Psychological Managements for Psychosomatic Disorders

ISBN-13: 9783540192985 / Angielski / Miękka / 1989 / 335 str.

J. W. Paulley; H. E. Pelser; J. J. Groen

Opis

It is a privilege to introduce this unusual book. In a time when most docotrs practise medicine as a technical application of the natural sciences, the authors, both experienced clinicians, combine the use of modem techniques with human understanding and psychological management of their patients in the practice of internal medicine. Many of these patients suffer from "psychosomatic disorders," i. e. diseases in which emotional stresses play a major role in the production of the symptoms and/or signs. But just because such a large proportion of all illnesses seen by physicians fall within this category (whether functional or organic), this book is not only a guide to the theory of psychosomatic medicine; it describes the way in which the authors deal with patients in their daily practice. Based on many years of clinical experience and a critical appraisal of the literature, they have developed and tested an approach to what they describe as "psychological management." This is partly based on psychological and psychiatric principles but differs from specialised "psychotherapy" and can be learned and practised by physicians in combination with their technical medical treatment. Extensive attention is paid to the stresses, ambivalences and incompatibilities which the patients encounter in their communication with the key figures in their family and at work, and to which they have unsuccesfully tried to adapt without having been able to solve the problems actively.

Spis treści

1 Introduction.- 2 Definitions and Terms.- 2.1 Somatopsychic Presentations.- 2.2 Profiles and Associated Hypotheses.- 2.3 Typicality of Life Events and Situations.- 2.4 Multicausality.- 2.5 Syndrome Shift.- 2.6 Superstability.- 2.7 Alexithymia.- 2.8 Hypochondriasis.- 2.9 Placebo Effect.- 2.10 Conversion Hysteria Versus Psychosomatic Disorder: Diagnosis.- 3 Psychosomatic Disorders: Who should Treat Them?.- 3.1 A Need for Greater Clinical Exposure.- 3.2 Why Clinicians Gave up Referring Classical Psychosomatoses.- 3.3 The Team.- 3.3.1 Weekly Nurses’ Meeting.- 3.3.2 Combind Hospital and General Practitioner Care.- 3.4 Support Groups.- 3.5 Couple Therapy.- 3.6 Group Therapy.- 3.7 Reassurance.- 4 Psychodynamic Concepts and Mechanisms.- 4.1 Transference.- 4.1.1 Hazards of Parent-Child Transference.- 4.2 Ambivalence.- 4.3 “Identifying With”.- 4.4 Defences.- 4.5 When Illness Is Gainful.- 4.6 Stages of Personality Development.- 5 Interviews.- 5.1 The First Interview.- 5.1.1 The Appointment.- 5.1.2 The Setting.- 5.1.3 The Doctor’s Appearance.- 5.1.4 Taking the History.- 5.1.5 Biographical Anamnesis.- 5.1.6 Facilitations.- 5.1.7 Hesitations and Qualifications.- 5.1.8 Silences.- 5.1.9 “Tin-Opening” Questions.- 5.1.10 Typicality.- 5.1.11 Non-Verbal Communications.- 5.2 Subsequent Appointments and Spacing of Interviews.- 5.2.1 Breaks in Care Continuity: Holidays.- 5.2.2 Termination.- 5.3 An Additional Note for General Practice.- 5.3.1 Confidentiality.- 5.3.2 Certification.