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The quantity and significance of psychological distress in medical patients. Some preliminary observations about the decision to seek medical aid
Abstract
The percentage of patients coming to a medical clinic with psychological distress was measured by recording symptoms in two studies in the same clinic at different times. The clinical study and the sociological study gave similar results, i.e., over 80 per cent incidence. The different definitions, criteria and measures in previous studies of ‘psychiatric illness’ in medical patients, as well as their implications, are reviewed. Depression was common in the clinical study. Such distress was considered significant in the decision to seek medical aid because of expectations of help from the doctor. That this distress may be related to the decision to go to the doctor is illustrated by case reports. Further validation is suggested by prospective and field studies outside the clinic.
... As mentioned above, for most of noncommunicable disorders, stress remains a major causative factor. [1] dynamic concEPt of mind Stress tries to destabilize the rhythm/order homeostasis and pushes system toward disease. Normally, an individual is resilient and his/her systems are in order. ...
... It is a concept. [1] According to Merriam-Webster dictionary, the element or complex of elements in an individual who feels, perceives, thinks, wills, and especially reasons. The mind is an abstract concept used to characterize thoughts, feelings, subjective states, and self-awareness that presumably arise from the brain. ...
... Monitoring and blunting may also be related to initial indices of perceived stress such as depression. Because depression, in turn, has been found to be both prevalent in primary care populations and related to health-seeking behaviors and health status, it is important to explore the effects of coping style while controlling for depressed state (Magill & Zung, 1982;Mechanic, 1978Mechanic, , 1980Nielson & Williams, 1980;Rodin & Voshart, 1986;Scaramella, 1977;Stoeckle, Zola, & Davidson, 1964). This article seeks to do that. ...
We explored individual differences in health-seeking behavior and health status in a primary care population. Specifically, we compared high monitors (those who typically scan for threat-relevant information) with low monitors (those who typically ignore threat-relevant information), while controlling for depression. Overall, high monitors came to the physician with less severe medical problems than did low monitors. Nevertheless, high monitors reported equivalent levels of discomfort, dysfunction, and distress compared with low monitors. Furthermore, during the week following their visit, high monitors expressed less symptom improvement in both physical and psychological problems than did low monitors. Finally, high monitors demanded more tests, information, and counseling during their visit than did their low monitoring counterparts, yet desired a less active role in their own care. The theoretical and practical implications of these findings are discussed.
... Standard psychological treatment of such problems, most of which was conducted within the psychodynamic model, has been largely ineffective (13,14,15,16). However, the recent success of behavioral treatments of numerous medical and health behaviors and problems ( 17,18,19,20,21) and the emerging recognition that, in addition to biomedical variables, broad psychosocial rather than narrow intrapsychic variables play an important role in determining patterns of "symptom" behaviors and health care utilization ( 3,22,23,24,25,26,27,28,29,30) has generated new interests, new concepts, and treatments in the systematic study of such patterns of behavior. ...
... Doctors focus on organs and their dysfunction, whereas patients see the impact of disease in their states of being and social function (11). Diseases and illnesses do not map distinctly onto each other (12). Thus, seeing the social implications in the cultural context is important. ...
... Somatizasyon, psikolojik temel üzerinde gelişen, organik nedeni açıklanamayan fiziksel yakınmaları ifade eder (28,29). Birinci basamak hekim başvurularının %30 ila %80'inde psikosomatik kaynaklı bir neden olduğu düşünülmektedir (30)(31)(32). Çarpıntı da somatizasyon belirtilerinden biridir (10). Çarpıntı yakınması ile başvuran hastaların genel topluma göre ...
... Numerosos estudios epidemiológicos han sido realizados sobre el tema (17)(18)(19)(20)(21), que desgraciadamente son difíciles de comparar, por la diversidad de ambientes y metodologías empleadas (ver cuadro 1). Si hubiéramos de guiarmos ciegamente por algunos autores, se podría pensar que la mayoría de los pacientes que acuden al médico son, en realidad, pacientes psiquiátricos, y que deberían ser vistos por un psiquiatra. ...
