By Richard Mayou, Michael Sharpe, Alan Carson
This booklet presents either the proof and the tips to let medical professionals to enhance their evaluate and administration of the mental and behavioural features of the most typical difficulties proposing normally treatment. It summarises the new learn facts and gives logic suggestions on how mental and psychiatric elements of affliction might be addressed in the scientific session.
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This publication offers either the facts and the assistance to permit medical professionals to enhance their evaluation and administration of the mental and behavioural elements of the most typical difficulties proposing quite often therapy. It summarises the hot learn facts and gives logic suggestions on how mental and psychiatric elements of disorder will be addressed in the clinical session.
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You have been attending the (GP) surgery most weeks because you’ve been very worried about cancer (and about your husband leaving you). You also told me that these pains often occur when you are anxious and panicky, and at these times other physical complaints such as trembling and nausea occur. ” Chronic multiple functional somatic symptoms Summary of a 15 year “segment” of the life of a patient with chronic multiple functional somatic symptoms Date (age) Symptoms (life events) 1970 (18) Abdominal pain 1973 (21) Pregnant (boyfriend in prison) Referral GP to surgical outpatients GP to obstetrics and gynaecology outpatients GP to gastroenterology and neurology outpatients Investigations Appendicectomy Termination of pregnancy Outcome Normal appendix — All tests normal 1979 (27) Pelvic pain (wants to be sterilised) 1981 (29) Fatigue (problems at work) GP to obstetrics and gynaecology outpatients GP to infectious disease clinic Sterilised, ovaries preserved 1983 (31) Aching, painful muscles GP to rheumatology clinic Mild cervical spondylosis.
Good, rapid communication between hospital and primary care is essential. Detail of Very Slippy Weather by James Gillray (1757-1815) Lifetime prevalence of specific traumatic events (n=2181) Type of trauma Assault Serious car or motor vehicle crash Other serious accident or injury Fire, flood, earthquake, or other natural disaster Other shocking experience Diagnosed with a life threatening illness Learning about traumas to others Sudden, unexpected death of close friend or relative Any trauma Prevalence 38% 28% 14% 17% 43% 5% 62% 60% 90% Immediate effects of frightening trauma x Causes a varied picture of anxiety, numbness, dissociation (feeling distanced from events, having fragmentary memories), and sometimes apparently inappropriate calmness x Those who believe they are the innocent victims of others’ misbehaviour are often angry, and this may be exacerbated by subsequent frustrations x The term “acute stress disorder” is now used for a combination of distress, intrusive memories (flashbacks, nightmares), avoidance, and numbing in the months after the trauma.
The picture of a shellshocked soldier is reproduced with permission of British Pathe. The graph of effects of cognitive behaviour treatment for hypochondriasis is adapted from Clark DM et al, Br J Psychiatry 1998;173:218-25. 20 up up fo llo w m on th 12 6 m on th fo llo w up fo llo w m on th 3 Po st -tr ea tm en t M id -tr ea tm en t 0 Pr et re at m en t Referral for specialist treatment There is always a temptation to refer difficult patients to another doctor. However, this can result in greater long term difficulties if not carefully planned.
ABC of Psychological Medicine by Richard Mayou, Michael Sharpe, Alan Carson