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Psychosomatic disorders

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psychosomatic illness in psychiatric nursing

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Psychosomatic disorders

  1. 1. PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITIONS PRESENTED BY:- PRIYANKA MARWAHA
  2. 2. INTRODUCTION • Psychological factors can influence physical health either indirectly, by changing behaviors that affect our health, such as eating, sleeping and socializing, or directly, by producing changes in our hormones and/or heart rate. Additionally, the mind can interact with the benefits of a medicine, reducing the effectiveness of a certain drug or worsening the negative symptoms associated with certain medical conditions. • Psychosomatic (psychophysiological) medicine has been a specific area of study within the field of psychiatry for more than 75 years. It is informed by two basic assumptions: There is a unity of mind and body (reflected in the term mind-body medicine); and psychological factors must be taken into account when considering all disease states.
  3. 3. CONT... • Concepts derived from the field of psychosomatic medicine influenced both the emergence of complementary and alternative medicine (CAM), which relies heavily on examining psychological factors in the maintenance of health, and the field of holistic medicine with its emphasis on examining and treating the whole patient, not just his or her disease or disorder. • The concepts of psychosomatic medicine also influenced the field of behavioral medicine, which integrates the behavioral sciences and the biomedical approach to the prevention, diagnosis, and treatment of disease. Psychosomatic concepts have contributed greatly to those approaches to medical care.
  4. 4. DEFINITION • A group of ailments in which emotional stress is a contributing factor to physical problems involving an organ system under involuntary control. Bimla kapoor 1994
  5. 5. CONT.. • Disorders in which psychic elements are significant in initiating alteration in chemical, physiological or structure of the individual resulting in physical symptoms. Sreevani R
  6. 6. PSYCHOLOGICAL BIOLOGICAL SOCIAL PERSONALITY ETIOLOGICAL FACTORS
  7. 7. PSYCHE-SOMA INTERACTION • Mind–body interactions have long been a focus of interest, both in health and in disease. Psychiatric illness and medical disease frequently coexist. • A more modern approach has been to recognize that all medical illnesses are potentially affected by many different factors in the biological, psychological, and social realms.
  8. 8. DSM-IV- TR CRITERIA FOR PSYCHOLOGICAL FACTORS AFFECTING GENERAL MEDICAL CONDITION • A general medical condition (coded on Axis III) is present. • Psychological factors adversely affect the general medical condition in one of the following ways: • the factors have influenced the course of the general medical condition as shown by a close temporal association between the psychological factors and the development or exacerbation of, or delayed recovery from, the general medical condition • the factors interfere with the treatment of the general medical condition • the factors constitute additional health risks for the individual • stress-related physiological responses precipitate or exacerbate symptoms of the general medical condition •
  9. 9. CONT.. • These psychological factors include: • Mental disorders (e.g., Major Depressive Disorder) • Psychological symptoms (e.g., depressed mood or anxiety) • Personality traits or coping style (e.g., denial of need for medical care) • Maladaptive health behaviors (e.g., smoking or overeating) • Stress-related physiological responses (e.g., tension headaches) • Other unspecified psychological factors (e.g., interpersonal or cultural factors)
  10. 10. ASTHMA • Asthma affects between 3-5 per cent of the population. The three hallmarks of the disease are airway inflammation, airway hyper-responsiveness, and a partially reversible airway obstruction. Definition • Asthma is a disorder of the bronchial airways characterized by inflammation of the mucosal lining of the bronchial tree and spasm of the bronchial smooth muscles, which caused narrow airways and air trapping. Epidemiology • It affects 22 million Americans, including approximately 9 million children younger than age 18 (Centers for Disease Control [CDC], 2007). Asthma may occur at any age, although it is more common in individuals younger than 40 years of age.
  11. 11. PREDISPOSING FACTORS • Biological Influences • Allergies • Psychosocial influences Induced by emotional stress. Individuals with asthma are characterized as having excessive dependency needs Personality characteristics, including fears, emotional lability, increased anxiety, and depression.
