Functional Disorders and Medically Unexplained Symptoms

Per Fink And Marianne Rosendal

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: 9788771249361
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Functional Disorders and Medically Unexplained Symptoms Assessment and treatment

Edited by Per Fink and Marianne Rosendal

Functional Disorders and Medically Unexplained Symptoms

Functional Disorders and Medically Unexplained Symptoms Assessment and treatment

Edited by Per Fink and Marianne Rosendal

The Research Clinic for Functional Disorders and Psychosomatics Aarhus University Hospital 2015

This page is protected by copyright and may not be redistributed

Functional Disorders and Medically Unexplained Symptoms Edited by Per Fink and Marianne Rosendal Englis translation by Morten Pilegaard © he autors and Aarus University Press Layout and typesetting: Narayana Press Cover design: Sparre Grafisk E-book production:Narayana Press

ISBN 978-87-7124-936-1

Aarus University Press www.unipress.dk

In collaboration wit

he Researc Clinic for Functional Disorders and Psycosomatics Aarus University Hospital DK-8000 Aarus C Denmark

International distribution UK & Eire: Gazelle Book Services Ltd. Wite Cross Mills Higtown, Lancaster, LA1 4XS United Kingdom www.gazellebookservices.co.uk

Nort America: ISD 70 Enterprise Drive, Suite 2 Bristol, CT 06010 USA www.isdistribution.com

Publised wit te financial support of Aarus University Researc Foundation

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Table of content

Editors

Authors

Preface Reading guide Abbreviations used

PART I

Introduction to functional disorders

CHAPTER 1 Background Terminology used

CHAPTER 2 Prevalence Prevalence of physical symptoms Prevalence of functional disorders Bodily distress syndrome Health anxiety Consumption of health and social services

CHAPTER 3 Symptoms, clinical findings and the diagnostic process Classification and definition Common symptoms of stress and strain Physical symptoms Emotional symptoms Cognitive symptoms How to make a diagnosis What is demanded of a diagnosis? Making a diagnosis in clinical practice

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17 20 20

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25 27

29 29 31 32 32 33

35 35 36 37 38 39 40 40 41

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CHAPTER 4 Classification and characteristics Classification of patients with functional symptoms I. Symptom diagnoses: Mild and transient symptoms II. Natural reactions to strain or stress III. Distress, stress and adjustment reactions IV. Bodily Distress Syndrome (BDS) V. Health anxiety VI. Dissociative disorders VII. Factitious disorder and Münchhausen’s syndrome VIII. Malingering IX. Physical symptoms and illness worries in other mental disorders X. Psychological factors affecting a medical condition Diagnosis and differential diagnosis

CHAPTER 5 Aetiology Causes Predisposing and precipitating factors Perpetuating factors

CHAPTER 6 Biological basis Biological mechanisms Pathological central processing and modulation of physical stimuli Increased symptom production Conclusion

CHAPTER 7 The interaction between the doctor and patientswith functional disorders Mismatch The doctor’s contribution (iatrogenic factors) The fear of overlooking a physical disease The fear of complaints and prosecution Absence of other treatment Lack of understanding of the nature and character of the illness Lack of knowledge in handling functional disorders The doctor’s personality and perception of his/her role as a medical professional

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43 43 45 46 47 48 52 55 56 57

58 59 60

63 63 64 65

69 69 70 72 74

75 75 76 77 78 78 79 80

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Modesty Pandora’s Box or the fear of loss of control The fear of dependency Time pressure

CHAPTER 8 The patient’s symptom perception and illness beliefs Previous experience and internal evaluation External sources

PART II Treatment

CHAPTER 9 Overview of treatment options The medical specialist and general hospital specialist departments The general practitioner (GP) Specialised treatment Pharmacological treatment

CHAPTER 10 Ensuring a good doctor-patient relationship Avoid assuming a responsibility that is not yours Form of communication Acceptance of the limits of medicine

CHAPTER 11 Primary assessment and treatment (TERM model) Definition of own task in treatment and assessment Considerations before the consultation General conversation techniques Socratic questioning Summaries Express empathy (emotional feedback) TERM model step A: Understanding A.1 Take a full symptom history A.2 Explore emotional clues A.3 Inquire directly about symptoms of anxiety and depression A.4 Explore stressors and external factors (social, occupational and familial) A.5 Explore functional level, handling of the illness (coping) and illness behaviour

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85 87 88

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93 96 97 97 99

101 102 103 103

107 107 108 109 109 111 112 113 114 115 116

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A.6 Explore the patient’s illness beliefs (and wait to tell your own) 118 A.7 Explore the patient’s expectations to the examination and treatment 119 A.8 Make a focused clinical examination and any indicated paraclinical examinations 119 TERM model step B: The GP’s expertise and acknowledgement 120 B.1 Provide feedback on findings 120 B.2 Acknowledge the reality of the symptoms 121 B.3 Explain that there is no indication for further tests or treatments 121 TERM model step C 122 General conversation techniques 123 Avoid conflict 123 Support self-help and own control (empowerment) 123 TERM model step C: Negotiation of a new or modified model of understanding 124 C.1 Clarify the patient’s illness beliefs 124 C.2.A Clarify possible and impossible causal explanations 124 C.2.B Treatment of mild cases 125 C. 2.B. a Qualifying normalisation and reassurance 125 C. 2.B.b Reaction to strains, stress or nervousness 125 C. 2. B.c Demonstration/presentation of possible associations 126 C.2.C Treatment of severe cases 127 C. 2.C.a The disorder is known and has a name 127 C.2.C.b-c Cause unknown but possible biological basis 127 C. 2.C.d Coping – the importance of behaviour regardless of cause 128 TERM model step D: Summary and planning of further treatment course 128 TERM model step E: Management of chronic disorders 129 Status consultation 130 Before the consultation 130 During the consultation 132 The limits of medicine (medical science) 133 General advice on management of chronic functional disorders 133

PART III Follow-up treatment

CHAPTER 12 Follow-up treatment Mild cases with functional somatic symptoms Moderate functional disorders

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141

143 143 143

Severe functional disorders Referral to a specialist

CHAPTER 13 Contents of the follow-up treatment Follow-up consultations Follow-up consultations – general aspects Problem-solving model Basic concepts in cognitive therapy The basic model for cognitive functional disorders Modification of dysfunctional assumptions and actions Dysfunctional illness beliefs Coping – provoking and relieving factors Graded exercise therapy and activation Steps of objectives and list of goals

CHAPTER 14 Example of a course of conversations in primary care Background The first regular consultation The second regular consultation 1st conversation 2nd conversation 3rd conversation 4th conversation 5th conversation 6th conversation 7th conversation

PART IV Children

CHAPTER 15 Children Introduction Special factors in children Frequency Clinical presentation Diagnostic criteria Family factors Diagnostic assessment

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145 146 147 148 149 151 151 152 153 153 155

157 157 158 159 159 160 161 162 163 163 164

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169 169 169 170 171 171 171 172

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