Tradicionalmente, la Psiquiatría ha estado sepa-rada de las demás especialidades médicas, no sólo por el objeto y el método de sus investigaciones, sino también por un distanciamiento físico. En el desarrollo histórico de la asistencia psi-quiátrica, la creación de servicios de psiquiatría en el seno del hospital general aparece como un nuevo signo de madurez y respetabilidad de nuestra profe-sión. Por una parte, la locación de estos nuevos de-partamentos de psiquiatría viene a tiempo para co-rroborar la idea, relativamente reciente, de que los trastornos mentales son enfermedades «como las de-más», y que, en consecuencia, los enfermos afligi-dos por estos trastornos deben ser atendidos en el mismo hospital que aquellos con enfermedades cla-ramente orgánicas. Por otra parte, el hospital general ofrece al públi-co y a la profesión médica una imagen menos te-mible que el clásico «manicomio», lo cual se tra-duce en un acceso más fácil y rápido al tratamiento psiquiátrico (Mann y Vacaflor, 1972) (1). Uno de los fenómenos resultantes de este acerca-miento físico, es el descubrimiento de la interfase entre la psiquiatría y las demás especialidades. En el desarrollo de su diferenciación interna, el depar-tamento de psiquiatría, felizmente implantado en el hospital general, acaba creando un Servicio de Con-sultas o de «liaison» psiquiátrica (o psicosomatica, como algunos prefieren llamarlo). En ocasiones, es-te Servicio es el núcleo inicial, a partir del cual po-drá llegar más tarde a formarse un verdadero De-partamento de Psiquiatría. Con frecuencia, del funcionamiento de este Ser-vicio depende el prestigio de todo el departamento de psiquiatría, y la calidad de sus relaciones con los departamentos vecinos. El Servicio de Consulta Psi-quiátrica es el nexo de unión entre los médicos que (*) Este trabajo está basado, en parte, en la tesis de licencia-tura del primer autor, realizada bajo la dirección del profesor doctor José (Canadá). se ocupan del cuerpo, y los que se ocupan de la mente, y su difícil misión es convencer a unos y a otros que el ser humano no puede dividirse, y que solamente una orientación holística puede ayudar al hombre total cuando enferma. La primera dificultad que el psiquiatra ha de ven-cer en su actividad de consultor, es la desconfianza que otros médicos puedan tener sobre su sentido práctico. Por eso, sus primeros esfuerzos deben ir encaminados a mostrar la valía de sus propios co-nocimientos, desarrollar una labor de utilidad in-mediata para el enfermo y hacerse aceptar como parte integrante del equipo terapéutico. Resolver el problema que el paciente y su actividad plantea al médico tratante, y que después de todo es el moti-vo de la consulta y de la existencia misma del Ser-vicio, es la primera función del psiquiatra consul-tor, pero no la única ni la más importante. Su misión fundamental es propagar la orienta-ción psicosomática, despertar el interés por el Hom-bre como ser social, espiritual y biológico, no me-diante vana palabrería, sino demostrando con su ac-tividad que una tal orientación constituye buena me-dicina. Un interesante ejemplo de la importancia de factores otros que los estrictamente biológicos en la enfermedad orgánica es presentado por Egbert (2), quien, en un estudio cuidadosamente controla-do de 97 pacientes quirúrgicos, demostró que un procedimiento tan simple como informar al pacien-te de la naturaleza de la operación y de sus conse-cuencias, de la posible severidad y duración del do-lor postoperatorio y de sus causas, etc., reduce sig-nificativamente la necesidad de analgésicos (es de-cir, experiencia subjetiva de dolor) y acelera el res-tablecimiento.
... This means being able to judiciously use the resources of the community and health care system for the benefit of the patient. In Family Medicine, up to 50 per cent of patient visits to Family Physicians include a primary or secondary psychosocial reason for the visit (Katon, Williamson & Ries, 1981;Stoeckle, Zola & Davidson 1964;Williamson, Beitman & Katon, 1981). As a result, Family Physicians are often the entry point for many problems beyond disease; therefore, a working knowledge of community resources is essential to providing optimal care. ...
... [24][25][26][27] There have always been some doctors who were masters of knowing the patient. Stoeckle et al., 28 as long ago as the 1960s, reported that the majority of primary care patients come with psychological or social concerns. In my practice, I also find the majority of patients have concerns of a psychosocial nature. ...
This paper aims to honour the Hippocratic Oath in modern practice by providing reflections on the development of ways for doctors to know the whole person that have accrued over the five decades to the present.
I present a perspective piece, which includes personal reflections and cites relevant literature.
