scholarly journals Az orvos–beteg kommunikáció jelentősége a szomatizáló páciensek ellátásában

2016 ◽  
Vol 157 (17) ◽  
pp. 664-668
Author(s):  
Adrienne Stauder ◽  
Dániel Eörsi ◽  
János Pilling
Keyword(s):  
Stress Reduction ◽  
Secondary Care ◽  
Medical Training ◽  
Treatment Guidelines ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Evidence Based ◽  
Medical Visits ◽  
Structured Intervention ◽  
As Stress

The term “somatization” refers to the manifestation of multiple somatic complaints not explained by organic changes. According to the literature, 15–25 percent of all medical visits are related to somatization. As medical training does not put enough emphasis on the evaluation of the possible psychological background of certain somatic symptoms, physicians may feel powerless and make unjustified diagnostic and therapeutic efforts. The patients may also feel helpless and frustrated, their anxiety and the intensity of their complaints may increase. As stress is an important factor in the somatization process, stress reduction and improvement of coping are key elements of the treatment guidelines for chronic diseases. Evidence based interventions range from short counselling and medication to cognitive and behavioral psychotherapy. Reattribution, a short (10–30 minutes) structured intervention that can be implemented in primary or secondary care, in certain cases can result in significant decrease in somatic symptoms and anxiety. Orv. Hetil., 2016, 157(17), 664–668.

The Red Legs RATED tool to improve diagnosis of lower limb cellulitis in the emergency department

2021 ◽  
Vol 30 (12) ◽  
pp. S22-S29
Author(s):  
Gillian O'Brien ◽  
Patricia White
Keyword(s):  
Emergency Department ◽  
Lower Limb ◽  
Treatment Guidelines ◽  
Positive Impact ◽  
Data Gathering ◽  
Pilot Project ◽  
Accurate Diagnosis ◽  
Evidence Based ◽  
Significant Burden ◽  
User Friendly

Background: Lower limb cellulitis poses a significant burden for the Irish healthcare system. Accurate diagnosis is difficult, with a lack of validated evidence-based tools and treatment guidelines, and difficulties distinguishing cellulitis from its imitators. It has been suggested that around 30% of suspected lower limb cellulitis is misdiagnosed. An audit of 132 patients between May 2017 and May 2018 identified a pattern of misdiagnosis in approximately 34% of this cohort. Objective: The aim of this pilot project was to develop a streamlined service for those presenting to the emergency department with red legs/suspected cellulitis, through introduction of the ‘Red Leg RATED’ tool for clinicians. Method: The tool was developed and introduced to emergency department clinicians. Individuals (n=24) presenting with suspected cellulitis over 4 weeks in 2018 were invited to participate in data gathering. Finally, clinician questionnaire feedback regarding the tool was evaluated. Results: Fourteen participants consented, 6 female and 8 male with mean age of 65 years. The tool identified 50% (n=7) as having cellulitis, of those 57% (n=4) required admission, 43% (n=3) were discharged. The remainder who did not have cellulitis (n=7) were discharged. Before introduction of the tool, all would typically have been admitted to hospital for further assessment and management of suspected lower limb cellulitis. Overall, 72% (n=10) of patients who initially presented with suspected cellulitis were discharged, suggesting positive impact of the tool. Clinician feedback suggested all were satisfied with the tool and contents. Conclusion: The Red Leg RATED tool is user friendly and impacts positively on diagnosis treatment and discharge. Further evaluation is warranted.