- 6 Alimentary Tract.- 6.1 The Aphthoses.- 6.1.1 Aphthous Ulcer of the Mouth.- 6.1.2 Behçet’s Syndrome.- 6.2 Sjögren’s Syndrome/Sicca Syndrome/Keratoconjunctivitis Sicca.- 6.3 Nervous Dysphagia/Oesophageal Spasm and Aerophagy.- 6.4 The Splenic Flexure Syndrome.- 6.5 Persistent Severe Disabling Aerophagy and/or Dysphagia.- 6.6 Duodenal Ulcer.- 6.6.1 Prophylaxis for Duodenal Ulcer and Ischaemic Heart Disease.- 6.6.2 Psychological Management for Duodenal Ulcer and Ischaemic Heart Disease.- 6.6.3 Typicality of Double-Barrelled Stress.- 6.6.4 Transcript.- 6.7 Whipple’s Disease (Intestinal Lipodystrophy).- 6.7.1 Case History.- 6.8 Coeliac Disease (Idiopathic Steatorrhoea).- 6.9 Appendicitis.- 6.10 Crohn’s Disease (Regional Enteritis).- 6.10.1 Previous Reports.- 6.10.2 Psychological Management.- 6.10.3 Case Histories and Transcript.- 6.10.4 Summary.- 6.11 Ulcerative Colitis.- 6.11.1 Psychological Management.- 6.11.2 Transcripts and Case History.- 6.11.3 Summary.- 6.12 Irritable Bowel Syndrome.- 6.12.1 Psychological Management.- 6.12.2 Case Histories and Transcripts.- 6.12.3 Summary.- 6.13 Proctalgia Fugax.- 6.14 Chronic Relapsing Amoebic Dysentery.- 6.15 Chronic Constipation.- 7 Respiratory Tract.- 7.1 Hyperventilation Syndrome.- 7.1.1 Psychological Management.- 7.1.2 Psychosomatic Management.- 7.1.3 Case Histories.- 7.2 Vasomotor Rhinitis.- 7.2.1 Psychological Management.- 7.3 Asthma.- 7.3.1 Allergic and Psychogenic Causes.- 7.3.2 Mechanisms of the Expiratory Wheeze.- 7.3.3 Psychological Management.- 7.3.4 Transcripts.- 8 Cardiovascular Disorders.- 8.1 Essential Hypertension.- 8.1.1 Psychological Management.- 8.1.2 Case Histories and Transcript.- 8.2 Cardiac Arrhythmias.- 8.2.1 Premature Contractions (Ectopic Beats).- 8.2.2 Paroxysmal Auricular Tachycardia.- 8.2.3 Auricular Fibrillation and Flutter.- 8.3 Ischaemic Heart Disease.- 8.3.1 Psychological Management.- 8.3.2 Psychological Management After Infarction.- 8.3.3 Transcript.- 8.4 Raynaud’s Phenomenon.- 9 Central Nervous System.- 9.1 Migraine, Vascular Headache and Premenstrual Tension.- 9.1.1 Diagnosis and Examination.- 9.1.2 Treatment.- 9.1.3 Summary.- 9.1.4 Premenstrual Tension.- 9.1.5 Transcripts.- 9.2 Multiple Sclerosis.- 9.2.1 Typicality.- 9.2.2 Case Histories.- 9.2.3 Childlike Appearances and Behaviour.- 9.2.4 Life Event Research.- 9.2.5 Psychological Management.- 9.3 Stroke.- 9.3.1 Psychological Management.- 9.4 Subarachnoid Haemorrhage.- 9.4.1 Psychological Management.- 9.5 Idiopathic Parkinsonism.- 9.6 Guillain-Barré Syndrome.- 9.7 Myasthenia Gravis.- 10 Immune System: Disorders of Immunological Competence and Autoimmunity.- 10.1 Rheumatoid Arthritis and Autoimmune Disease.- 10.1.1 Typical Coping Responses and Attitudes.- 10.1.2 Psychological Management.- 10.1.3 Transcripts and Case Histories.- 10.2 Infectious Mononucleosis.- 10.2.1 Psychological Management.- 10.3 Sarcoidosis.- 10.4 Cancer and Malignancy: Psychosomatic Aspects.- 10.5 Guillain-Barré Syndrome.- 10.5.1 Case Histories.- 11 Endocrinological Disorders.- 11.1 General Considerations.- 11.2 Diabetes Mellitus.- 11.2.1 The Education of Diabetes Educators.- 11.2.2 The Group Approach.