Psych 17 Somatic - Cognitive Disorders DEAN Algo Apostol
Psych 17 Somatic - Cognitive Disorders DEAN Algo Apostol
→ The term psychosomatic began to be used to The five specific somatoform disorders are as
convey the connection between the mind (psyche) follows:
and the body (soma) in states of health and illness. 1. Somatization disorder- is characterized
Essentially, the mind can cause the body either to by multiple physical symptoms.
create physical symptoms or to worsen physical - it begins by 30 years of age, extends
illnesses. Real symptoms can begin, continue, or be over several years, and includes a
worsened as a result of emotional factors. Examples combination of pain and
include diabetes, hypertension, and colitis, all of gastrointestinal, sexual, and
which are medical illnesses influenced by stress and pseudoneurologic symptoms.
emotions. When a person is under a lot of stress or
is not coping well with stress, symptoms of these SYMPTOM OF SOMATIZATION DISORDER
medical illnesses worsen. In addition, stress can o Pain Symptoms: complaints of
cause physical symptoms unrelated to a diagnosed headache; pain in the abdomen, head,
medical illness. After a stressful day at work, many joints, back, chest, rectum; pain during
people experience “tension headaches” that can be urination, menstruation, or sexual
quite painful. The headaches are a manifestation of intercourse.
stress rather than a symptom of an underlying o Gastrointestinal Symptoms: nausea,
medical problem. bloating, vomiting (other than during
pregnancy), diarrhea, or intolerance of
→ The term hysteria refers to multiple physical several foods.
complaints with no organic basis; the complaint are o Sexual Symptoms: sexual
usually described dramatically. The concept of indifference, erectile or ejaculatory
hysteria is believed to have originated in Egypt and dysfunction, irregular menses, excessive
is about 4,000 years old. In the Middle Ages, menstrual bleeding, vomiting
hysteria was associated with witchcraft, demons, throughout pregnancy.
and sorcerers. People with hysteria, usually women, o Pseudoneurologic Symptoms:
were considered evil or possessed by evil spirits. conversion symptoms such as impaired
Paul Briquet and Jean-Martin Charcot, both French coordination or balance, paralysis or
physicians, identified hysteria as a disorder of the localized weakness, difficulty swallowing
nervous system. or lump in throat, aphonia, urinary
retention, hallucinations, loss of touch
OVERVIEW OF SOMATIC SYMPTOM or pain sensation, double vision,
ILLNESSES
blindness, deafness, seizures;
• Somatization is defined as the transference of dissociative symptoms such as amnesia;
mental experience and states into bodily symptoms. or loss of consciousness other than
Somatic symptom illnesses can be characterized as fainting.
the presence of physical symptoms that suggest a 2. Conversion Disorder- sometimes called
medical condition without a demonstrable organic conversion reaction, involves unexplained,
basis to account fully for them. usually sudden deficits in sensory or motor
• Somatoform disorders can be characterized as function (e.g. blindness, paralysis).
the presence of physical symptoms that suggest - These deficits suggest a neurologic
medical condition without a demonstrable organic disorder but are associated whit
basis to account fully for them. psychological factors. An attitude of
• The three central features of somatoform disorders a la belle indifference, a seeming
are as follows: lack of concern or distress, is a key`
o Physical complaints suggest major medical feature.
illness but have no demonstrable organic 3. Pain Disorder- has the primary physical
basis. symptom of pain, which generally is
o Psychological factors and conflicts seem unrelieved by analgesics and greatly
important in initiating, exacerbating, and affected by psychological factors in terms of
maintaining the symptoms. onset, severity, exacerbation, and
maintenance.
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
CULTURAL CONSIDERATIONS
• The type and frequency of somatic symptoms
and their meaning may vary across cultures.
