PowerPoint Presentation...Family Physician 44(9):624-629 [email protected]...
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26/08/2019 1 Medically unexplained symptoms Louise Stone 2019 Welcome Childhood abuse and trauma Grief Health anxiety Autoimmune family history “Lyme disease” Using the cube Design your Difficult Patient • We all have a different interpretation of the “difficult” patient. In this workshop we’ll be trying to apply different strategies to a particular case which YOU will design. Choose a card of each colour (pink, yellow, red, orange and purple) and construct your group’s “difficult patient”. Give this patient a name. • It is Friday afternoon, and this patient has been fitted in. How does this patient make you feel BEFORE the consultation?
Transcript of PowerPoint Presentation...Family Physician 44(9):624-629 [email protected]...
26/08/2019
1
Medically unexplained symptomsLouise Stone2019
Welcome
Childhood abuse and trauma
Grief
Health anxiety
Autoimmune family history
“Lyme disease”
Using the cube
Design your Difficult Patient
• We all have a different interpretation of the “difficult” patient. In this workshop we’ll be trying to apply different strategies to a particular case which YOU will design. Choose a card of each colour (pink, yellow, red, orange and purple) and construct your group’s “difficult patient”. Give this patient a name.
• It is Friday afternoon, and this patient has been fitted in. How does this patient make you feel BEFORE the consultation?
26/08/2019
2
Design your Difficult Patient
• We all have a different interpretation of the “difficult” patient. In this workshop we’ll be trying to apply different strategies to a particular case which YOU will design. Choose a card of each colour (pink, yellow, red, orange and purple) and construct your group’s “difficult patient”. Give this patient a name.
• It is Friday afternoon, and this patient has been fitted in. How does this patient make you feel BEFORE the consultation?
Traditional clinical method:the “textbook” approach
Murtagh:Probability diagnosisSerious disorders not to be missedCommon masqueradesPitfalls
Syndromes
Botany
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26/08/2019
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Balint
Illness worry and Disease worry
Illness
worry
Disease
worry
Somatisation
Somatisation“
The tendency to experience, conceptualise and communicatemental states and distress as physical symptoms”
Experience
Attribution
Behaviour
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Common approaches to managing medically unexplained symptoms
Validation
Explanation
Coordination of care and advocacy
Symptom management
Broadening the agenda
Harm minimization
Empathy
Complex PTSD
Symptoms
Altered attention & conscious-ness, e.g.
dissociation amnesia
Somatic distress e.g. headaches,
pains, nausea
Hyper-arousal e.g.
being on edge,
irritable, insomnia -
PTSD
Avoidance of
reminders, triggers –
PTSDFlashbacks, nightmares (reexperiencing) - PTSD
Belief systems affected,
e.g. loss of faith, self of
self
Difficulties in
relationships e.g.
withdrawal, helplessness
Difficult to regulate
emotions, e.g. self-
harm, rage
What is complex PTSD?Complex PTSD involves the core symptoms of PTSD plus additional groups of symptoms.
Source: ISTSS Expert Consensus Treatment Guidelines for Complex PTSD in Adults.
Illustration adapted from TraumaAndDissociation, www.dissociative-identity-disorder.net/wiki/Complex_PTSD
Lifestyle
Stone L 2015 Managing medically unexplained illness in
general practice Australian Family Physician 44(9):624-629
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