurophysiological Theory

8. Hypochondriasis :
Hypochondriasis may be defined as an unrealistic or inaccurate
interpretation of physical symptoms or sensations, leading to
preoccupation and fear of having a serious disease.
Individuals with hypochondriasis often have a long history of “doctor
shopping” and are convinced that they are not receiving the proper
care.

10. Predisposing factor :
• Psychodynamic Theory
• Cognitive Theory
• Social Learning Theory
• Past experiences with physical illness
• Genetic influences

11. Conversin Disorder :
Conversion disorder is a loss of or change in body function resulting
from a psychological conflict, the physical symptoms of which
cannot be explained in terms of any known medical disorder or
pathophysiological mechanism. Clients are unaware of the
psychological basis and are therefore unable to control their
symptoms.

13. Predisposing factor :
• Psychoanalytical Theory
• Familial Theory
• Neurophysiological Theory
• Behavioral Theory

14. Body Dysmorphic Disorder :
This disorder, formerly called dysmorphophobia, is characterized by
the exaggerated belief that the body is deformed or defective in
some specific way. The most common complaints involve imagined
or slight flaws of the face or head, such as thinning hair, acne,
wrinkles, scars, vascular markings, facial swelling or asymmetry, or
excessive facial hair (APA, 2000).

16. Predisposing factor :
• The etiology of body dysmorphic disorder is unknown.
• Body dysmorphic disorder has also been defined as the fear of
some physical defect thought to be noticeable to others although
the client appears normal. These interpretations suggest that the
disorder may be related to predisposing factors similar to those
associated with hypochondriasis or phobias.

17. Sleep Disorders :
Sleep can be regarded as a physiological reversible reduction of
conscious awareness.

18. Insomnia :
Insomnia refers to disorder of initiation and maintenance of sleep.
This includes frequent awakening during the night and early
morning awakening.

19. Hypersomnia :
Hypersomnia is known as Disorder of Excessive Somnolence
(DOES). It includes excessive day-time sleepiness, sleep attacks
during daytime, sleep drunkenness (person needs much more time
to awaken, and during this period he is confused or disoriented).

20. Narcolepsy:
Excessive daytime sleepiness
characterized by:
• Sleep attacks
• Cataplexy—Sudden decrease or loss of (sleep paralysis) muscle
tone, often generalized and may lead on to sleep.
• Sleep paralysis—It occurs either at awakening in morning or at
sleep onset. The person is conscious but unable to move
his body.
• Hypnagogic hallucinations.

21. Parasomnias :
Parasomnias are unusual to undesirable behaviors that occur during
sleep.

22. Nightmare disorder :
Nightmares are frightening dreams that lead to awakening from
sleep.
Nightmares are clearly remembered in the morning.

23. Sleep terror disorder :
The patient suddenly gets up screaming with autonomic arousal
(tachycardia, sweating and hyperventilation). He may be diffi cult to
arouse and rarely recalls the episode on awakening

24. Sleep walking :
The patient carries out automatic motor activities that range from
simple to complex. He may leave the bed, walk about or leave the
house. Arousal is diffi cult and accidents may occur during sleep-
walking.

25. Circadian rhythm :
Circadian rhythm sleep disorders can be described as a
misalignment between sleep and waking behaviors. The normal
sleep-wake schedule is disrupted.

26. Shift work type
‘Work-shift’ from day to night or vice-versa. Shift workers who
experience rapid and repeated changes in their work schedules.

27. Jet lag type :
This typically occurs during international flights crossing many ‘time
zones’. At the new place, the person’s internal time of sleep and
the sleep time of surroundings are different, leading to insomnia
during
the new sleep time and somnolescence in the new daytime, thus
causing impairment of functioning.

28. Delayed sleep phase type :
Some persons are unable to sleep early. They typically sleep late
at night and get up late in the morning. They are called as ‘ owls’.
Others are similarly unable to remain awake at night. They
typically sleep early at night and get up early in the morning. They
are called
as ‘ larks’. Some others have a longer-than 24 hour sleep-wake
cycle (usually of 25 hours).

29. Predisposing factor :
 Genetic or familial patterns are thought to play a contributing role.
 A number of medical conditions, as well as aging, have been
implicated in the etiology.
 Environmental conditions that can contribute to sleep disorders.

30. Treatment modalities : (Somatoform disorder)
• Individual Psychotherapy
• Group Psychotherapy
• Behavior Therapy
• Psychopharmacology

31. Treatment modalities: (Sleep disorder)
Primary Insomnia -
• Relaxation Therapy
• Biofeedback
• Pharmacotherapy
Primary Hypersomnia/ Narcolepsy -
• Pharmacotherapy

32. Parasomnias -
• Measures to relieve stress
• Family or Individual Therapy
• Pharmacological interventions
Sleep-wake schedule disturbances -
• Treated with behavior modification - train himself/ herself to adapt
to the change in schedule.
• Phototheraphy - require 30mins to 2hrs of daily exposure to bright
light.

33. Somatoform disorders, known historically as hyseria. The
person with somatization disorder has physical symptoms
that may be vague, dramatized, or exaggerated in their
presentation.

34. Reference
• Townsend M C. Somatoform & sleep disorder, 5th ed.
:Jaypee brothers
• Vyas JN, Niraj A. Textbook of post graduate psychiatry.
New Delhi: Jaypee brothers.
• Ahuja N. A short textbook of psychiatry, 7th ed. New
delhi: Jaypee brothers; 2011.
• Sreevani R. A guide to Mental Health & psychiatric
nursing, 3rd ed. New delhi: Jaypee brothers.