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
• Cognition is the brain’s ability to process, • Delirium almost always results from an
retain, and use information. identifiable physiological, metabolic, or
• These cognitive abilities are essential for many cerebral disturbance or disease or from drug
important tasks, including making decisions, intoxication or withdrawal.
solving problems, interpreting the environment, • Often, delirium results from multiple causes
and learning new information. and requires a careful and thorough
• Cognitive abilities include: physical examination and laboratory tests
o Reasoning for identification.
o Judgment
DSM-IV-TR DIAGNOSTIC CRITERIA:
o Perception
o Attention • Difficulty with attention
o Comprehension • Easily distractible
o Memory • Disoriented
• May have sensory disturbances such as
illusions, misinterpretations, or
COGNITIVE DISORDER hallucinations.
• Can have sleep-wake cycle disturbances
• Cognitive disorder is a disruption or impairment
• Changes in psychomotor activity
in these higher-level functions of the brain.
• May experience anxiety, fear, irritability,
• Cognitive disorders can have devastating
euphoria, or apathy.
effects on the ability to function in daily life.
They can cause people to forget the names of COMMON CAUSES OF DELERIUM
immediate family members, be unable to
1. Physiological or metabolic
perform daily household tasks, and neglect
• Hypoxemia; electrolyte
personal hygiene.
disturbances; renal or hepatic
• The primary categories of cognitive disorders
failure; hypoglycemia or
are delirium, dementia, and amnestic disorders.
hyperglycemia; dehydration; sleep
All involve in impairment of cognition, and effect
deprivation; thyroid or
on clients and family members or caregivers.
glucocorticoid disturbances;
DELERIUM thiamine or vitamin B12 deficiency;
vitamin C, niacin, or protein
• Delirium is a syndrome that involves a
deficiency; cardiovascular shock;
disturbance of consciousness accompanied by a
brain tumor; head injury; and
change in cognition.
exposure to gasoline, paint solvents,
• Delirium usually develops over a short period,
insecticides, and related substances.
sometimes a matter of hours, and fluctuates, or
2. Infections as Causes
changes, throughout the course of the day.
• Systemic:
• Clients with delirium have difficulty paying
o Sepsis
attention, are easily distracted and disoriented,
o Urinary Tract Infection
and may have sensory disturbances such as
o Pneumonia
illusions, misinterpretations, or hallucinations.
• Cerebral:
An electrical cord on the floor may appear to
o Meningitis,
them as a snake (illusion).
o Encephalitis
• They may mistake the banging of a laundry cart
o HIV
in the hallway for a gunshot
o Syphilis
(misinterpretation).
3. Drug Related
• They may see “angels” hovering above when
• Intoxication: Anticholinergics,
nothing is there (hallucination).
lithium, alcohol, sedatives, and
• At times, they also experience disturbances in
hypnotics
the sleep–wake cycle, changes in psychomotor
• Withdrawal: Alcohol, sedatives, and
activity, and emotional problems such as
hypnotics
anxiety, fear, irritability, euphoria, or apathy.
• Reactions to anesthesia, prescription
medication, or illicit (street) drugs.
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 clients may feel guilt, shame, and humiliation, • If limits on the client’s actions are necessary,
or think, “I’m a bad person; I did this to myself.” explain limits and reasons clearly, within the
This would indicate possible long-term client’s ability to understand.
problems with self-concept. • Involve the client in making plans or decisions
as much as he or she is able to participate.
NURSING DIAGNOSES
• Assess the client daily or more often if needed
• Risk for Injury for his or her level of functioning.
• Acute Confusion • Allow the client to make decisions as much as
• Disturbed Sensory Perception he or she is able.
• Disturbed Thought Process • Assist the client to establish a daily routine,
• Disturbed Sleep Pattern including hygiene, activities, and so-forth.
• Risk for Deficient Fluid Volume • Teach the client about underlying causes of
• Risk for Imbalanced Nutrition: Less Than Body confusion and delirium.