  12. 12. SIGNS AND SYMPTOMS Asthma is characterized by episodes of bronchial constriction resulting in • Dyspnoea • Wheezing • Productive cough • Restlessness, • Eosinophilia • Expiration is prolonged • Breathing reflects use of accessory muscles. • Tachypnea, nasal flaring are common. • The individual is usually diaphoretic and quite apprehensive, with total attention focused on his or her breathing.
  13. 13. TREATMENT MODALITIES • Bronchodilators • Beta-adrenergic agonists such as albuterol, metaproterenol. • Oral administration of Theophylline and other Methylxanthines are also used, but it produces more side effect than inhalers. • Corticosteriods
  14. 14. PSYCHO THERAPY • Psycho therapist focuses on attitudes and emotions and helping the client to progress with the separation- individuation process.
  15. 15. CANCER • Many health professionals and lay people believe that psychological factors play a major role in cancer onset and progression. The media have promoted popular ideas of overcoming cancer through “mind over body.” Definition • Cancer is a malignant neoplasm in which the basic structure and activity of the cells have become deranged, usually because of changes in the DNA. • These mutated cells grow widely and rapidly and lose their similarity to the original cells. The malignant cells spread to other areas by invading surrounding tissues and by entering the blood and lymphatic system.
  16. 16. EPIDEMIOLOGY • Cancer is the second leading cause of death in the United States. However, 5-year survival rates have increased as a result of early diagnosis and treatment and the improvement of treatment modalities for most cancers. The largest number of deaths from cancer in both men and women is attributed to cancer of the lung (American Cancer Society [ACS], 2007).
  17. 17. PREDISPOSING FACTORS Biological influences: • Hereditary factors • Certain cancers, such as those of the stomach, breast, colon, kidney, uterus, and lung tend to occur in a familial pattern. Continuous irritation also predispose individuals to certain types of cancer. e.g: chronic exposure to sun is thought to predispose to melanoma. • Environmental factors • Exposure to occupational or environmental carcinogens leads to specific cancers. Examples include cigarette smoke, aniline dye, radium, arsenic, chromate, uranium, and asbestos. Various drugs such as immunosuppressive agents, diethylstilbestrol, oral contraceptives, cytotoxic agents, and radioisotopes may also predispose individuals to specific cancer.
  18. 18. PSYCHOSOCIAL INFLUENCES • Cancer is also known as “nice guy’s disease”. It is more common among people with type C personality. Type C personality characteristics include; • Suppress anger and hostility to an extreme • Express a calm • Commonly feels depressed and in despair • Has low self-esteem, low self-worth • Put others’ needs before his or her own • Has a tendency towards self-pity • Sets unrealistic standards and is inflexible in the enforcement of these standards
  19. 19. SIGNS AND SYMPTOMS Early warning signs of cancer include: • Thickening or lump in the breast or any other part of the body • Obvious change in a wart or mole • A sore that doesn’t heal • Nagging cough or hoarseness • Changes in bowel or bladder habits • Indigestion or difficulty swallowing • Unexplained changes in weight • Unusual bleeding or discharge
  20. 20. LATE STAGE CANCER SYMPTOMS INCLUDE: • Anaemia, • Infection • Thrombocytopenia • Cachexia • Weakness • Weight loss • Dyspnoea • Ascites • Pleural effusion
  21. 21. TREATMENT 1) Surgery 2) Radiation therapy 3) Chemotherapy 4) Psychotherapy
  22. 22. PSYCHOTHERAPY It is helpful to cancer prone individual with type C personality. The individual must learn to express the feelings and emotions that have been suppressed. Some studies indicate a decrease in mortality rate in cancer patients who experience a reduction of anxiety, depression, and traumatic stress (Levenson, 2003).