Powerful role models sustained the concept of knowing the whole patient in an era of scientific medicine. Beginning in the 1980s, skills allowing ordinary doctors to know the whole patient were made transparent to learners in courses and medical school curricula. As we approach the 2020s, increasing numbers of doctors have mastered these skills and are teaching them.
A modern way of practice is emerging; this emphasises the human side of medicine and its rewards, despite barriers such as those imposed by time limitations.
... The number of patients in any family practice with some degree of somatic fixation is high. One study found that half of all medical patients had symptoms of undetermined cause (10). Another study found somatization disorder in a family practice to be not only a prevalent problem but an expensive and difficult one. ...
Presents a biopsychosocial approach to somatic fixation in which the physician or treatment team establishes a collaborative relationship with the patient system and strives to reach a mutually acceptable explanation for the symptoms. The principles of this type of approach are illustrated, using a case example of a somatically fixated couple. The case provides an example of the vicious cycle that can occur in interactions between physicians and somatically fixated patients. Biomedical and psychosocial evaluations are integrated from the beginning, and the patient's somatic defenses and mode of communicating are respected. Limited goals are established and levels of patient functioning, rather than symptoms, are monitored. Collaborating with another physician or a family therapist is often helpful in work with these difficult cases. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... This article revisits the idea of somatic fixation and attempts to place it in historical perspective, recognizing the fact that symptoms of undetermined cause, said to be present in 50% of medical patients (19), do not necessarily imply that their bearer is somatically fixated. A possible bacterial etiology for duodenal ulcer indicates that we still have much to learn even in a strictly biomedical sense. ...
Somatic fixation is a ubiquitious phenomenon and must be distinguished from somatization. It should be regarded as the unfortunate outcome of a failed patient/physician interaction. The health care system, too, can encourage its development. Somatization, however, is a psychiatric diagnosis and is often 'learned' in the family. This article reviews the subject of somatic fixation from the perspectives of history, the doctor/patient relationship, prevention, and its occurrence outside of the health care system in what is called the popular sphere of medicine. Some recent contributions from the literature (in Dutch) are included, and emphasis is placed on the fact that somatic fixation is a side effect of the pharmacological agent called 'doctor.'
... The work they did with a number of colleagues in the early 1960s on the processes involved in seeking medical care, exerted an important influence on medical sociologists in the USA and elsewhere. A number of the publications arising out of this collaboration have remained key references for studies in two overlapping areas: the relationships between society, culture and illness and the reasons for people taking their symptoms to a doctor (Zola 1963a;Stoeckle et al. 1963;Zola 1964;Stoeckle et al. 1964;Zola 1966;1972b;1972d;1973a). ...
The theme of this essay is that medicine is becoming a major institution of social control, nudging aside, if not incorporating, the more traditional institutions of religion and law, It is becoming the new repository of truth, the place where absolute and final judgements are made by supposedly morally neutral and objective experts, And these judgements are made, not in the name of virtue or legitimacy, but in the name of health (Zola 1972:4871).
This 2006 volume provides a comprehensive discussion of communication between doctors and patients in primary care consultations. It brings together a team of leading contributors from the fields of linguistics, sociology and medicine to describe each phase of the primary care consultation, identifying the distinctive tasks, goals and activities that make up each phase of primary care as social interaction. Using conversation analysis techniques, the authors analyze the sequential unfolding of a visit, and describe the dilemmas and conflicts faced by physicians and patients as they work through each of these activities. The result is a view of the medical encounter that takes the perspective of both physicians and patients in a way that is both rigorous and humane. Clear and comprehensive, this book will be essential reading for students and researchers in sociolinguistics, communication studies, sociology, and medicine.