Requirements
DEMENTIA
NURSING INTERVENTIONS
• Mental disorder that involves multiple cognitive
1. Promoting Client’s Safety deficits, primarily memory impairment, and at
• Teach client to request assistance for activities. least one of the following cognitive
• Provide close supervision to ensure safety disturbances:
during these activities. • APHASIA which is deterioration of language
• Promptly respond to client’s call for assistance. function. Diri na nakakayakan.
2. Managing Client’s Confusion • APRAXIA which is impaired ability to excuse
• Speak to client in a calm manner in a clear low motor functions despite intact motor abilities. Di
voice; use simple sentences. nakakalakat, di nakakasuklay.
• Allow adequate time for client to comprehend • AGNOSIA which is inability to recognize or
and respond. name objects despite intact sensory abilities.
• Allow client to make decision as much as Ex: Diri maaram na saging iton, sige la tudlok.
possible. • DISTURBANCE IN EXECUTIVE
• Provide orienting verbal cues when talking with FUNCTIONING which is the ability to think
client. abstractly and to plan, initiate, sequence,
• Use supportive touch if appropriate. monitor, and stop complex behavior. Diri na
3. Controlling Environment to Reduce Sensory nakakaplano, mayda difficulty in choosing kung
Overload ano gagawin.
• Keep environmental noise to minimum • Memory impairment is the prominent early sign
• Monitor client’s response to visitors; explain to of dementia. Clients have difficulty learning new
family and friends that client may need to visit material and forget previously learned material.
quietly one on one • Initially, recent memory is impaired – for
• Validate client’s anxiety and fears, but do not example, forgetting where certain objects were
reinforce misperception placed or that food is cooking on the stove.
4. Promoting Sleep and Proper Nutrition • Aphasia usually begins with the inability to
• Monitor sleep and elimination patterns. name familiar objects or people and then
• Monitor food and fluid intake; provide prompts progresses to speech that becomes vague or
or assistance to eat and drink adequate empty with excessive use of terms such as it or
amounts of food and fluid. thing.
• Provide periodic assistance to bathroom if client • Clients may exhibit ECHOLALIA (echoing what
does not make requests. is heard) or PALILALIA (repeating words or
• Discourage daytime napping to help sleep at sounds over and over).
night.
DSM-IV-TR DIAGNOSTIC CRITERIA:
• Encourage some exercise during day like sitting,
walking, or other activities client can manage. • LOSS OF MEMORY
o Initial stages, recent memory loss
INTERVENTIONS
such as forgetting food cooking on
• Do not allow the client to assume responsibility the stove.
for decisions or actions if they are unsafe.
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1• Early signs include personality changes, loss Dementia can be a direct pathophysiologic
of social skills and inhibitions, emotional consequence of head trauma. The degree and type of
blunting, and language abnormalities cognitive impairment and behavioral disturbance
• Onset is most commonly 50 to 60 years of depend on the location and extent of the brain injury.
age; death occurs in 2 to 5 years. When it occurs as a single injury, the dementia is
4. CREUTZFELDT-JACOB DISEASE usually stable rather than progressive. Repeated head
• A central nervous system disorder that injury may lead to progressive dementia.
typically develops in adults 40 to 60 years of
TREATMENT AND PROGNOSIS
age.
• It involves altered vision, loss of • The prognosis for the progressive types of
coordination or abnormal movements, and dementia may vary, but all prognoses involve
dementia that usually progresses. progressive deterioration of physical and mental
• The cause of the encephalopathy is an abilities until death.
infectious particle resistant to boiling, some • Typically, in the later stages, clients have
disinfectants, and ultraviolet radiation. minimal cognitive and motor function, are
Pressured autoclaving or bleach can totally dependent on caregivers, and are
inactivate the particle. unaware of their surroundings or people in the
5. HUMAN IMMUNODEFICIENCY VIRUS environment. They may be totally
• Lead to dementia and other neurologic uncommunicative or make unintelligible sounds
problems. or attempts to verbalize.
• These may result directly from invasion of • For degenerative dementias, no direct therapies
nervous tissue by HIV illnesses such as have been found to reverse or retard the
toxoplasmosis and cytomegalovirus. fundamental pathophysiologic processes.