  23. 23. 5) PSYCHOSOCIAL INTERVENTION AND CANCER OUTCOME • A number of studies have shown improvement in the quality of life in cancer patients receiving group therapy, including improved mood and vigor, decreased pain, and better adjustment (Trijsburg et al. 1992 , Andersen 1992 , Fawzy et al. 1993 , Spiegel et al. 1981 , Goodwin et al. 2001). • The possibility that a psychological intervention might improve longevity in metastatic breast cancer patients was exciting, supported initially by some studies (e.g., Spiegel et al. 1989 , Cunningham et al. 1998 ), but not by the definitive replication study (Goodwin et al. 2001) as well as some others. Thus the evidence to date suggests that patients with cancer can be told that group therapy contributes to living better, not necessarily longer.
  24. 24. 6) AUTOGENIC RELAXATION AND MENTAL IMAGERY • Simonton and Simonton reported positive results with autogenic relaxation and mental imagery in the role of adjunct therapy for clients with malignant disease.
  25. 25. C) CORONARY HEART DISEASE Introduction Coronary heart disease is also called coronary artery disease or ischemic heart disease. The presence of major depressive disorder in a patient with cardiac disease has a significant impact on morbidity and mortality. Carney et al. found that major depressive disorder was the best single predictor of myocardial infarction, angioplasty, and death during the 12 months following cardiac catheterization. Patients with a history of myocardial infarction and major depressive disorder are five times more likely to die within 6 months of discharge than non-depressed patients following infarction.
  26. 26. PREDISPOSING FACTORS Hereditary factors Environmental factors Psychosocial factors
  27. 27. CHARACTERISTICS OF TYPE A PERSONALITY INCLUDE: • Having easily aroused hostility that is usually kept under control but flares up unexpectedly, often when others would consider it as unwanted. • Being very aggressive, very ambitious, concentrating almost exclusively on his/her career. • Having no time for hobbies, and during any leisure time, feeling guilty just relaxing as if wasting time. • Seldom feeling satisfied with accomplishments; always feeling must do more. • Measuring achievements in numbers produced and money earned • Continually struggling to achieve and feeling there is never enough time • Appearing to be very extroverted and social; often dominating conversation; having an outgoing personality but often concealing a deep seated insecurity about one’s own worth. • Experiencing driving ambition and the need to win.
  28. 28. CONT… According to Denollet, (1997) CHD is associated with type D personality (distressed personality). Individuals with type D personality have a tendency to experience negative emotions such as anger, anxiety, depression, worry, and hopelessness and the inability to express feelings in social situations.
  29. 29. SIGNS AND SYMPTOMS • Myocardial ischemia. Myocardial ischaemia often leads to myocardial infarction. Acute myocardial infarction can develop at rest or with normal activity, and can be the first clinical manifestation of coronary heart disease. • Angina pectoris can occur spontaneously in relation to increased myocardial oxygen demand. Characteristics of pain associated with angina include squeezing, burning, pressing, chocking, aching or bursting pressure. The discomfort of angina lasts for 2 to 5 minutes, sometimes as long as 15minutes and rarely as long as 30 minutes. • Pain associated with myocardial infarction is similar to that experienced in angina, but lasts longer than 15 to 30 minutes. Symptoms include nausea, vomiting, diaphoresis, syncope, palpitation, dyspnoea. Up to one third of people experiencing MI will not experience chest pain. This phenomenon is more prevalent among elderly population, in women, and in clients with diabetes.
  30. 30. TREATMENT • Surgical interventions with CABG • Percutaneous transluminal coronary angioplasty (PTCA) • Intervention with chemotherapeutic agents is common in the treatment of CHD. Vasodilators, beta-adrenergic blocking agents (e.g., propranolol) and calcium channel blockers (e.g., verapamil, diltiazem) to treat angina and hypertension; and antihyperlipidemic agents (e.g., simvastatin, atorvastatin, gemfibrozil) to lower serum lipid levels are commonly prescribed. • A combination of education, interpersonal counselling, and behavioural modifications have been showed positive outcomes in reduction of type A behaviours.