Arterial hypertension is a major public health issue. Non-pharmacological approaches like Mindfulness-Based Stress Reduction (MBSR) might be a promising addition to conventional therapy. This systematic review and meta-analysis aim to evaluate the effects of MBSR on systolic (SBP) and diastolic blood pressure (DBP) among individuals with prehypertension or hypertension. We searched Medline/PubMed, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCTs) from their inception until August 1st 2021. RCTs were included that compared MBSR to any control intervention in participants with diagnosed prehypertension (120-139/80-89 mmHg) or hypertension (≥140/≥90 mmHg). Mean differences (MD) and 95% confidence intervals (CI) were calculated. Risk of Bias was assessed using the Cochrane tool. Seven RCTs with 429 participants were included. Very low quality of evidence was found for positive effects of MBSR on SBP (MD = -11.26 mmHg, 95%CI = -20.24 to -2.29, p = 0.01) but no evidence for effects on DBP levels (MD = -3.62 mmHg, 95%CI = -8.52 to 1.29, p = 0.15) compared to waitlist control. Compared to active control, very low quality of evidence was found for positive effects on DBP (MD = -5.51 mmHg, 95%CI = -10.93 to -0.09, p = 0.05) but no effects on SBP levels (MD = -4.33 mmHg, 95%CI = -12.04 to 3.38, p = 0.27). Overall, the studies showed a high degree of heterogeneity. The effects found were robust against selection, detection, and attrition bias. Only one RCT reported safety data. MBSR may be an option for lowering blood pressure in people with prehypertension to hypertension. More and larger high-quality studies are needed to substantiate our findings.
The role of excessive or persistent stress as a major contributor to morbidity and mortality is well recognized. Meditation and other mind–body practices are increasingly popular for their perceived physical and mental health benefits and stress relief.
Primary-care practice includes the diagnosis and treatment of both medical and mental disorders. However, primary-care practitioners infrequently diagnose mental disorders.1,2 Such “missed diagnoses” may be due to several factors: lack of education about detection and treatment of mental disorders; the constraints on time in a busy office practice that preclude indepth psychiatric interviews with every patient; and the difficulty of distinguishing symptoms of mental disorders amid physical complaints. Just as with medical illnesses, preventing the complications of mental disorders begins with early and accurate diagnosis. This chapter outlines the means of improving the detection of mental disorders by discussing (1) the role of prevention in mental disorders; (2) the epidemiology of mental disorders in the community and in the medical office; (3) the groups at risk for mental disorders; and (4) the symptoms (anxiety and depression) associated with the major mental disorders seen in office practices.
Somatic fixation is a process whereby a physician and/or a patient or family focuses exclusively and inappropriately on the somatic aspects of a complex problem (1). Somatic fixation can occur not only in hypochondriasis, somatization disorder, and psychosomatic disease, but in any illness, especially chronic illness, when there is a one-sided emphasis on the biomedical aspects of a multifaceted problem. In spite of very difficult life situations, somatically fixated patients tend not to present with anxiety, depression, or trouble coping, but with numerous physical symptoms. The number of patients in any family practice with some degree of somatic fixation is high. One study found that one-half of all medical patients had symptoms of undetermined cause (2). Another study found somatization disorder in a family practice to be not only a prevalent problem, but also an expensive and difficult one. deGruy et al. found that these patients had a 50% higher rate of office visits, 50% higher charges, charts that were close to twice as thick as the average chart, and significantly more diagnoses than matched controls (3).
The view that mind and body coexist separately was as old as written history and had gone through many shifts before the dichotomy was codified by René Descartes in the seventeenth century. Dualism, or the view that there is mind and there is body, has been called untenable by many philosophers of science.1,2,3,4,5 They argue for a holistic or monistic perspective, maintaining that all phenomena described as either mind or body are one in the same. Despite the lack of strict scientific authenticity, the postion held by most of us is that mind and body exit as separate entites and that these two forces act “on” us and interact within us analogy might lead to more clarity: When seeing a painting, the perspective of the art lover is different from that of a pigment chemist. They both view the same phenomenon evolving out of the materials that give color to the canvas, but the picture, as painted, is to be understood by its own values and rules. For the chemist (who may have little aesthetic concern), the value of the painting resides in the composition of the paint in terms of amounts of cobalt, zinc, lead, titanium, cadmium, etc. The art lover (probably unaware of chemistry) sees the totality of the painting as residing only within the viewer’s experience. Neither of these extremes alone encompasses all of reality.
The interaction between patient and physician is widely recognized as central to the delivery of health care services. Previous studies have demonstrated that physician behavior during the medical encounter is directly related to such patient outcomes as satisfaction, recall of information given, and compliance.1–9 Research in physician-patient communication has emanated from several academic disciplines including sociology, anthropology, psychology, linguistics, philosophy, economics, law, and clinical medicine, suggesting that the physician-patient relationship is important to human society from a variety of perspectives.10 This interdisciplinary research is inevitably disjointed because no single study can possibly be comprehensive. It is further fragmented because few fully developed models exist to integrate the studies.