Masked Depression: Its Interrelations with Somatization, Hypochondriasis and Conversion

1988 ◽  
Vol 17 (4) ◽  
pp. 367-379 ◽  
Author(s):  
Robert Z. Fisch
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Diagnosis And Treatment ◽  
Clinical Phenomenon ◽  
Clinical Problems

Masked depression appears to be a common clinical phenomenon. Most depressions present with some somatic complaints in addition to affective and cognitive ones. About one half of all depressions seen by primary care physicians initially present predominantly or exclusively with somatic symptoms. Many of these depressions are not recognized or are misdiagnosed and mistreated. The possible reasons for this are discussed here. The phenomenon of somatization in depressions and other conditions is reviewed and the interface with other related clinical problems like hypochondriasis and conversion is delineated. It is hypothesized that the proportion of depressions that are masked is positively correlated to the patients' tendency to somatize and negatively correlated to the doctors' ability to recognize depressions that hide behind somatic complaints. Suggestions for the diagnosis and treatment of masked depressions are given.

scholarly journals Diagnostic and treatment barriers to persistent somatic symptoms in primary care – representative survey with physicians

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Marco Lehmann ◽  
Nadine Janis Pohontsch ◽  
Thomas Zimmermann ◽  
Martin Scherer ◽  
Bernd Löwe
Keyword(s):  
Primary Care ◽  
Primary Care Physicians ◽  
Rating Scales ◽  
Treatment Guidelines ◽  
Somatic Symptoms ◽  
Diagnosis And Treatment ◽  
Treatment Barriers ◽  
Adequate Treatment ◽  
Physical Disease ◽  
Federal States

Abstract Background Many patients consult their primary care physician with persistent somatic symptoms such as pain or sickness. Quite often these consultations and further diagnostic measures yield no medical explanation for the symptoms – patients and physicians are left in uncertainty. In fact, diagnostic and treatment barriers in primary care hinder timely health-care provision for patients suffering from persistent somatic symptoms (PSS). The significance of individual barriers is still unknown. We compare and quantify these barriers from the perspective of primary care physicians and identify subpopulations of primary care physicians who experience particular barriers as most severe. Methods We mailed a questionnaire to primary care physicians (PCP) in Germany and asked them which barriers they consider most important. We invited a random sample of 12,004 primary care physicians in eight federal states in Germany. Physicians provided anonymous mailed or online responses. We also mailed a postcard to announce the survey and a mail reminder. Main measures were Likert rating scales of items relating to barriers in the diagnosis and treatment of PSS in primary care. Information on demography and medical practice were also collected. Results We analyzed 1719 data sets from 1829 respondents. PCPs showed strongest agreement with statements regarding (1.) their lack of knowledge about treatment guidelines, (2.) their perceptions that patients with PSS would expect symptom relief, (3.) their concern to overlook physical disease in these patients, and (4.) their usage of psychotropic drugs with these patients. More experienced PCPs were better able to cope with the possibility of overlooking physical disease than those less experienced. Conclusions The PCPs in our survey answered that the obligation to rule out severe physical disease and the demand to relieve patients from symptoms belong to the most severe barriers for adequate treatment and diagnosis. Moreover, many physicians admitted to not knowing the appropriate treatment guidelines for these patients. Based on our results, raising awareness of guidelines and improving knowledge about the management of persistent somatic symptoms appear to be promising approaches for overcoming the barriers to diagnosis and treatment of persistent somatic symptoms in primary care. Trial registration German Clinical Trials Register (Deutschen Register Klinischer Studien, DRKS) https://www.drks.de/drks_web/setLocale_EN.do The date the study was registered: October 2nd 2017 The date the first participant was enrolled: February 9th 2018 DRKS-ID: DRKS00012942

Somatization in Primary Care: A Comparative Survey of Immigrants from Various Ethnic Groups in Rome, Italy

2005 ◽  
Vol 35 (3) ◽  
pp. 241-248 ◽  
Author(s):  
Massimiliano Aragona ◽  
Lorenzo Tarsitani ◽  
Francesco Colosimo ◽  
Barbara Martinelli ◽  
Hassan Raad ◽  
...  
Keyword(s):  
Primary Care ◽  
Ethnic Groups ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Central Americans ◽  
Primary Care Unit ◽  
Primary Care Settings ◽  
South Central ◽  
Current Prevalence ◽  
Comparative Survey

