Functional Disorders and Medically Unexplained Symptoms

Description

This book is based on extensive research in assessment and treatment of patients with functional disorders and provides a thorough background to functional disorders as well as the etiology, classification and treatment of the disorders. The book primarily targets clinicians in primary care, non-psychiatric specialties and other health care professionals. The chapters combine research and clinical experience and also provide techniques that can be applied in daily clinical practice, both in terms of identifying the patients as well as helping the patients to better cope with their disorder. The highly structured hands-on treatment programme described in the book is now a compulsory part of the specialist training of Danish primary care physicians and has won the Academy of Psychosomatic Medicines Alan Stoudemire Award for Innovation and Excellence in Psychosomatic Medicine Education.

Sujets

• Diseases
• Medical
• Médecine

Informations

• Publié par: Aarhus University Press
• Date de parution: 01 juillet 2015
• Nombre de lectures: 0
• EAN13: 9788771840629
• Langue: English

Extrait

Edited by Per Fink and Marianne Rosendal
Functional Disorders and Medically Unexplained Symptoms
Assessment and treatment
The Research Clinic for Functional Disorders and Psychosomatics Aarhus University Hospital 2015
Editors
Per Fink
PhD from Aarhus University in 1993 with a thesis about the relationship between the prevalence of mental and physical diseases, and in 1997 Doctor of Medicine with a dissertation on chronic somatisation. Since 1999 employed as a senior doctor at The Research Clinic for Functional Disorders, Aarhus University Hospital, and the same year employed as a Clinical Associate Professor at the University of Aarhus. In 2009 Per Fink was appointed professor.
Per Fink has published around 130 scientific articles in international journals, textbook chapters in Denmark and abroad, and has lectured extensively at home and abroad. Per Fink s research is devoted to the study of functional diseases, and together with Marianne Rosendal and Tomas Toft, he has devised an educational programme for general practitioners and other doctors in the treatment of functional disorders, the so-called TERM model.
Per Fink is also a co-founder of the European Organization for Liaison Psychiatry and Psychosomatics, and is a Fellow of the Academy of Psychosomatic Medicine in the United States. He helped create the Interest Group on Liaison Psychiatry of the Danish Society of Psychiatry and was the Group s first President. Per Fink has won several research prizes, among others he was awarded The Alan Stoudemire Award for Innovation and Excellence in Psychosomatic Medicine Education in 2007 for his work with the TERM model.
Marianne Rosendal
MSc from Odense University in 1989 and a general practice specialist in 1996. After some years in general practice, Marianne Rosendal acquired a PhD degree at the Faculty of Health Sciences, Aarhus University in 2003. Her research focused on the treatment of medically unexplained symptoms and functional disorders in general practice. From 2003 to 2006, Marianne Rosendal served as a general practitioner in her own practice, but since 2006 she has been a senior researcher at The Research Unit for General Practice, Aarhus University, where she has also participated in quality development in relation to general practice.
Together with Per Fink and Tomas Toft, Marianne Rosendal helped lay the foundation for the treatment programme, the TERM model, and has ever since participated in its further development and dissemination. Marianne Rosendal has also been involved in the development of classification systems in relation to symptoms and functional disorders in general practice. In that connection, she has served on the working groups under the WHO and Wonca (the World Organization of Practitioners). As part of her research and teaching of functional disorders, Marianne Rosendal coordinated the work to develop a clinical guide on this topic which was published by the Danish College of General Practitioners in 2013.
Authors
Andreas Schr der, PhD, MD
Senior registrar, senior researcher
The Research Clinic for Functional Disorders,
Aarhus University Hospital, Denmark
Ann Ostenfeld-Rosenthal, PhD, MA
Associate professor
Department of Public Health
University of Southern Denmark
Charlotte Ulrikka Rask, PhD, MD
Clinical associate professor, postdoctoral fellow
The Research Clinic for Functional Disorders,
Aarhus University Hospital, Denmark
Lene Toscano, MD
Specialist in General Medicine
The Research Clinic for Functional Disorders,
Aarhus University Hospital, Denmark
Marianne Rosendal, PhD, MD
Senior researcher
The Research Unit for General Practice
Aarhus University, Denmark
Mette Bech Ris r, PhD, MA
Researcher
The Research Unit for General Practice, Department of Social Medicine
University of Tromso, Norway
Per Fink, PhD, MD, DmSc
Director
The Research Clinic for Functional Disorders,
Aarhus University Hospital, Denmark
Tomas Toft, PhD, MD
Consultant
The Psychiatric Ward
Odense University Hospital, Denmark
Trine Dalsgaard, PhD, MA
Anthropologist, Denmark
Preface
Physical symptoms are common, but some people experience a condition of actual bodily distress , where the symptoms themselves cause an illness, although the symptoms do not fit into any known psychiatric or somatic disease pattern. Besides being a symptom of a possible physical disease, somatic symptoms may, in some cases, be an expression of physical, mental or social stress or strain.
