By Richard Mayou, Michael Sharpe, Alan Carson
This booklet offers either the proof and the suggestions to allow medical professionals to enhance their evaluate and administration of the mental and behavioural elements of the commonest difficulties featuring as a rule remedy. It summarises the new study facts and gives logic counsel on how mental and psychiatric points of disease could be addressed in the scientific session.
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Extra info for ABC of Psychological Medicine
Malingering is behaviour and not a diagnosis. The extent to which a doctor feels it necessary to confront this issue will depend on the individual circumstances. Failing to recognise and institute appropriate management for patients with multiple functional somatic symptoms may lead to iatrogenic harm from excessive and inappropriate medical and surgical intervention Münchausen’s syndrome x Münchausen’s syndrome is an uncommon subtype of factitious illness in which the patient, who is often a man with sociopathic traits and an itinerant lifestyle, has a long career of attending multiple hospitals with factitious symptoms and signs x Management is as for factitious disorder, but engagement with psychiatric treatment is rare Evidence based summary x Prevalence of chronic multiple functional somatic symptoms depends on how many functional symptoms are required—the fewer symptoms the higher the prevalence x Patients with chronic multiple functional somatic symptoms (somatisation disorder) can be effectively managed in primary care, with resulting cost savings Kroenke K, Spitzer RL, deGruy FV, Hahn SR, Linzer M, Williams JB, et al.
Investigation An appropriate physical examination and necessary medically indicated investigation are clearly essential. Thereafter, before further investigation is done, the potential adverse psychological effect on the patient should be balanced against the likelihood and value of new information that may be obtained. Reassurance and explanation Most patients are reassured by being told that the symptoms they have are common and rarely associated with disease and that their doctor is familiar with them.
Explanation and advice, perhaps in the context of a cardiac rehabilitation programme, may make a substantial contribution to patients’ quality of life. Conclusion An understanding of the interaction of biological, psychological, interpersonal, and medical factors in the predisposition, precipitation, and perpetuation of functional somatic symptoms allows convincing explanations to provided for patients and effective treatment to be planned. Important components of general management include effective initial reassurance, a positive explanation, and practical advice.