Epidemiologic studies in primary care have documented that between 25 and 75 percent of all patient visits are due to psychosocial stress as opposed to biomedical problems (Stoeckle, Zola, and Davidson, 1964; Manucci, Friedman, and Kaufman, 1961; Garfield, Collen, Feldman, et al., 1976). Studies that have used structured interviews and research diagnostic criteria for psychiatric illness have determined that one in every four primary care patients has a major mental illness. Hoeper and others (1979) in a study of primary care patients utilizing the Schedule for Affective Disorders and Schizophrenia (SADS) and Research Diagnostic Criteria found that 26.7 percent of patients in a primary care clinic suffered from a mental illness. Hoeper, Nyczi, Cleary, et al. (1979) as well as Marsland, Wood and Mayo (1970), have demonstrated that the anxiety and affective disorders are the two most common types of mental disorders afflicting primary care patients.
In the three and a half decades since the Second World War, there have been remarkable gains in the effectiveness of preventive and therapeutic measures in medicine. To mention but a few examples of the former: vaccines which can prevent poliomyelitis, rubella and measles; Rho (D) immune human globulin administered to Rh negative mothers at the birth of an Rh positive infant to prevent sensitization of the mother and hemolytic disease in subsequent children; screening measures leading to appropriate management to minimize the consequences of inherited metabolic disorders; and prenatal diagnosis to assure a normal birth. As examples of the latter, consider only: antibiotic treatment of infectious diseases; diuretics and alpha blockers to control hypertension; open heart surgery to correct valvular defects; total hip replacement; chemotherapy for childhood leukemias; drugs capable of aborting acute psychotic episodes and of minimizing their recurrence. To a medical graduate of the mid-1940’s who has seen these changes during his own professional lifetime, the new capabilities are a continuing source of wonder and gratification.
The goal of this chapter is to define a useful, readily utilizable data base to assist the physician in the initial evaluation of severely disturbed psychiatric patients admitted to the hospital. The purpose of this initial laboratory workup is not to mindlessly suspend the physician’s judgment nor to go on an unnecessary laboratory search for imaginary pathology, rather it is: (1) to provide a workable and useful data base for a patient likely to receive psychotropic medication, (2) to assist in defining unrecognized physical illness, and (3) to establish patient specific laboratory and physiologic norms which can subsequently be monitored for change, to provide a baseline for long term treatment.
Panic disorder is one of the most common psychiatric disorders. It is often associated with agoraphobia and has an estimated prevalence of 1%-6%. The use of antidepressants, primarily imipramine, in the treatment of panic disorder is effective. Both tricyclic and tetracyclic antidepressants and MAOIs are effective therapy. One of the major advances in the treatment of panic disorder in the last two decades has resulted from the introduction of selective 5-HT reuptake inhibitors (SSRIs). In short term, the high potent benzodiazepines are useful as well. The patients are very sensitive to side effects of the drugs.
John D Stoeckle has influenced several generations of clinicians, scholars, students, and activists concerned about the social dimensions of medicine and public health. Among his many contributions, Stoeckle fostered collaboration between practitioners and social workers, largely to address social conditions that affect the processes and outcomes of clinical care. His seminal article, "Social Work in a Medical Clinic," was published in the American Journal of Public Health in 1966 and is excerpted here. (Am J Public Health. Published online ahead of print December 21, 2015: e1-e5. doi:10.2105/AJPH.2015.302936).
Working within frameworks drawn from the writings of Immanuel Kant, Alfred Schutz, and Kenneth Burke, this article examines the role that diagnostic categories play in autobiographical accounts of illness, with a special focus on chronic disease. Four lay diagnostic categories, each with different connections to formal medical diagnostic categories, serve as typifications to make sense of the way the lifeworld changes over the course of chronic illness. These diagnostic categories are used in conjunction with another set of typifications: lay epidemiologies, lay etiologies, lay prognostics, and lay therapeutics. Together these serve to construct and reconstruct the self at the center of the lifeworld. Embedded within the lay diagnostic categories are narratives of progression, regression, or stability, forms of typification derived from literary and storytelling genres. These narratives are developed by the self in autobiographical accounts of illness.