  31. 31. PEPTIC ULCER • Peptic ulcer disease occurs when the balance between stomach acid and mucosal defence factors is disrupted. Peptic ulcers are an erosion of mucosal wall in the esophagus, stomach, duodenum, or jejunum. Deeper lesions may penetrate the mucosal layer and extend into the muscular layers of intestinal wall. Epidemiology • Peptic ulcers occur four times more frequently in men than in women. The disease occurs in approximately 10 percent of the population, and peak ages have been identified as 40 to 60 years.
  32. 32. PREDISPOSING FACTORS • Biological influences • Environmental factors • Psychological influences There is an increased gastric secretion and motility in the presence of hostility, resentment, and frustration (Karren et al., 2002). Ulcer prone individuals tend to have an unhealthy attachment to others, they are dependent by nature, and they perceive that they have few people on whom they can depend in times of crisis. They are excessive worriers and pessimists. Anxiety and depression are common among ulcer prone individuals. •
  33. 33. SIGNS AND SYMPTOMS • Pain is the characteristic clinical manifestation of peptic ulcer disease. • It is usually experienced in the upper abdomen near the midline, and may radiate to the back, sternum, or lower abdomen. • Pain is usually worse when the stomach is empty and gastric secretions are high. • Food or antacid medications often relieve the pain Treatment modalities • The focus of treatment for peptic ulcer is to alleviate symptoms, promote healing, and prevent complications or recurrence
  34. 34. MANAGEMENT Pharmacological interventions • Antacids • Antisecretory agents • Histamine H2 antagonists • Proton pump inhibitors • Anticholinergics • Cytoprotective agents • Antibiotics and anti-infectives to treat H. pylori infection. Dietary management
  35. 35. CONT…. Surgical interventions • Gastrectomy • Vagotomy • Pyloroplasty Psychotherapy • Psychotherapy with ulcer clients focuses on troublesome conflicts such as passivity, dependency, aggression, anger, and frustration. It has been beneficial with ulcer clients whose personality characteristics, ego strength, and coping mechanisms favour increased vulnerability to stress. • Peptic ulcer clients should be screened for anxiety characteristics. • CBT can help patients feel a greater sense of mastery over feared calamities and less helpless and overwhelmed. Clinicians also should identify depression, overuse of NSAIDs, alcohol abuse, smoking, job stress, and other psychosocial factors that may aggravate peptic ulcer for appropriate therapeutic intervention. (Levenson 2003)
  36. 36. ESSENTIAL HYPERTENSION Definition • It is the persistent evaluation of blood pressure for which there is no apparent cause or associated underlying disease (Fanning & Lewis,2003). It is a major cause of cerebrovascular accident (Stroke), cardiac disease, and renal failure. Epidemiological statistics • Approximately 30% of the adult population in the United States is hypertensive. (American Heart Association, 2005). Because hypertension is often asymptomatic it is estimated that 30% of persons with hypertension do not know they have it. • The disorder is more common in men than in women and is twice as prevalent in the African American population as it is in the white population.
  37. 37. PREDISPOSING FACTORS • Biological influences • Physiological influences • Environmental factors • Psychosocial influences • Karren and associates (2002) report on studies that suggest there is a correlation between suppressed anger and hypertension. • Some psychoanalyst believes this may be associated with childhood rearing that forbade expression of angry feelings. Several studies showed consistent results of a significant relationship between suppressed anger and elevated blood pressure.
  38. 38. SIGNS AND SYMPTOMS • Most commonly hypertension produces no symptoms, particularly in the early stages. When symptoms do occur, they may include • headache • Vertigo • Flushed face • Spontaneous nosebleed • Blurred vision. • Chronic progressive hypertension may reveal signs and symptoms associated with specific organ system damage.