Objectives: Those responsible for interviewing immigrants in primary care settings often underestimate the importance of somatic symptoms arising from psychological distress. This study investigates the current prevalence of somatization in immigrants, and evaluates the comparative rates of somatic complaints in four ethnic groups (Caucasians, Asians, South/Center Americans, and Africans). Methods: We studied the 301 consecutive outpatients (aged between 16 and 70 years) attending the “Caritas” primary care unit for immigrants in Rome (Italy) from January to December 2003, all of whom completed the 21-item version of the Bradford Somatic Inventory (BSI-21). Patients scoring 14 or more on the BSI-21 were considered at risk for somatization. Results: The current prevalence of somatization was 35.2%; 62.3% of the somatizers were women. A multiple regression analysis adjusting for the possible confounding effects of sex, age, education, and months of stay in Italy showed that South/Central Americans had significantly higher somatization scores than the other three groups. Conclusions: These findings suggest a high probability of somatization syndromes in immigrant patients. South/Central Americans tend to somatize more than other ethnic groups. A psychosomatic approach may be useful for immigrants in primary care settings.

Role of perceived social support in depressive and somatic symptoms experienced by Bedouin Arab and Jewish Israeli undergraduates

2018 ◽  
Vol 56 (2) ◽  
pp. 359-378 ◽  
Author(s):  
Sarah Abu-Kaf ◽  
Golan Shahar ◽  
Gal Noyman-Veksler ◽  
Beatriz Priel
Keyword(s):  
Social Support ◽  
College Students ◽  
Depressive Symptoms ◽  
Ethnic Minority ◽  
Emotional Support ◽  
Perceived Social Support ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Arab Students

Elevated levels of depressive and somatic symptoms have been documented among college students. Over the past two decades, there has been an increase in the number of Bedouin Arab students studying at institutions of higher education in southern Israel. To date, research on coping and mental health problems among students who are members of this ethnic minority has been limited. This study examined the role of three aspects of perceived social support – availability, satisfaction, and the ability to get emotional support – in predicting depressive and somatic symptoms among Jewish Israeli and Bedouin Arab college students. A total of 89 Bedouin and 101 Jewish first-year students participated in this study, which involved two assessment waves 12 to 14 months apart. Participants completed questionnaires assessing depressive symptoms, somatic complaints, three aspects of perceived social support, and demographics. At Time 1, Bedouin students exhibited higher levels of depressive and somatic symptoms and lower levels of all three aspects of social support. Regression analyses showed that level of emotional support was a prospective predictor of somatization at Time 2. Moreover, when levels of emotional support were low, ethnic group predicted depression at Time 2; emotional support predicted depression only among Bedouin Arabs. The present study highlights the importance of the use of emotional support in predicting somatic complaints and depressive symptoms specifically among Bedouin Arab students. Clinical implications on intervention programs for ethnic minority students will be discussed.

Relations among Positive Affect, Negative Affect, and Somatic Symptoms in a Medically Ill Patient Sample

2000 ◽  
Vol 87 (1) ◽  
pp. 227-233 ◽  
Author(s):  
Steven A. Kvaal ◽  
Shobhana Patodia
Keyword(s):  
Psychological Distress ◽  
Negative Affect ◽  
Positive Affect ◽  
Pain Intensity ◽  
Somatic Symptoms ◽  
Somatic Complaints ◽  
Positive And Negative Affect ◽  
Medical Patients ◽  
Medically Ill ◽  
Different Populations