- 11.2.3 Patients as Educators.- 11.2.4 Future Considerations.- 11.2.5 Summary.- 11.3 Dwarfism: Emotional Deprivation and Growth Retardation.- 11.4 Idiopathic Hirsutism.- 11.5 Hyperprolactinaemia.- 11.6 Thyroiditis.- 12 Musculoskeletal System.- 12.1 The Dropped Shoulder Syndrome — Costoclavicular Compression.- 12.1.1 Diagnosis.- 12.1.2 Psychological Management.- 12.1.3 Case Histories.- 12.2 Intervertebral Disc Disorders.- 12.2.1 Acute Disc Prolapse.- 12.2.2 Psychological Management.- 12.2.3 Case Histories.- 13 Urological Disorders.- 13.1 Case Histories.- 13.2 Urethral Syndrome, Detrusor Irritability or Pseudocystitis.- 13.2.1 Psychological Management.- 13.2.2 Case History.- 13.3 Hunner’s Ulcer — Interstitial Cystitis.- 13.3.1 Psychological Management.- 13.4 Factitious Haematuria.- 14 Disorders of Blood.- 14.1 Pernicious Anaemia.- 14.2 Infectious Mononucleosis.- 14.3 Acquired Haemolytic Anaemia and Essential Thrombocytopenia.- 14.3.1 Case History.- 14.4 Hypereosinophilic Syndrome.- 14.4.1 Case Histories.- 14.5 Psychogenic Purpura: Autoerythrocyte Sensitisation.- 14.6 Thrombosis.- 14.7 The Haematological Stress Syndrome.- 15 Disorders of the Skin.- 15.1 Psoriasis.- 15.1.1 Consultation.- 15.1.2 Communication.- 15.1.3 Psoriasis Associations.- 15.1.4 Learning to Live with Psoriasis.- 15.1.5 Summary.- 15.2 Atopic Dermatitis.- 15.2.1 Psychophysiological and Psychoimmunological Mechanisms.- 15.2.2 Personality and Other Psychological Triggering Factors.- 15.2.3 Case History.- 15.2.4 Psychological Management.- 15.2.5 Therapeutic Approach to Atopic Dermatitis Patients.- 15.2.6 Psychotherapy.- 15.3 Chronic Urticaria.- 15.3.1 Psychophysiological Aspects.- 15.3.2 Psychological Treatment.- 15.3.3 Patient Management.- 16 Gynaecology, Obstetrics and Sexual Function.- 16.1 Menstrual Disorders.- 16.1.1 Amenorrhoea.- 16.1.2 Menorrhagia.- 16.1.3 Dysmenorrhoea.- 16.2 Vaginal Discharge.- 16.2.1 Teenage Discharge.- 16.2.2 Leucorrhoea.- 16.3 Irritable Colon, Colon Spasm, Spastic Colon.- 16.4 Infertility.- 16.4.1 Fertility Drugs and Fertilisation Techniques: Psychological Hazards.- 16.5 Pregnancy and Labour.- 16.5.1 Hyperemesis Gravidarum.- 16.5.2 Premature Labour.- 16.5.3 Uterine Inertia.- 16.6 Breast Feeding.- 16.7 Disorders of Sexual Function.- 16.7.1 Female Disorders.- 16.7.2 Male Disorders.- 17 Anorexia Nervosa, Bulimia, Induced Vomiting and Purging.- 17.1 Psychopathogenesis.- 17.2 Psychological Management.- 17.3 Behavioural Management.- 17.4 Outpatient or Inpatient Management or Both.- 17.5 Family Therapy — The Systems Model.- 17.6 Prognosis.- 18 Ear, Nose and Throat and Eye Disorders.- 19 Psychosomatic Medicine: Past, Present and Future.- 19.1 Distant Past.- 19.2 Past.- 19.2.1 Years of Promise.- 19.2.2 Years of Confusion.- 19.3 Recent Past and Present.- 19.3.1 The Retreat from Patients.- 19.3.2 Personality Inventories: An Unhelpful Diversion.- 19.3.3 Behavioural Science: Another False Lead.- 19.3.4 Resistances to Psychosomatic Medicine.- 19.4 The Future.- 19.4.1 Holistic Medicine Is Not Psychosomatic Medicine.- 19.4.2 A Plan for the Future: New Departments of Clinical or Applied Medicine.- 19.5 Summary.