  39. 39. TREATMENT • Dietary modification • Weight reduction and sodium restriction. • Decrease the intake of caffeine, alcohol, saturated fats. • Environmental factors Individuals with hypertension should not smoke. • Physical exercise • Increased physical activity (e.g: 30 to 45 minutes of brisk walking three to five times a week) has been shown to lower blood pressure in some patients.
  40. 40. MIGRAINE (VASCULAR) AND CLUSTER HEADACHES • Migraine (vascular) headache is a disorder characterized by recurrent unilateral headaches, with or without related visual and gastrointestinal disturbances (e.g., nausea, vomiting, and photophobia).
  41. 41. PREDISPOSING FACTORS Biological Influence • Functional disturbance in the cranial circulation. • Can be precipitated by cycling estrogen, which may account for their higher prevalence in women. • Some foods, beverages and drugs individuals like caffeine, chocolate, cheese, vinegar, organ meats, alcoholic beverages, etc can precipitate migraine in certain.
  42. 42. CONT… Psychological influences • Stress is also a precipitant, and many persons with migraine are overly controlled, perfectionists, and unable to suppress anger. Cluster headaches are related to migraines. • They are unilateral, occur up to eight times a day.
  43. 43. TREATMENT • Migraines and cluster headaches are best treated during the prodromal period with ergotamine tartrate (Cafergot) and analgesics. • Prophylactic administration of propranolol or verapamil (Isoptin) is useful when the headaches are frequent. • Sumatriptan (Imitrex) is indicated for the short-term treatment of migraine and can abort attacks. SSRIs are also useful for prophylaxis. • Psychotherapy to diminish the effects of conflict and stress and certain behavioral techniques (e.g., biofeedback) have been reported to be useful.
  44. 44. CONT… Pharmacotherapy • Pharmacological intervention may be with a diuretic, beta-blocker, calcium channel blocker, or angiotensin converting enzyme (ACE) inhibitor. Supportive psychotherapy • Supportive psychotherapy, during which the individual is encouraged to express honest feelings, particularly anger, may also be helpful.
  45. 45. RELAXATION THERAPY • Rhythmic breathing • Deep breathing • Visualized breathing • Progressive muscle relaxation • Relax to music • Mental imagery relaxation
  46. 46. POSITIVE STATEMENTS TO BE PRACTISED • Let go of things, i cannot control • I am healthy, vital and strong • All my need are met • I am completely and utterly safe • Everyday in every way i am getting stronger
  47. 47. CONT.. • Hypnosis • Biofeedback • Cognitive behavior therapy
  48. 48. RHEUMATOID ARTHRITIS Definition • Rheumatoid arthritis is a disease characterized by chronic musculoskeletal pain arising from inflammation of the joints. The disorder's significant causative factors are hereditary, allergic, immunological, and psychological.
  49. 49. PREDISPOSING FACTORS Biological influences: • Heredity appears to be influential in the predisposition to rheumatoid arthritis .The serum protein rheumatoid factor is found in at least half of people with rheumatoid arthritis and frequently in their close relatives .Rheumatoid arthritis affects people with a family history of the disease two to three times more often than the rest of the population • An additional theory postulates that rheumatoid arthritis may be the result of a dysfunctional immune mechanism initiated by an infectious process although the causative agent is yet to be identified
  50. 50. PSYCHOLOGICAL INFLUENCES: • Rheumatoid arthritis clients are postulated to be self sacrificing ,anxious, unassertive, inhibited and perfectionistic with an inherent inability to express anger .Female rheumatoid clients are described as nervous ,tense, worried ,moody and depressed and typically had mothers whom they felt rejected them and fathers who were unduly strict . • Stress can predispose patients to rheumatoid arthritis and other autoimmune diseases by immune suppression. • Depression is comorbid with rheumatoid arthritis in about 20 percent of individuals. Individuals with rheumatoid arthritis and depression commonly demonstrate poorer functional status, and they report more of the following: painful joints, pronounced experience of pain, health care use, bed days, and inability to work than do patients with similar objective measures of arthritic activity without depression.
