1/47. Severe paroxysmal hypertension (pseudopheochromocytoma): understanding the cause and treatment.Severe, symptomatic paroxysmal hypertension always generates suspicion of a pheochromocytoma, a catecholamine-secreting tumor. However, most patients with this disorder do not have this tumor and their condition remains undiagnosed and ineffectively treated. This case series, summarizing the course of 21 such patients, suggests a cause and an effective treatment approach. All 21 patients insisted that the paroxysms were not related to stress or emotional distress, initially discouraging consideration of a link to emotions. Nevertheless, with careful psychosocial interviewing, the disorder could be attributed to emotions patients were not aware of, and, therefore, unable to report. Such emotions were related either to previous severe emotional trauma or to a general tendency to keep distressful emotions out of awareness. With treatment based on this understanding, further paroxysms were eliminated in 13 (62%) of 21 patients. Alpha- plus beta-blockade was used, combined, when necessary, with an antidepressant agent, with or without an anxiolytic agent. In 3 cases, the disorder was cured with psychotherapy alone. Because the presenting symptoms are physical rather than emotional, patients present to internists and primary care physicians rather than to psychotherapists. For this reason, more awareness of this disorder in the medical community is needed.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/47. The power of the visible: the meaning of diagnostic tests in chronic back pain.This article explores the meaning of diagnostic tests for people with chronic back pain. Lower back pain is one of the most common health problems in the US. Five to ten percent of the patients who visit a primary care provider for back pain ultimately develop a chronic condition. We draw on interviews with chronic back pain patients in Atlanta, Dallas and Seattle to argue that testing constitutes an important element in the legitimation of pain for these patients. We discuss three aspects that make testing an area of concern for patients: a strong historical connection between visual images and the medicalization of the interior of the body, a set of cultural assumptions that make seeing into the body central to confirming and normalizing patients' symptoms, and the concreteness of diagnostic images themselves. Our interviews show that when physicians cannot locate the problem or express doubt about the possibility of a solution, patients feel that their pain is disconfirmed. Faced with the disjunction between the cultural model of the visible body and the private experience of pain, patients are alienated not only from individual physicians but from an important aspect of the symbolic world of medicine. This paper concludes by suggesting that a fluid, less localized understanding of pain could provide a greater sense of legitimacy for back pain patients.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
3/47. A case study of neurosis secondary to trauma in an eight-year-old girl. Comments on the tendency for psychogenic illness to become chronic.This case study deals with an eight-year-old girl who developed persistent abdominal pain and vomiting for which no physiological cause could be discovered. After two months of unsuccessful treatment for her illness, the girl was referred for a psychiatric consultation. During the psychiatric interview, the psychogenic nature of the girl's illness became readily apparent, as did the nature of the conflict which had produced it. The tendency is strong for psychogenic illness, such as this, to become chronic without psychiatric treatment. Many physicians are reluctant to apply clinically basic psychiatric techniques to the treatment of physical illness. A suggestion is made that closer collaboration between psychiatry and other medical specialties could be of great value in preventive medicine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/47. Stress and distress in clinical practice: a mind-body approach.Primary care physicians are often taxed by patient complaints that do not seem to have a clear etiology, nor do the patients improve despite good medications and expensive procedures. Current studies show that stress or distress may have a significant effect on the onset, the course, and the management of many, if not all, diseases. Understanding patient's underlying stress physiology and coping mechanisms may enable physicians to better understand various clinical disorders and treat their manifested symptoms. Evidence is reviewed by which stress may exacerbate or cause illness and by which behavioral medicine interventions can improve clinical outcomes.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
5/47. dermatitis artefacta. case reports.patients who seek care for foot problems may present to the podiatrist with concurrent problems, such as anxiety, depression, phobias, personality disorders, and psychoses. These may or may not have any direct relationship to the pathogenesis of the foot problem. The podiatrist may learn of the presence of an emotional problem directly from the patient or from a family member. In many cases, the patient may be unaware or deny the presence of an emotional problem, leaving the podiatric physician in the dark about the patient's mental health state or its implications for the management of the skin problem. In a review of the psychosomatic aspects of dermatology, Koblenzer offered a working classification of the psychodermatoses. This is helpful to the podiatrist in recognizing those dermatologic disease states in which the various aspects of the individual participate in the disease, signs and symptoms of the disease, and the potential psychological value of the disease for the patient. It is also helpful to the podiatrist for recognizing those dermatoses in which psychiatric consultation may be useful so that recognition, treatment, improvement, and perhaps cure may be effected quickly.