• This type of dementia can result in a wide • Levels of numerous neurotransmitters such as
variety of symptoms ranging from mild acetylcholine, dopamine, norepinephrine, and
sensory impairment to gross memory and serotonin are decreased in dementia. This has
cognitive deficits to severe muscle led to attempts at replenishment therapy with
dysfunction. acetylcholine precursors, cholinergic agonists,
6. PARKINSON’S DISEASE and cholinesterase inhibitors.
• Slowly progressive neurologic condition • Donepezil (Aricept), Rivastigmine (Exelon), and
characterized by tremor, rigidity, Galantamine (Reminyl) are cholinesterase
bradykinesia, and postural instability. inhibitors and have shown modest therapeutic
• It results from loss of neurons of the basal effects and temporarily slow the progress of
ganglia. dementia.
• Characterized by cognitive and motor • Tacrine (Cognex) is also a cholinesterase
slowing, impaired memory, and impaired inhibitor; however, it elevates liver enzymes in
executive functioning. about 50% of clients using it. Lab tests assess
7. HUNTINGTON’S DISEASE liver function are necessary every 1 to 2 weeks;
• An inherited, dominant gene disease that therefore, tacrine is rarely prescribed.
primarily involves cerebral atrophy, • Memantine (Namenda) is an NMDA receptor
demyelination, and enlargement of the antagonist that can slow the progression of
brain ventricles. Initially, there are Alzheimer’s in the moderate or severe stages.
choreiform movements that are continuous • Antidepressants are effective for significant
during waking hours and involve facial depressive symptoms; however, they can cause
contortions, twisting, turning, and tongue delirium. SSRI antidepressants are used since
movements. the have fewer side effects.
• Personality changes are initial psychosocial • Antipsychotics, such as haloperidol (Haldol),
manifestations, followed by memory loss, olanzapine (Zyprexa), risperidone (Risperdal),
decreased intellectual functioning, and and quetiapine (Seroquel), may be used to
other signs of dementia. manage psychotic symptoms. The potential
• The disease begins in the late 30s or early benefit of antipsychotics must be weighed with
40s and may last 10 to 20 years or more risks, such as increased mortality rate, primarily
before death. from cardiovascular complications. Due to this
increased risk, the FDA has not approved
antipsychotics for dementia treatment.
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
ALGO, APOSTOL
COGNITIVE DISORDERS
17 NCM 117: Psychiatric Nursing
Dr. SOCCORO SALVACION-GASCO • JUNE 24, 2021
1 acts. Identify environmental triggers to help such as aphasia, apraxia, agnosia, and impaired
client avoid them. executive functions.
2. PROMOTING ADEQUATE SLEEP, PROPER • Several medical conditions can cause brain
NUTRITION AND HYGIENE, AND ACTIVITY damage and result in an amnestic disorder—for
• Prepare desirable foods and foods client can example, stroke or other cerebrovascular
self-feed events, head injuries. and neurotoxic
• Monitor bowel elimination patters exposures, such as carbon monoxide poisoning.
• Remind the client to urinate; provide pads chronic alcohol ingestion. and vitamin 812 or
or diapers as needed thiamine deficiency.
• Encourage mild physical activity such as • Alcohol-Induced Amnestic Disorder results
walking from a chronic thiamine or vitamin B deficiency
3. STRUCTURING ENVIRONMENT AND ROUTINE and is called Korsakoff’s syndrome.
• Encourage client to follow regular routine
and habits of bathing and dressing. Monitor
environmental stimulation and adjust when
needed.
4. PROVIDING EMOTIONAL SUPPORT
• Be kind, respectful, calm, and reassuring
• Use supportive touch when necessary
5. PROMOTING INTERACTION AND
INVOLVEMENT
• Plan activities geared towards client’s
interests and abilities
• Reminisce with client about the past
• Employ techniques of distraction
RELATED DISORDERS
ALGO, APOSTOL