Lorraine, a client diagnosed with somatic symptom disorder, states, “My doctor thinks I should see a psychiatrist. I can’t imagine why he would make such a suggestion.” What is the basis for Lorraine’s statement?
She thinks her doctor wants to get rid of her as a client.
She does not understand the correlation of symptoms and stress.
She thinks psychiatrists are only for “crazy” people.
She thinks her doctor has made an error in diagnosis.
The Correct Answer is B
Somatic symptom disorder involves persistent physical symptoms that cause significant distress and functional impairment, often without a clear medical cause. The symptoms are not intentionally produced and reflect maladaptive coping, emotional dysregulation, and heightened sensitivity to bodily sensations. Patients frequently lack insight into the psychological origins of their symptoms and may misinterpret psychiatric referrals as dismissive or irrelevant to their physical complaints.
Rationale for correct answers
2. Lorraine’s confusion reflects a lack of understanding of the link between psychological stress and physical symptoms. This is common in somatic symptom disorder, where emotional distress is somatized.
Rationale for incorrect answers
1. The belief that the doctor wants to abandon her implies rejection, but this is not the core issue; Lorraine’s concern is rooted in misunderstanding.
3. Associating psychiatry with “crazy” implies stigma, but the stem does not suggest Lorraine holds this belief specifically.
4. Thinking the diagnosis is wrong reflects denial, but Lorraine’s statement centers more on confusion than disbelief in the diagnosis.
Take Home Points
- Patients with somatic symptom disorder often lack insight into the psychological basis of their symptoms.
- Psychiatric referrals may be misinterpreted as dismissive or irrelevant due to poor understanding of mind-body connections.
- Education on the role of stress and emotional factors in physical symptoms is essential.
- Empathetic communication helps reduce resistance and stigma around psychiatric care.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Duloxetineis a serotonin-norepinephrine reuptake inhibitor (SNRI) used for chronic pain, major depression, and generalized anxiety disorder. It modulates descending inhibitory pain pathways by increasing serotonin and norepinephrine levels in the central nervous system. It is FDA-approved for fibromyalgia, diabetic neuropathy, and musculoskeletal pain, making it suitable for patients with somatic symptom disorder where pain is the predominant feature. It is contraindicated in uncontrolled narrow-angle glaucoma and should be used cautiously in hepatic impairment.
Rationale for correct answers
4.Duloxetine targets both painand mood symptoms by enhancing serotonergic and noradrenergic transmission, making it effective for somatic symptom disorder with pain predominance.
Rationale for incorrect answers
1.Chlorpromazine is an antipsychotic used for psychosis, not indicated for somatic symptom disorder or pain management.
2.Diazepam is a benzodiazepine used for anxietyand muscle spasms, but it carries dependency risks and lacks efficacy for chronic pain.
3.Carbamazepine is an anticonvulsant used for seizuresand trigeminal neuralgia, not appropriate for generalized somatic pain.
Take Home Points
- Duloxetine is effective for somatic symptom disorder with predominant pain due to its dual action on serotonin and norepinephrine.
- Benzodiazepines are not first-line for chronic somatic pain due to tolerance and dependency risks.
- Antipsychotics and anticonvulsants are reserved for specific psychiatric or neurological conditions, not somatic pain syndromes.
- Always assess comorbidities and contraindications before initiating pharmacologic treatment for somatic symptom presentations.
Correct Answer is D
Explanation
Paroxetineis a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for depression, anxiety, and somatic symptom disorders. It works by increasing serotonin levels in the central nervous system, which helps regulate mood and perception of pain. Among its most frequent side effects are nausea, sexual dysfunction, insomnia, and dry mouth. It may also cause withdrawal symptoms if discontinued abruptly and should be used cautiously in patients with hepatic impairment or those taking other serotonergic agents.
Rationale for correct answers
4.Nausea is a well-documented and commonside effect of SSRIs like paroxetine due to increased serotoninactivity in the gastrointestinal tract.
Rationale for incorrect answers
1.Constipation is a less frequentside effect and not among the most commonly reported with paroxetine use.
2.Increased appetite may occur but is not a primaryconcern with paroxetine; weight gain is more variable and dose-dependent.
3.Flatulence is not a notableside effect of paroxetine and is rarely reported in clinical practice or literature.
Take Home Points
- Paroxetine is an SSRI used for mood and somatic symptom disorders, with nausea as a common side effect.
- Gastrointestinal symptoms are frequent due to serotonin’s role in gut motility and sensitivity.
- Always monitor for withdrawal symptoms and serotonin syndrome when adjusting or combining serotonergic medications.
- Educate patients on gradual dose changes and the importance of adherence to minimize adverse effects.
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