  51. 51. TREATMENT: • Pharmacological Treatment: • Psychotropic agents may be of use in some patients. Sleep, which is often disrupted by pain, can be assisted by the combination of a nonsteroidal anti-inflammatory drug (NSAID) and trazodone (Desyrel) or mirtazapine (Remeron), with appropriate cautionary advice regarding orthostatic hypotension. • Tricyclic drugs exert mild anti-inflammatory effects independent of their mood-altering benefit; however, anticholinergic effects (prominent among the tricyclic drugs and also present with some serotonergic agents) can aggravate dry oral and ocular membranes in some patients with the disorder.
  52. 52. SURGICAL TREATMENT: • Various surgical treatments are available for clients with rheumatoid arthritis. • Synovectomy is performed to relieve pain and maintain muscle and joint balance .Joint fusion may provide stability to a joint and decrease deformity . • Spinal fusion may be necessary to treat subluxation. • Total joint replacement is performed to restore motion to a joint and function to the muscles ,ligaments and other soft tissue structures that control a joint.
  53. 53. THERAPIES • Relaxation therapy • Biofeedback • Cognitive behavior therapy • Coping skills training
  54. 54. PSYCHOLOGICAL TREATMENT: • Psychotherapy and prompt recognition and treatment of psychiatric morbidity may help clients cope and adapt to this condition. A client’s initial reaction to the diagnosis of rheumatoid arthritis depends on the degree of incapacity at the time and the immediate threat to his or her lifestyle. • Depression may need to be treated separately . • Clients should be encouraged to function as independently as possible. • The focus on cure should be deflected to a focus on control of the disease and prevention of disability
  55. 55. ULCERATIVE COLITIS • Ulcerative colitis is an inflammatory bowel disease affecting primarily the large intestine. • The cause of ulcerative colitis is unknown. • The predominant symptom of ulcerative colitis is bloody diarrhea. Extracolonic manifestations can include uveitis, iritis, skin diseases, and primary sclerosing cholangitis.
  56. 56. PREDISPOSING FACTORS Biological Influences: • A genetic factor may be involved in the development because individuals who have a family member with ulcerative colitis are at greater risk than the general population. • The possibility that ulcerative colitis may be an autoimmune disease has generated a great deal of research interest .High rates of anticolon antibodies are found in relatives of ulceratives colitis clients.
  57. 57. PSYCHOSOCIAL INFLUENCES: • Predominance of obsessive compulsive traits. They are neat ,orderly ,punctual and have difficulty expressing anger. • A pathological mother child relationship resulting in feelings of helplessness and hopelessness has also been implicated . • Stressful life events or psychological trauma. • The altered immune status that accompanies psychological stress may be an influencing factor in predisposed individuals.
  58. 58. TREATMENT: Nutritional Therapy • A low residue diet is initiated and advanced as tolerated with one food added at a time. Milk may be a problem for some clients. • Total parenteral nutrition may be necessary. Pharmacological Treatment • Sulfasalazine which appears to have both anti-inflammatory and antimicrobial properities. • Severe forms of the disease are treated with corticosteroids eg hydrocortisone, prednisone, prednisolone. • Antibiotics eg metronidazole, ciprofloxacin may be administered when an infectious process is present.
  59. 59. PSYCHOLOGICAL SUPPORT • Psychological support may help to decrease the frequency of these attacks by helping the individual to recognize the stressors that precipitate exacerbations and identify more adaptive ways of coping . • Feels a lack of control over his or her life . • Psychological support may help the client cope with feelings of insecurity ,dependency, and depression .It is extremely important that the individual express feelings of repressed or suppressed anger and hostility.