There is an ambivalence toward ritual in social science. On the one hand, it is seen as immensely valuable to the individual and to society. On the other hand, there is an underlying feeling that ritual is impotent. This paper presents a theory of the distancing of emotion which integrates the positive and negative orientations toward ritual. The theory links ritual to the process of catharsis of repressed emotion, which subsumes the positive orientation. The theory also suggests that when ritual is either over- or underdistanced, it will be seen either as meaningless, in the case of overdistancing, or tension-producing, in the case of underdistancing, which subsumes the negative orientation toward ritual. The relationship between this theory and Freud and Breuer's theory of repression and catharsis is described. Finally, some evidence from ethnology is reviewed which relates sense of well-being, distancing, and catharsis in funeral rites and in curing rituals.
Integrating illustrations from personal experience, the author reviews wide range of literature in the area of psychoneuroimmunology, demonstrating the current scientific understanding of mind-body interaction.
Thoughts, feelings, and moods can have a significant effect on the onset of some diseases, the course of many, and the management of nearly all.Many visits to the doctor are occasioned by psychosocial distress. Even in those patients with organic medical disorders, functional health status is strongly influenced by mood, coping skills, and social support, yet the predominant approach in medicine is to treat people with physical and chemical treatments that neglect the mental, emotional, and behavioral dimensions of illness. This critical mismatch between the psychosocial health needs of people and the usual medical response leads to frustration, ineffectiveness, and wasted health care resources. There is emerging evidence that empowering patients and addressing their psychosocial needs can be health and cost effective. By helping patients manage not just their disease but also common underlying needs for psychosocial support, coping skills, and sense of control, health outcomes can be significantly improved in a cost-effective manner. Rather than targeting specific diseases or behavioral risk factors, these psychosocial interventions may operate by influencing underlying, shared determinants of health such as attitudes, beliefs, and moods that predispose toward health in general. Although the health care system cannot be expected to address all the psychosocial needs of people, clinical interventions can be brought into alignment with the emerging evidence on shared psychosocial determinants of health by providing services that address psychosocial needs and improve adaptation to illness.
Objective
To describe the evolution and characteristics of the NANDA taxonomy I nursing diagnosis of «situational low self-esteem» (SLS) and its related factors in Primary Care patients from the towns of Fuenlabrada and Leganés in the Autonomous Community of Madrid, in the period 2003-2009.
Method
An observational retrospective case series of patients diagnosed by their Primary Care nurse with SLS according to the NANDA I taxonomy. This case series was performed in the towns of Fuenlabrada and Leganes (Madrid). Descriptive analysis of the variables obtained from the database management software for electronic health records in Primary Care (OMI AP). Data observed in percentages. The main variable is 00120 NANDA I diagnosis: SLS. A total of 342 care plans with a SLS diagnosis having completed all the nursing process phases. The NANDA, NOC and NIC classifications were used for the diagnostic formulas, the performance criteria to measure the effectiveness and efficiency of care, and the interventions that were performed to achieve them. The assessment of the nursing process was made according to the Marjory Gordon Functional Health Patterns.
Results
The incidence between 2003 and 2009 increased 8-fold. The large majority (80%) were women, with 52.4% between 40 and 64 years. Eighteen percent of the cases were closed, with 88% positively resolved. The most frequent distinctive characteristic was «negative self-verbalization» (26.5%). The main related factors were «disturbed body image» (23.8%). The most established NOC was «to improve the self-esteem» (41.3%) and its evolution was positive in 61%. Just over half (53.2%) of the interventions were «to increase facing up to responsibilities» and «to boost self-esteem». More than half (55%) of the diagnoses were made due to psychological causes, with episodes of a feeling anxiety-nervousness-tension in 33%.
Conclusions
Although the approach is still difficul, the resolution of psychosocial problems, particularly those of self-esteem, continue to improve. The diagnoses with follow-up show positive results. We must increase our knowledge of psychosocial problems and communication skills in order to respond to the current demands of the population.
To describe the evolution and characteristics of the NANDA taxonomy I nursing diagnosis of «situational low self-esteem» (SLS) and its related factors in Primary Care patients from the towns of Fuenlabrada and Leganés in the Autonomous Community of Madrid, in the period 2003-2009.
An observational retrospective case series of patients diagnosed by their Primary Care nurse with SLS according to the NANDA I taxonomy. This case series was performed in the towns of Fuenlabrada and Leganes (Madrid). Descriptive analysis of the variables obtained from the database management software for electronic health records in Primary Care (OMI AP). Data observed in percentages. The main variable is 00120 NANDA I diagnosis: SLS. A total of 342 care plans with a SLS diagnosis having completed all the nursing process phases. The NANDA, NOC and NIC classifications were used for the diagnostic formulas, the performance criteria to measure the effectiveness and efficiency of care, and the interventions that were performed to achieve them. The assessment of the nursing process was made according to the Marjory Gordon Functional Health Patterns.
