1/64. The management of medically unexplained symptoms.Medically unexplained symptoms occur in up to 50% of new medical out-patients. Health care seeking may not be related to the presence of physical disease but may reflect social problems, psychological disturbance, or frank psychiatric disorder. Management of unexplained physical symptoms depends on the duration of symptoms. If acute, exclusion of physical disease, as well as providing symptomatic care, is a priority. The patient's fears of illness need to be addressed and an explanation in simple terms of the symptoms provided. Adverse life situations should be identified and, where possible, rectified. Psychiatric disorders require appropriate treatment. When symptoms are chronic, conservative management is required to contain the symptoms and avoid iatrogenic problems.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/64. Thanatomania in an Asmat community. A report of successful "western" treatment.Case report from the Asmat-area, West New Guineaof black magic in a 12-year-old boy, confirmed anthropologically and medically. Successful treatment by western medicine was achieved by removing the emotional pressure exerted by the community on the patient through physical and pharmaceutical isoledical help saving a black magic victim. A follow-up of the medicine and anthropology, permitting a discussion of the medical cultural implication.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
3/64. 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 = 0.33333333333333keywords = physical (Clic here for more details about this article) |
4/64. Psychiatric patients presenting with primarily somatic symptoms: report of two cases.Two recent cases of psychiatric disorders, presenting primarily with physical symptoms are described, which suggest that both psychotic and psychoneurotic disorders can present with somatic symptoms for which no adequate physical cause could be defined. It is emphasised that such cases require specialist psychiatric evaluation and assessment for the appropriate management to be initiated. Recent studies have stressed the frequency with which psychiatric illness or psychological distress is presented in most African patients as somatic illness, especially in depressive illness, psychotic disorders and psychoneurotic disorders (1). Two such cases of different diagnoses are presented here.- - - - - - - - - - ranking = 0.66666666666667keywords = physical (Clic here for more details about this article) |
5/64. work-related posttraumatic upper limb disorder. A case report.In this paper we describe a patient with mor-sensory loss in the right forearm and hand, which persisted more than 2 years after work-related crush trauma of the left hand. Radiographic and electromyographic investigations, somatosensory evoked potentials, CT scans of the encephalus as well as the minnesota Multiphasic personality inventory and the Roarschach test have been performed. On the basis of these investigations, we think this represents a case of conversion disorder with somatic features. Included is a brief overview of other psychological illness with physical findings involving the upper limb.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
6/64. Physically manifested illness in children and adolescents. A biobehavioral family approach.This article presents a family systems approach to the assessment and treatment of children and adolescents with physically manifested illness. A biobehavioral continuum of psychologically and physically manifested disease is offered to replace the false dichotomy of organic versus psychological illness. The Biobehavioral family Model, an empirically validated model of the mutual influence of family relational patterns and childhood illness, organizes the treatment approach. The family Process Assessment Protocol provides a method of diagnosing the child's illness in the context of family relational functioning. Two cases, a child with conversion disorder and a child with asthma, illustrate this approach. Additional family systems approaches are referenced in a table with citations.- - - - - - - - - - ranking = 0.66666666666667keywords = physical (Clic here for more details about this article) |
7/64. Psychosomatic disorders in pediatrics.Psychosomatic symptoms are by definition clinical symptoms with no underlying organic pathology. Common symptoms seen in pediatric age group include abdominal pain, headaches, chest pain, fatigue, limb pain, back pain, worry about health and difficulty breathing. These, more frequently seen symptoms should be differentiated from somatoform or neurotic disorders seen mainly in adults. The prevalence of psychosomatic complaints in children and adolescents has been reported to be between 10 and 25%. These symptoms are theorized to be a response to stress. Potential sources of stress in children and adolescents include schoolwork, family problems, peer pressure, chronic disease or disability in parents, family moves, psychiatric disorder in parents and poor coping abilities. Characteristics that favour psychosomatic basis for symptoms include vagueness of symptoms, varying intensity, inconsistent nature and pattern of symptoms, presence of multiple symptoms at the same time, chronic course with apparent good health, delay in seeking medical care, and lack of concern on the part of the patient. A thorough medical and psychosocial history and physical examination are the most valuable aspects of diagnostic evaluation. Organic etiology for the symptoms must be ruled out. Appropriate mental health consultation should be considered for further evaluation and treatment.- - - - - - - - - - ranking = 0.41578605006912keywords = physical, physical examination (Clic here for more details about this article) |
8/64. 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 = 0.33333333333333keywords = physical (Clic here for more details about this article) |
9/64. Orgone (Reichian) therapy in tension headache.Orgone (Reichian) therapy, which utilizes a unique physical approach in addition to standard character-analysis, is illustrated in cases of muscle contraction (tension) headache. It offers a more direct technique for attacking the muscular tension (somatic armor) while undermining the psychic defenses.- - - - - - - - - - ranking = 0.33333333333333keywords = physical (Clic here for more details about this article) |
10/64. psychophysiologic disorders in children and adolescents.Psychosomatic disorders in children and and adolescents is a topic that covers a wide variety of illnesses and one which is difficult if not impossible to define accurately. In general, chronic emotional states, often nonspecific, serve as strong contributors to the development of a physical illness. The particular illness is often dictated by varying degrees of biological predisposition in one physiological system-i.e., such a predisposition in the respiratory system may lead to asthma or in the gastrointestinal system to ulcerative colitis. In some cases the biological factor is large and the emotional factor minimal, while in other cases the reverse is true. In the early days of research in psychosomatic disorders it was widely believed that each disorder was accompanied by certain specific emotional problems. Further study has shown this is not true. It was also felt that many, if not most of these disorders could be cured by psychotherapy, and this also has proven to be a fallacy. we have moved more and more to the team approach. Since both psyche and soma are involved, more than one specialist is usually required. In children and adolescents this may involve a child psychiatrist, a pediatrician, an allergist or gastroenterologist, a social worker and a psychologist. It requires time and patience to form an effective and smoothly functioning team in which all members respect one another's potential contribution. Some examples of team operation are presented and some of the problems outlined. In addition, there is attention given to the special problems of the adolescent and also the child with chronic nonspecific physical complaints as well as the child who requires hospitalization.- - - - - - - - - - ranking = 0.66666666666667keywords = physical (Clic here for more details about this article) |
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