A patient with somatic symptom disorder reports persistent body aches and has undergone several diagnostic tests with no significant findings. How should a clinician approach this type of disorder?
Initiate a new series of tests to find other possible medical conditions
Focus on managing and reducing the symptoms' impact on daily life
Refer the patient immediately to a psychiatrist for further evaluation
Reassure the patient that all tests are negative and they have nothing to worry about
The Correct Answer is B
Choice A reason: Initiating redundant diagnostic investigations for a patient diagnosed with somatic symptom disorder often exacerbates the pathology by reinforcing the client's preoccupation with physical illness. Repeated testing can lead to unnecessary medical trauma, increased healthcare costs, and the accidental discovery of incidentalomas, which further fuels health-related anxiety.
Choice B reason: The primary therapeutic objective in somatic symptom disorder is functional improvement rather than the total elimination of physical sensations. By focusing on symptom management and enhancing the quality of daily life, clinicians help patients develop coping mechanisms that reduce the disability associated with their perceived physical distress.
Choice C reason: While psychiatric consultation is often beneficial, an immediate referral without establishing a therapeutic alliance or explaining the rationale can feel like abandonment to the patient. Effective management typically involves a collaborative approach where the primary clinician maintains regular contact to provide a sense of security and validation.
Choice D reason: Simple reassurance that nothing is wrong is frequently perceived by the patient as a dismissal of their genuine suffering. Patients with this disorder experience real pain and discomfort; therefore, telling them they have nothing to worry about invalidates their subjective experience and often causes them to seek other providers.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: During an acute panic attack, the patient often hyperventilates, which leads to respiratory alkalosis and exacerbates symptoms like dizziness and chest pain. Encouraging slow, deep diaphragmatic breathing helps stabilize the patient's physiological state by increasing carbon dioxide levels and activating the parasympathetic nervous system to counteract the "fight or flight" response.
Choice B reason: Providing detailed education is inappropriate during the peak of an acute panic attack because the patient's cognitive processing is severely impaired by intense physiological arousal. Complex information will not be retained and may increase the patient's sense of overwhelm; education should be reserved for the post-crisis stabilization phase.
Choice C reason: Selective serotonin reuptake inhibitors (SSRIs) are first-line medications for the long-term management and prevention of panic disorder, but they have a delayed onset of action. They are ineffective for the immediate termination of acute symptoms, which requires rapid-acting interventions such as benzodiazepines or behavioral grounding techniques.
Choice D reason: Cognitive-behavioral therapy (CBT) is an evidence-based, structured psychological treatment used to address the root causes and patterns of anxiety over multiple sessions. It is not an acute intervention. A patient in the midst of a panic attack is unable to engage in the complex cognitive restructuring required for CBT.
Correct Answer is C
Explanation
Choice A reason: Tardive dyskinesia is a late-onset adverse effect characterized by involuntary, choreoathetoid movements, particularly of the tongue, face, and jaw. It does not typically present with systemic instability, autonomic dysfunction, or acute muscle rigidity, making it an unlikely diagnosis for a patient exhibiting sudden confusion and fluctuating vital signs.
Choice B reason: Akathisia is a subjective feeling of inner restlessness and an objective need to remain in motion, such as pacing or foot tapping. While distressing, it does not cause the life-threatening physiological collapse, profound "lead-pipe" muscle rigidity, or the significant cognitive alterations associated with the patient's current clinical presentation.
Choice C reason: Neuroleptic Malignant Syndrome is a rare but fatal idiosyncratic reaction to dopamine antagonists. The hallmark triad includes severe muscle rigidity, hyperthermia, and autonomic instability, such as tachycardia and labile blood pressure. The patient's confusion and recent dose escalation are classic indicators of this medical emergency requiring immediate intervention.
Choice D reason: Extrapyramidal symptoms is a broad umbrella term encompassing dystonia, parkinsonism, and akathisia. While the symptoms described are technically related to the extrapyramidal system, NMS is a specific, acute, and far more dangerous syndrome that requires a precise diagnosis beyond the general category of extrapyramidal side effects.
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