  60. 60. THERAPIES • Psychoanalytic psychohterapy • Relaxation therapy • Cognitive behavior therapy 1.Individual CBT 2.Group CBT
  61. 61. TREATMENT OF PSYCHOSOMATIC DISORDERS • A major role of psychiatrists and other physicians working with patients with psychosomatic disorders is mobilizing the patient to change behavior in ways that optimize the process of healing. This may require a general change in lifestyle (e.g., taking vacations) or a more specific behavioral change (e.g., giving up smoking). Whether or not this occurs depends in large measure on the quality of the relationship between doctor and patient. • Failure of the physician to establish good rapport accounts for much of the ineffectiveness in getting patients to change. • Ideally, both physician and patient collaborate and decide on a course of action. At times this may resemble a negotiation in which doctor and patient discuss various options and reach a compromise about an agreed-on goal. Aaron Lazare described specific negotiating strategies to achieve behavioral changes:
  62. 62. CONT… • Direct education Explain the problem, goals, and methods to achieve goals. Education must be geared to the patient's socioeconomic level and cultural traditions. If the patient has questions, they should be answered frankly. Explanations in keeping with the patient's capacity to understand should be given. Such factors as intelligence, sophistication in regard to personality reactions, and degree and type of illness should influence the vocabulary and content of the physician's response. Every effort should be made to convey to belligerent patients both understanding and tolerance for their feelings. • Third-party intervention Family members, friends, and other clinicians can provide support and encourage the patient to follow a course of action. This may occur in a group setting, which is especially effective in motivating patients who have substance abuse problems to obtain treatment (called an intervention). • Exploration of options. There may be alternative methods for achieving a desired goal. For example, quitting smoking can be done with support groups, nicotine patches or gum, psychotropic drugs
  63. 63. CONT… • Provision of sample treatment If a patient fears a particular course of action or considers change impossible, a treatment trial can be implemented. The patient always may opt out of the prescribed program. • Control sharing. Some patients resent any approach that appears to be authoritarian. They may wish to set the pace of a withdrawal program or titrate their medication depending on adverse effects.
  64. 64. CONT.. • Concession making The clinician may grant the patient something that he or she wants (e.g., medication) as a bargaining chip to get the patient to comply with advice. • Empathic confrontation Patients who resist change may do so because of fear or other uncomfortable emotions of which they are unaware. The doctor can try to step into the patients' shoes• in an effort to raise their level of awareness. Doctors should be prepared to answer the patient's question
  65. 65. CONT… • Standard setting Guidelines or standards (sometimes called milestones) should be set to evaluate the progress of an agreed-upon program (e.g., the loss of 1 pound of weight every 2 weeks to achieve a weight loss of 10 pounds in 20 weeks). • In rare cases in which negotiations break down and an impasse is reached it may be necessary to threaten to terminate the relationship
  66. 66. STRESS MANAGEMENT • Self-observation • Cognitive restructuring • Relaxation training • Time management • Problem-solving.
  67. 67. RELAXATION TRAINING • JPMR • Benson relaxation therapy • Hypnosis • Biofeedback
  68. 68. TIME MANAGEMENT They may be asked to list the important areas in their lives and, then, asked to provide two time estimates: (1) the amount of time they currently spend engaging in these activities and (2) the amount of time they would like to spend engaging in these activities. Frequently, a substantial difference is seen in the time individuals would like to spend on important activities and the amount of time they actually spend on such activities. With awareness of this difference comes increased motivation to make changes.
  69. 69. PROBLEM SOLVNIG • The final step is problem-solving in which patients basically try to apply the best solution to the problem situation and then review their progress with the therapist.
  70. 70. NURSING MANAGEMENT
  71. 71. ASTHMA • Ineffective airway clearance related to bronchospasm, ineffective cough, excessive mucus production, tenacious secretions, and fatigue. • Anxiety related to difficulty breathing, perceived or actual loss of control, and fear of suffocation. • Activity intolerance related to difficulty breathing, perceived or actual loss of control, and fear of suffocation.
  72. 72. CANCER • Fear related to pain and perceived actual threat of death. • Anticipatory grieving related to perceived actual threat of death. • Disturbed body image related to drug side effect.