The incidence between 2003 and 2009 increased 8-fold. The large majority (80%) were women, with 52.4% between 40 and 64 years. Eighteen percent of the cases were closed, with 88% positively resolved. The most frequent distinctive characteristic was «negative self-verbalization» (26.5%). The main related factors were «disturbed body image» (23.8%). The most established NOC was «to improve the self-esteem» (41.3%) and its evolution was positive in 61%. Just over half (53.2%) of the interventions were «to increase facing up to responsibilities» and «to boost self-esteem». More than half (55%) of the diagnoses were made due to psychological causes, with episodes of a feeling anxiety-nervousness-tension in 33%.
Although the approach is still difficul, the resolution of psychosocial problems, particularly those of self-esteem, continue to improve. The diagnoses with follow-up show positive results. We must increase our knowledge of psychosocial problems and communication skills in order to respond to the current demands of the population.
Evidence is mounting that addressing the psychosocial needs of patients makes economic and health sense. If there were a drug or surgical procedure that could reduce ambulatory care visits, decrease postsurgical length of stay, reduce c-section rates, or decrease death rates from cancer, this medical intervention would be widely accepted and utilized with little hesitation. The beliefs and biases that delay and retard use of psychosocial interventions need to be challenged. This brief review of mind-body interventions in this chapter suggests that health care providers can ill afford to treat patients simply as disordered machines whose health can be restored with physical or chemical interventions alone. Indeed, a burgeoning interest in alternative and complementary medicine with a focus on non-drug, non-surgical interventions, as well as the exploding field of lay literature and self-help groups suggests that many patients are ready, willing, and even demanding that mind-body health techniques to be considered as a part of health care. While the health care system cannot be expected to address all the psychosocial needs of people, clinical intervention can be brought into better alignment with the emerging evidence on the health and cost-effectiveness of mind-body interventions. Mind-body medicine is not something separate or peripheral to the main tasks of medical care but should be an integral part of evidence-based, cost-effective, quality health care.
In January 1974 a Louisville, Kentucky chemical company announced that a link had been found between angiosarcoma and exposure to vinyl chloride. A program of medical screening identified "at risk" workers, some of whom were reassigned to an alternative work setting, a wood pallet plant. Twenty-four "high risk" pallet plant workers (PP) were matched with an equal number of workers with some abnormal test results (TP) and normal results (TN). Illness behavior in the form of medical visits for reasons of illness and injury was documented from the dispensary medical records. Frequency of dispensary use was compared across groups for each PP worker's first year in the pallet plant and for one year prior to furlough or reassignment.
Findings in relation to illness and injury for the three groups and the two time periods were not significant. Although the results were unexpected and negative, they demonstrate that high-risk workers can be perceived in a derogatory way. Such workers are faced with stigmatization as well as difficulties associated with their uncertain state of health.
Interviewed 26 patients with 29 illnesses over 3 mo to explore the patient's illness model outside the usual clinical situation and without focusing on any particular illness. A questionnaire, pilot-tested with 15 patients, was administered in the form of a structured interview. Data suggest that 1) the illness attribution model used by the majority of patients was biomedical; 2) most patients had specific fears but did not always discuss them with their physicians; 3) fears and attributions were often based on past illness experience within the family; and 4) patients' and families' explanatory models were frequently different. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Every human being experiences fatigue and everyone occasionally experiences an unnatural degree of fatigue not clearly explained by the mental, emotional, and physical stresses of the previous days, but such fatigue is usually transient. This chapter describes the illness characterized by a chronic disorder. Chronic fatigue is a common problem in general medical practice. Depression and anxiety with psychologic or social distress expressed in patients as bodily complaints also is common in general medical practice, and one of the more common complaints among somatizing patients is fatigue. Primary psychiatric disorders, particularly depression and anxiety, are the cause of most cases of chronic fatigue in a general medical practice. The diagnosis of these organic illnesses is not always clear, with different physicians making different diagnoses of the same patient.