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/47. Psychogenic (nonepileptic) seizures.Psychogenic (nonepileptic) seizures are among the most common and serious of all psychogenic neurological disorders. They account for approximately 20% of all intractable seizure disorders referred to comprehensive epilepsy centers and present with a reported annual incidence of approximately 4% that of true epilepsy. These events are serious and disabling. Indeed, compared with patients with true epilepsy, patients with psychogenic seizures exhibit more frequent, severe, and disabling seizures as well as a poorer quality of life. The diagnosis and management of psychogenic seizures remain challenging, although advances in video electroencephalographic (EEG) monitoring have improved the ability of physicians to identify these disorders accurately. The prognosis of these patients is still relatively poor, and a good outcome seems dependent on a young age at diagnosis, early diagnosis, less severe psychological comorbidities, and continued follow-up and management by the diagnosing neurologist or clinician. Additional psychological or psychiatric assessment may be beneficial, particularly in elucidating the etiology of the disorder as well as identifying comorbid disorders, and may help in the long-term management of these patients. This review presents the history, epidemiology, differential diagnosis, and management of psychogenic seizures, with particular attention to the use of diagnostic testing, including video EEG monitoring.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/47. Undiagnosed purpura: a case of autoerythrocyte sensitization syndrome associated with dermatitis artefacta and pseudo-ainhum.A 23-year-old young woman presented with recurrent episodes of painful bruising along with linear erosions on the accessible areas of the body of nine years duration with a pseudo-ainhum of her left nipple for the past three months. Her case history included repeated visits to various physicians at different centers and an extensive investigative profile. A diagnosis of autoerythrocyte sensitization was made on the basis of the clinical history, dermatological examination complemented by a positive autoerythrocyte sensitization test, psychiatric evaluation and absence of any organic cause for her ailment. She was placed on psychiatric management and has remained symptom-free after six months follow-up. The case is reported for its rarity, as well as for the association of autoerythrocyte sensitization syndrome with frank dermatitis artefacta and pseudo-ainhum, which to the best of our knowledge has not yet been reported in the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/47. Enhancement of physicians' treatment of illness by behavior therapy.The author criticizes physicians who cling to the conventional belief that successful diagnosis and treatment of physical symptoms can only be handled by medical interventions. He describes the behavioral treatment of three patients who had been treated for almost two years unsuccessfully by medical specialists and who improved significantly with behavioral interventions. A physician who lacks the psychological information that illuminates the environmental and personal contingencies that help to initiate, support, and maintain a patient's symptoms--information such as that obtained by a behavioral analysis--risks deriving a deceptive image of the illness, extends treatment time, prolongs suffering, augments the risk of iatrogenic complications, and increases treatment costs.- - - - - - - - - - ranking = 6keywords = physician (Clic here for more details about this article) |
9/47. Conversion reactions in pediatric athletes.We report five children and adolescents who displayed a conversion reaction in response to stresses induced by athletic competition. Failure to make proper diagnosis led to additional physician referral, needless testing, rehabilitation, or orthotic management. patients are characterized as high achievers who are frequently younger than peers in the sport. Conversation between child and physician identified the source of conflict in four patients. Physical therapy helps resolve symptoms associated with an acute episode and facilitates transition into psychotherapy. psychotherapy is recommended only for patients with persistent maladaptive behavior.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
10/47. family systems intervention and physical illness.family systems theory provides the physician with a comprehensive paradigm to investigate the social and interpersonal context of physical illness. All physical illnesses, particularly life-threatening and chronic ones, profoundly affect the family life of the patient, and the changed family circumstances in turn have impact upon the physically ill patient. This reciprocal interaction between the illness and the family system varies according to the onset, course, outcome, and level of disability. This paper discusses the general application of family systems theory to physical illness as well as the description of the family dimension of acute life-threatening illness, AIDS, chronic illness, chronic neurologic disease, dementia, chronic pain, and cancer in children. We propose that an operational knowledge of theoretical concepts and technical competencies of family systems theory can enhance the therapeutic reach of physicians and other health professionals.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
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