The Positive and Negative Affect Scale (PANAS), a brief measure of Positive and Negative Affect, may be useful in assessing mood of medical patients because it does not include somatic items frequently confounded with medical conditions. In previous research Positive and Negative Affect have been independent and uncorrelated, and Negative Affect but not Positive Affect has been positively correlated with somatic symptoms. However, relationships between variables may vary in different populations, and there is relatively little information on Positive and Negative Affect in medical patients. In the current study, the PANAS was used to assess the relationships among Positive Affect, Negative Affect, and somatic symptoms and pain in a medically ill hospital population. Positive and Negative Affect scores were positively correlated and for patients reporting pain, Positive Affect scores were positively correlated with pain intensity. Results from this and other studies indicate that Positive and Negative Affect are independent but in some populations may be correlated; positive affects such as hopefulness may co-occur with both somatic complaints and psychological distress.

scholarly journals Current Approaches in Management of Patients with Hypophosphatasia

2021 ◽  
Vol 17 (6) ◽  
pp. 519-528
Author(s):  
Alexander A. Baranov ◽  
Leyla S. Namazova-Baranova ◽  
Sergey I. Kutsev ◽  
Tea V. Margieva ◽  
Nato D. Vashakmadze ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Genetic Disease ◽  
Pediatric Patients ◽  
Clinical Guideline ◽  
Treatment Guidelines ◽  
Differential Diagnostics ◽  
Evidence Based ◽  
Specific Alkaline Phosphatase ◽  
Enzyme Replacement ◽  
Based Medicine

he authors present the latest data on the hypophosphatasia (HPP) management in children. Hypophosphatasia is a rare genetic disease caused by deficiency of tissue-specific alkaline phosphatase due to mutation in the ALPL gene. The article covers all the features of epidemiology, etiology and pathogenesis, detailed stages of differential diagnostics. Treatment guidelines for pediatric patients are provided, they are based on the principles of evidence-based medicine. Special attention was given to the only effective method of hypophosphatasia management —enzyme replacement therapy (ERT). This material is the clinical guideline draft for the management of patients with hypophosphatasia prepared by the Union of Pediatricians of Russia and the Association of Medical Geneticists.

scholarly journals The emotional brainbow

2019 ◽  
Vol 10 (3) ◽  
pp. e117-118
Author(s):  
Luckshi Rajendran
Keyword(s):  
Interpersonal Relationships ◽  
Health Care Professionals ◽  
Clinical Training ◽  
Medical Training ◽  
Fluorescent Proteins ◽  
First Year ◽  
Evidence Based ◽  
Neural Connections ◽  
Axonal Connections ◽  
The Brain

It was early in my first year of medical school that I learned about the “brainbow” - an innovative means of using genetic expression of various fluorescent proteins to colourfully label individual neurons, allowing for the visualization of neural networks within the brain. I was fascinated by the beautiful complexity of these axonal interconnections. In reflection, I drew parallels to my journey through medicine, and the intricacies of navigating human interpersonal relationships. Medical practice includes both the soft and the hard sciences. Academic institutions teach us the hard sciences: the pathophysiology of disease, and the evidence-based practice for diagnosis and management. Over the years of my clinical training, I am learning that much of the soft science of medicine is in the human connection. It is in our ongoing practice of communication and interpersonal skills, and the subsequent relationships that we develop (or sometimes, lose) with our friends, partners, and colleagues, as we face the miracles and the hardships throughout our medical training. It is in our patient interactions: the emotions we share, the empathy we convey, and the rapport that we build in order to provide compassionate patient care. Much like the brain’s neural network, these connections are complex and ever-changing - some connections are strengthened, and others are unfortunately, and perhaps painfully, pruned. My piece “The emotional brainbow” uses fine multicolours of sewn thread to reflect the intricate axonal connections of brain centres involved in processing and expressing emotions: the cortex, the limbic system, the brainstem, and the cerebellum. These crucial structures communicate to facilitate our ability to understand and empathize with others, and contributes towards our continually developing practice of manoeuvering interpersonal relationships. There is a complex, overlapping interplay of these neural connections within the emotion-regulating brain centres, much like the beautifully intricate emotional human connections, which we, as health care professionals, both create and navigate.

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