By Richard Mayou, Michael Sharpe, Alan Carson
This publication offers either the proof and the counsel to allow medical professionals to enhance their evaluation and administration of the mental and behavioural points of the commonest difficulties proposing more often than not remedy. It summarises the hot study facts and offers logic assistance on how mental and psychiatric features of disease may be addressed in the scientific session.
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Potential CMFS patients may be identified simply by the thickness of their paper notes, from records of attendance and hospital referral, and by observation of medical, nursing, or clerical staff. Charles Darwin (1809-82) suffered from chronic anxiety and varied physical symptoms that began shortly after his voyage in the Beagle to South America (1831-6). Despite many suggested medical explanations, these symptoms, which disabled him for the rest of his life and largely confined him to his home, remain medically unexplained Management in primary care Assessment It is helpful if one doctor is identified as a patient’s principal carer.
Arch Gen Psychiatry 1997;54:352-8 Smith GR, Monson RA, Ray DC. Psychiatric consultation in somatization disorder—a randomized controlled study. N Engl J Med 1986;314:1407-13 Suggested reading Conclusion Patients with multiple longstanding functional symptoms are relatively uncommon, but their interaction with the health system is memorable in that it often leaves both them and their doctors frustrated. Their effective management requires that special attention be paid to their interpersonal difficulties (including those arising in their relationship with the doctor), the limiting of unhelpful demands, and the avoidance of iatrogenic harm.
Because these patients have often visited several specialists, conventional and alternative, they may have been given inappropriate information and advice, inappropriate treatment, or, in some cases, frank misdiagnosis. Factitious disorders and malingering Factitious disorders Factitious disorders are characterised by feigned physical or psychological symptoms and signs presented with the aim of receiving medical care. They are therefore different from functional symptoms. The judgment that a symptom is produced intentionally requires direct evidence and exclusion of other causes.