  73. 73. CORONARY ARTERY DISEASE • Pain related to myocardial ischemia and decreased myocardial oxygen supply. • Fear related to perceived actual threat of death, pain, possible life style changes. • Activity intolerance related to fatigue secondary to decreased cardiac output and poor lung and tissue perfusion
  74. 74. PEPTIC ULCER • Pain related to increased gastric secretions, decreased mucosal protection, and ingestion of gastric irritants. • Ineffective therapeutic regimen management related to lack of knowledge of long- term management of peptic ulcer disease and consequences of not following treatment plan and unwillingness to modify life style.
  75. 75. Migraine Headache • Pain • Ineffective role performance • Rheumatoid Arthritis • Pain • Self care deficit • Activity intolerance
  76. 76. ULCERATIVE COLITIS • Pain related to erosion of mucosal lining • Risk for imbalanced nutrition less than body requirements
  77. 77. SOME NURSING DIAGNOSES COMMON TO THE GENERAL CATEGORY OF PSYCHOLOGICAL FACTORS AFFECTING MEDICAL CONDITION INCLUDE: • Ineffective coping related to repressed anxiety and inadequate coping methods, evidenced by initiation or exacerbation of physical illness. • Deficient knowledge related to psychological factors affecting medical condition, evidenced by statements such as “I don’t know why the doctor put me on the psychiatric unit. I have a physical problem.” • Low self-esteem related to unmet dependency needs, evidenced by self-negating verbalizations and demanding sick-role behaviors. • Ineffective role performance related to physical illness accompanied by real or perceived disabling symptoms, evidenced by changes in usual patterns of responsibility.
  78. 78. THE FOLLOWING CRITERIA MAY BE USED FOR MEASUREMENT OF OUTCOMES IN THE CARE OF THE CLIENT WITH A PSYCHO PHYSIOLOGICAL DISORDER: The client: • Denies pain or other physical complaint. • Demonstrates the ability to perform more adaptive coping strategies in the face of stressful situations. • Verbalizes stressful situations that have led to or worsened physical symptoms in the past. • Verbalizes a plan to cope with stressful situations in an effort to prevent exacerbation of physical symptoms. • Performs activities of daily living independently.
  79. 79. NURSING PLANNING/IMPLEMENTATION Ineffective coping related to repressed anxiety and inadequate coping methods. • Perform thorough physical assessment. • Monitor laboratory values, vital signs, intake and output, and other assessments. • Help the client to set goals and identify the best way he or she can achieve those goals based on his or her believes. • Assist the client in problem solving • Encourage client to discuss current life situations that he or she perceives as stressful and feelings associated with each. • As client becomes able to discuss feelings more openly, discuss about the relation between feelings and physical symptoms. • Teach adaptive coping strategies that can be used for stressful situations. • Help the client to identify support system within his community for the expression of feelings.
  80. 80. CONT.. Knowledge deficit related to psychological factors affecting medical conditions. • Assess the client’s level of knowledge regarding effects of psychological problems on the body. • Assess client’s level of anxiety and readiness to learn. • Discuss physical examination and laboratory tests that have been conducted. • Explore client’s feelings and fears. Be supportive. • Encourage client to maintain two diaries; one for recording physical symptoms and the othe for stressful situations. • Help the client to identify the benefit for being in sick role. • Provide instruction in assertive technique. • Discuss adaptive methods of stress management such as relaxation technique, physical exercise, meditation, breathing exercise and autogenic.
  81. 81. CONCLUSION: • Medical Conditions Due To Psychological Factors could be very confusing and difficult to diagnose and therefore could hamper the care needed and provided to the patient. In order for the health care provider and team to make the diagnosis of PFAMC, either the factors must have influenced the course of the medical condition, interfered with its treatment, contributed to health risks, or physiologically aggravated the medical condition. It is the responsibility of a psychiatric nurse to have a sound knowledge in assessing and identified the illness in ordr to provide a complete holistic and unbiased care to the patient.

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