ABC of Psychological Medicine by Richard Mayou, Michael Sharpe, Alan Carson

By Richard Mayou, Michael Sharpe, Alan Carson

This publication presents either the facts and the assistance to allow medical professionals to enhance their overview and administration of the mental and behavioural elements of the most typical difficulties featuring typically treatment. It summarises the hot learn facts and offers logic information on how mental and psychiatric features of sickness should be addressed in the clinical session.

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6%) Other violence (20%) Burglary (40%) Theft (22%) Criminal damage and arson (11%) Other crime (5%) Chronic pain and disability A small number of those who have suffered trauma continue to complain of physical symptoms and disabilities that are difficult to explain. Investigations are negative or ambiguous, and the relationship between doctors and patients may become fraught. Doctors may feel their patient is disabled for psychological reasons, whereas patients may feel that doctors do not believe that their symptoms are real and that they are unsympathetic and are not offering appropriate treatment.

Only sometimes do they engage in the psychiatric care offered. Malingering A distinction should be made between factitious disorders and malingering. Malingerers deliberately feign symptoms to achieve a goal (such as to avoid imprisonment or gain money). 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.

Long appointment—During one or more long appointment a patient’s current problems and history should be fully explored. “Fat files” are a simple indicator of a high level of contact with medical services, which may indicate multiple chronic functional somatic complaints 21 ABC of Psychological Medicine Patients should be encouraged to talk not only about their symptoms but also about their concerns, emotional state, and social situation and the association of these with their symptoms. At the end of the assessment, patient and doctor should agree a current problem list, which can then be recorded in the notes.

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