Specific treatment is rarely necessary, but in some cases the symptoms become debilitating. We have previously found it difficult to treat some of the individuals with these symptoms, and doctors may have felt powerless. For this reason, some patients with bodily distress were perceived as difficult. As a doctor, you want to give these patients the same quality of treatment as that which is offered to other patients. The purpose of this initiative is to improve the doctors ability to recognise and prevent inappropriate illness behaviour, both on the doctors own part and among patients, and to improve our treatment of this patient group
The training programme has been prepared by the Research Clinic for Functional Disorders, Aarhus University Hospital, in collaboration with the Research Unit for General Practice, Aarhus University. In addition to this manual, the programme consists of an intensive course in which the various elements of the treatment model are trained by means of practical exercises. Separate training materials have been designed for participants and teachers. The training programme was originally developed for general practitioners 1 (GPs), but the current version has been modified to further its use by all non-psychiatric doctors. The training programme focuses on diagnosing and treatment of functional disorders, but many of the techniques taught are of a general nature and can therefore be of much benefit in the treatment of other mental disorders as well as in general everyday clinical practice. The programme was originally developed in connection with the FIP study 2 (prevention of functional disorders and inappropriate illness behaviour in general practice), which was an interdisciplinary collaboration involving The Research Clinic for Functional Disorders, Aarhus University Hospital, The Research Unit for General Practice, Aarhus University, The Department of Ethnography and Social Anthropology, Aarhus University, and The Department of Psychology, University of Aarhus. This project has worked closely with the study Somatising patients in general practice 3 which emanated from the Quality Improvement Committee Q2, Vejle County, and the Research Unit and Department for General Practice, Aarhus University. Our appreciation goes to the general practitioners Frede Olesen, Hans Kallerup, Laurits Ovesen, Jette Schj dt, Sven Ingerslev, Mogens Tuborgh, Annette Vib k Lund, Martin Holm, Kaj Sparle Christensen, Jette M ller Nielsen and Lene Agersnap, and psychiatrist Lene S ndergaard Nielsen, MSc in Psychology Lisbeth Frostholm for reading, commenting and actively participating in the development of this programme. We also wish to thank Professor Linda Gask, University of Manchester, who inspired the design of the original course programme. Furthermore, we wish to thank the many doctors who have completed the course and provided valuable feedback and ideas for improvement.
Some parts of the training programme build on The Reattribution Model developed in Manchester by Professor David Goldberg and Associate Professor Linda Gask in the early 1980s [1-11]. However, we have significantly modified the original model and added several new elements. The name has therefore been changed to the TERM Model ( The Extended Reattribution and Management Model ).
The most significant changes are:
a) General interview technique has been incorporated into the model.
b) A clearer discrimination is made between the different principles. For example, we emphasise only to use active listening and assessment in the first phase. Many doctors tend to be over efficient , to give advice and to offer explanations too quickly, which is very inappropriate when dealing with somatising patients.
c) Questions about mental illness, functional level and expectations to treatment, etc. are added as independent items.
d) The biological basis of somatoform disorders is central to the explanatory model.
e) We have added a guide for follow-up treatment.
f) We have added a guide for treatment or management of sub-acute and chronic somatising patients.
g) The project and the educational programme are described in detail for documentation purposes.
Some parts of the current version have been thoroughly revised compared to the first edition. The book and the treatment model have been rewritten to target all doctors. Chapters 1-9 on the theoretical background have been reviewed and updated with the latest knowledge. We have added a new Part III, which describes the follow-up care, and a Part IV on children and adolescents. Moreover, we have included anonymous patient stories and cases based on the authors experiences. All the patients identities have been blurred to a degree that they will not be recognisable by either themselves or by people who know them. The patient stories remain representative of the issues exemplified and illustrated.
The overall goals of this training programme are
1. To give doctors a better understanding of the characteristics of functional disorders.
2. To improve doctors capability to diagnose functional disorders.
3. To improve doctors capability of:

- terminating ineffective treatment or facilitating further treatment
- treating functional symptoms and less severe cases of functional disorders
- managing chronic cases of functional disorders.
Reading guide
Part I (Chapters 1-8) provides a theoretical introduction to the subject of functional disorders. Thi