Somatic Symptom Disorders

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Humanities

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To prepare:

  • Imagine that Jennifer Brea, whose TEDTalk (TED Conferences, LLC, 2016) you watched, is referred to you for ongoing supportive therapy when her psychiatry consultant decides that she does not have a conversion disorder. Despite the psychiatrist’s opinion, her primary care physician ignores that consult and labels Jennifer as having a somatic symptom disorder anyway.
  • Video:

Attached is a sample file


(5–7 slides) in which you address the following:

  • Explain in a concise professional manner how you would conduct your first meeting with Jennifer. Identify specific steps you would take to understand her circumstance and needs.
  • Explain how you would proceed with her medical team in terms of advocacy for her as a client believed to have this condition.
  • Explain why you would need to take a biopsychosocial approach to her ongoing care.
  • Explain what social, family, vocational, Internet, and medical supports you would explore to help with her longer-term stabilization.
  • Analyze the controversy in diagnosing a mental disorder based on unexplained physical symptoms. Within your analysis, consider how power and privilege influence who provides the diagnoses and which groups are more likely to be diagnosed with certain disorders. Explain your thoughts on this debate.

Unformatted Attachment Preview

SOMATIC SYMPTOM DISORDER/CONVERSION DISORDER: PSYCHOPATHOLOGY & DIAGNOSIS FOR SOCIAL WORK PRACTICE The Case of Jennifer Brea By: Cynthia Blevins Client Description & Problem Client Proxy: Jennifer Brea Ø Ø Ø Ø Role within her family system: Wife 33 years old Suffers from myalgic encephalomyelitis (chronic fatigue syndrome) Psychiatrist doesn’t feel anything wrong, but Primary Care diagnosed with Conversion Disorder/ Somatic symptom disorder Ø Illness has impaired ability to perform normal activities Jennifer Brea: Meeting with the Client Engagement skills with client Ø Ø Ø Ø Ø Ø Empathy Compassion Reflective listening Focus on your feelings and be cognizant of your reactions. Monitor your own feelings of defensiveness, impatience, frustration, or anger toward the client. Practice increased self-awareness. Client symptoms Ø Ø Ø Ø Ø Paralysis Fevers Sore throats Sinus infection Gastrointestinal Client Reassurance Ø Client must be reassured we believe her and understand she is in no way: Ø Malingering Ø Ø Symptoms are consciously produced or feigned Have various motivations, including financial gain, relief of work duties, or obtaining illicit drugs Ø Factitious Disorder Jennifer Brea: Multidisciplinary Approach Multidisciplinary Approach to the Problem: Ø Ø Ø Ø Social Worker Neurologist Husband Mental Health Professionals Ø Psychiatrist Ø Medical Social Worker Ø Case Manager Ø Home Health Care Nurse Jennifer Conversion Disorder Somatic Symptom DIsorder Neurologist Autoimmune Disease Nrurology Treatment Social Worker Social Service Support Individual Counseling Family Counseling Husband Family Support Caretaker Jennifer Brea: Biopsychosocial Approach Jennifer is cognizant of her condition and the limitations she has encountered based upon the onset of her illness. As I reviewed the case of Jennifer Brea and looked at her case from a biopsychosocial perspective, I have to consider biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. Ø Ø Ø Ø Ø Ø Client has some undisclosed issues that stem from her childhood that could be triggers Ø Counseling is needed to address these issues that could be impacting her recovery Client has a supportive husband Client doesn’t have the trust and confidence in her previous psychologist who doesn’t think she has conversion disorder Social and cultural factors are conceptualized as a particular set of stressful events (that can differentially impact mental health depending on the individual and his or her social context. Humanistic theorists view the client in context to what is happening at the time Ø Client was attending Harvard PhD program at the onset of her paralysis Life stressors like marital or work issues are precipitants for somatic symptoms Ø Client was attending school and was engaged to be married Jennifer Brea: Long-term Stabilization Approach Ø Cognitive-behavioral Therapy Ø CBT has been mentioned as an efficacious treatment for the range of the conditions loosely grouped under Somatic Symptom and Related Disorders. Randomized controlled clinical trials found that conversion disorder can be successfully treated with CBT which included the modification of catastrophic cognitions and inappropriate behaviors. A study conducted in Bangladesh showed CBT to be effective in treating general conversion disorder Ø Long-term management involves interrupting perpetuating factors Ø Maintaining the same doctor Ø Implementing Strategies for: Ø Ø Ø Ø Self-efficacy distress tolerance Coping Modulating the interaction of anxiety, stress, and physical symptoms Controversy in Diagnosing Mental Disorders Issues with DSM-5 Issues with Diagnosing Mental Disorders Ø The manual's shortcomings include its lack of scientifically conclusive field testing of some of its recommendations Ø Everyone seems to have bipolar disorder without ever having a manic experience Ø Failure to consider the prior effectiveness or ineffectiveness of anti-psychotic drugs to determine a patient's present diagnosis Ø An increasing number of primary care and other nonpsychiatric doctors are dispensing anti-psychotic drugs, despite their lack of training in that area of medicine. Ø Lumping of, for example, what had been a spectrum of depressions -- from the mildly melancholic to the severely debilitating -- into one group Ø DSM-5 would mislabel one in four people with chronic pain and irritable bowel syndrome with the DSM-5's newly created "somatic symptom disorder," which is diagnosed when a person has spent at least six months steadily thinking of and being anxious about their medical illness. Ø Aggressive sales and marketing by pharmaceutical companies may also be driving the surge in diagnosing mental disorders Questions? References American Psychiatric Association. (2013p). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09 TED Conferences, LLC (Producer). (2016). What happens when you have a disease doctor’s can’t diagnose [Video file]. Retrieved from https://www.ted.com/talks/jen_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose Soares ND, Grossman L: Somatoform disorder: conversion. 2005; Retrieved on 09.03.06 from: http://www.emedicaine.com/ped/topic2780.htm. Goldstein LH, Deale AC, Mitchell-O’Malley SJ, Toone BK, Mellers JDC: An evaluation of cognitive-behavioural therapy as a treatment for dissociative seizures: a pilot study. Cogn Behav Neurol; 2004; 17(1): 41 – 49. SOMATIC SYMPTOM DISORDER/CONVERSION DISORDER: PSYCHOPATHOLOGY & DIAGNOSIS FOR SOCIAL WORK PRACTICE The Case of Jennifer Brea By: Cynthia Blevins Client Description & Problem Client Proxy: Jennifer Brea Ø Ø Ø Ø Role within her family system: Wife 33 years old Suffers from myalgic encephalomyelitis (chronic fatigue syndrome) Psychiatrist doesn’t feel anything wrong, but Primary Care diagnosed with Conversion Disorder/ Somatic symptom disorder Ø Illness has impaired ability to perform normal activities Jennifer Brea: Meeting with the Client Engagement skills with client Ø Ø Ø Ø Ø Ø Empathy Compassion Reflective listening Focus on your feelings and be cognizant of your reactions. Monitor your own feelings of defensiveness, impatience, frustration, or anger toward the client. Practice increased self-awareness. Client symptoms Ø Ø Ø Ø Ø Paralysis Fevers Sore throats Sinus infection Gastrointestinal Client Reassurance Ø Client must be reassured we believe her and understand she is in no way: Ø Malingering Ø Ø Symptoms are consciously produced or feigned Have various motivations, including financial gain, relief of work duties, or obtaining illicit drugs Ø Factitious Disorder Jennifer Brea: Multidisciplinary Approach Multidisciplinary Approach to the Problem: Ø Ø Ø Ø Social Worker Neurologist Husband Mental Health Professionals Ø Psychiatrist Ø Medical Social Worker Ø Case Manager Ø Home Health Care Nurse Jennifer Conversion Disorder Somatic Symptom DIsorder Neurologist Autoimmune Disease Nrurology Treatment Social Worker Social Service Support Individual Counseling Family Counseling Husband Family Support Caretaker Jennifer Brea: Biopsychosocial Approach Jennifer is cognizant of her condition and the limitations she has encountered based upon the onset of her illness. As I reviewed the case of Jennifer Brea and looked at her case from a biopsychosocial perspective, I have to consider biological, psychological, and social factors and their complex interactions in understanding health, illness, and health care delivery. Ø Ø Ø Ø Ø Ø Client has some undisclosed issues that stem from her childhood that could be triggers Ø Counseling is needed to address these issues that could be impacting her recovery Client has a supportive husband Client doesn’t have the trust and confidence in her previous psychologist who doesn’t think she has conversion disorder Social and cultural factors are conceptualized as a particular set of stressful events (that can differentially impact mental health depending on the individual and his or her social context. Humanistic theorists view the client in context to what is happening at the time Ø Client was attending Harvard PhD program at the onset of her paralysis Life stressors like marital or work issues are precipitants for somatic symptoms Ø Client was attending school and was engaged to be married Jennifer Brea: Long-term Stabilization Approach Ø Cognitive-behavioral Therapy Ø CBT has been mentioned as an efficacious treatment for the range of the conditions loosely grouped under Somatic Symptom and Related Disorders. Randomized controlled clinical trials found that conversion disorder can be successfully treated with CBT which included the modification of catastrophic cognitions and inappropriate behaviors. A study conducted in Bangladesh showed CBT to be effective in treating general conversion disorder Ø Long-term management involves interrupting perpetuating factors Ø Maintaining the same doctor Ø Implementing Strategies for: Ø Ø Ø Ø Self-efficacy distress tolerance Coping Modulating the interaction of anxiety, stress, and physical symptoms Controversy in Diagnosing Mental Disorders Issues with DSM-5 Issues with Diagnosing Mental Disorders Ø The manual's shortcomings include its lack of scientifically conclusive field testing of some of its recommendations Ø Everyone seems to have bipolar disorder without ever having a manic experience Ø Failure to consider the prior effectiveness or ineffectiveness of anti-psychotic drugs to determine a patient's present diagnosis Ø An increasing number of primary care and other nonpsychiatric doctors are dispensing anti-psychotic drugs, despite their lack of training in that area of medicine. Ø Lumping of, for example, what had been a spectrum of depressions -- from the mildly melancholic to the severely debilitating -- into one group Ø DSM-5 would mislabel one in four people with chronic pain and irritable bowel syndrome with the DSM-5's newly created "somatic symptom disorder," which is diagnosed when a person has spent at least six months steadily thinking of and being anxious about their medical illness. Ø Aggressive sales and marketing by pharmaceutical companies may also be driving the surge in diagnosing mental disorders Questions? References American Psychiatric Association. (2013p). Somatic symptom and related disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author. doi:10.1176/appi.books.9780890425596.dsm09 TED Conferences, LLC (Producer). (2016). What happens when you have a disease doctor’s can’t diagnose [Video file]. Retrieved from https://www.ted.com/talks/jen_brea_what_happens_when_you_have_a_disease_doctors_can_t_diagnose Soares ND, Grossman L: Somatoform disorder: conversion. 2005; Retrieved on 09.03.06 from: http://www.emedicaine.com/ped/topic2780.htm. Goldstein LH, Deale AC, Mitchell-O’Malley SJ, Toone BK, Mellers JDC: An evaluation of cognitive-behavioural therapy as a treatment for dissociative seizures: a pilot study. Cogn Behav Neurol; 2004; 17(1): 41 – 49.
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