sturge_weber
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a 27 yr old man calls his doc with great discomfort ad wants an appointment for the next day. when questioned the man has a number of complaints, including abdominal pain, discomfort in the lower back, headaches, numbness in left foot, and dizziness.thro his coversation his speech is rapid and tinged with anger. the pt states that these symptoms have made it hard for the patient to concentrate at his job as an accountant. p/e is unremarkable. results from the routine chemistry tests re within the normal reference range. at the conclusion of the examination, the man still complaining of discomfort, asks the physician for instructions and what to do next. at this time the physicians best response would be
a. i suspect ur symptoms re psychological in nature, and like to talk to u furthr about them
b. i did like to run some additional tests,and then we can talk further
c. i did like u to use a heating pad to relieve the painu feel and schedule to see me next week to see how u re doing
d.i am going to schedule u with a consultation with a colleague of mine, who will help u cope up with the stress u re having
e. it looks like u just need to take some time off and relax for a while
f. well i cant find anything wrong, what do u think is causing ur symptoms
g. what would u like to do next?
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| gpsbrar
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confused in a and e. This is generalized anxiety patient.
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| drkpp
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c. looks like a somatoform disorder to me. regularlar scheduling and over the course of time to explain to the patient that it is indeed psychological...
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| sturge_weber
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well ya the ans is c. but acc to explanations its hypochondriasis, i too thought its a somatoform disorder, and the choice c also seems to correct to me,
but why not e......cant it be a somatization disorder where there is unconcious motivationa nd unconcious symptom production, and hence telling the patient to take time off and relax is the right choice
anyhow kaplan says it is hypochondriasis, and hence the cure will come out of knowing the underlying motivethat produces the irrational belief in the disease.and having an appointment again will establish the ongoing relationship
and to gps, u dont right away tell the pt that he has pyschological problem as he is already angry, and will never agree...u have to build a relation with him to let him know that it is pyschological
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| drkpp
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first of all sturge, when i said somatoform disorder it includes hypochondriasis and also somatization and also conversion disorder. in all cases of somatoform disorders the managemen is same. so i wld not bother to be worried whether it is one or the other.
but u r right in the exam if the diagnosis was asked it wld be a little tricky!!!!
i am surprised kap. says it is hypochondriasis cause usually hypochon. in fe,males and secondly they have a specific diagnosis in mind: say the pt. tells doc. i have HIV reagrdless of u convincing them.
whereas in somatization disorder which looks more like it inthis case the pt. has many vague symptoms but no specific diagnosis in mind..
so i wld go with u and say it is a somatization disorder rather then hypochondriasis...
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| sturge_weber
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thanks kpp. and thanks for the info that all somatization disorders, u have to keep following up
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| drkpp
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correction sturge all somatoform disorders and not somatization diasorders...
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| sturge_weber
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thanks again ya drkpp, somatoform disorders, which includes somatization, factitious , malingering, hypochondriasis, conversion, etc
am i correct this time
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