This article examines and clarifies controversies about the concept of illness in the field of family therapy. We contend that illness, as traditionally understood in all cultures, is a relational, transactional concept that is highly congruent with core principles of present-day family theories. Family therapists need not buy into a biotechnical, reductionistic reframing of illness as disease. Rather, it is more appropriate to conceptualize and work with illness as a narrative placed in a biopsychosocial context. Such a narrative includes how shared responsibility for coping and for finding solutions can take place, without becoming involved in disputes about causal models.
AcknowledgementsDiscussionReferences
The prevalence and significance of recent life stresses among patients presenting at the general hospital emergency unit is studied. Such stresses were found in 86% of sample patients, most reporting more than one, but they were rarely the presenting complaints. Emotional stresses were often recognized as problems but rarely brought for help. Physical stresses were often brought as complaints and most complaints were of a physical nature, as if this were the ticket of admission to the emergency unit. A few, gross stress factors were related to patient psycho-social complaints, and did not significantly account for them. A slightly wider range of stress factors was related to the attending physician's diagnosis of psycho-social problems, and did help to account for this diagnostic decision. A much wider range of stress characteristics, including more subtle ones, was associated with the research psychiatrist's findings of psychosocial problems, and accounted for an even larger proportion of this diagnostic decision. Aspects of the most recent stress were related to his judgment that psychosocial problems influenced this visit to the emergency unit. Crisis Theory suggests that the life stress produces a disequilibrium in the patient's life adjustment, which results either in illness or symptoms to aid in attracting professional help. The application to the emergency unit is the outcome.
These findings emphasize the need for medical authorities to understand illness in the perspective of the patient's life circumstances, and the emergency unit's obligation to act as a screening agency for life stresses requiring therapeutic intervention.
The subjects in this study were 125 male college sophomores in a large midwestern university. About one-third of the students had been Users of the facilities of the free Mental Health Clinic on campus, while the remainder, the Non-users, had not utilized any such facilities. Mailed questionnaires covered the following topics: demographic data, background factors and current life on campus, opinions and attitudes and perceptions of counseling and therapy, and diverse aspects of the students' adjustment and mental health.The major findings, differentiating the Users from the Non-users were: 1. The Non-users came from strongly religious backgrounds; they were more likely to adhere to home standards; they described their college friends as more religious; and they were more likely to belong to the Catholic or one of the Pietistic Protestant religions. 2. The Users were more likely to have fathers who had rather low incomes but relatively high status occupations. 3. Users were apparently higher on physical illness and/or illness behavior. 4. Users knew more friends who had gone for counseling; they estimated that a higher proportion of students needs counseling and a higher proportion goes for counseling; they were more likely to recommend counseling; and they were more likely to be used as confidants. 5. The perceptions and evaluations of counseling among the Non-users were only slightly more negative; less direct measures of perceptions yielded larger differences between Users and Non-users. 6. Self reported mental health was expectedly poorer among Users; however, symptoms and unpleasant affects showed only weak discrimination, whereas acknowledging emotional problems discriminated Users from Non-users more strongly. 7. Those Non-users who were as high on acknowledged emotional problems as the Users were of strongly religious background and showed especially negative evaluations of counseling and therapy. 8. Depression (but not irritation or frequency of symptoms) showed a marked conditioning effect: only when depression or depressive characteristics were present, did acknowledging emotional problems lead to helpseeking behavior. 9. All students showed a drop in church attendance from prior to college to during college; however, among Non-users, the size of this drop was positively associated with Self Report of Problems, while among Users, the association was negative. 10. Non-users had a particularly low readiness to translate the presence of emotional problems into a felt and acknowledged need for some help.Die 125 Probanden dieser Untersuchung waren in einer groen Universitt des Mittelwestens im 2. Jahr Collegestudenten. Ungefhr ein Drittel der Studenten waren Benutzer der Einrichtungen der kostenfreien psychiatrischen Abteilung des Studentischen Gesundheitsdienstes auf dem Campus, whrend die brigen, die Nicht-Benutzer, keine dieser Einrichtungen in Anspruch genommen hatten. Die mit der Post verschickten Fragebogen erstreckten sich auf folgende Themen: Demographische Daten, Faktoren aus dem vergangenen Leben, das gegenwrtige Leben auf dem Campus, Meinungen und Einstellungen und Auffassungen zu Beratung und Therapie und diverse Aspekte der Anpassung und der seelischen Gesundheit der Studenten.Die Hauptergebnisse, die die Benutzer von den NichtBenutzern unterschieden, waren: 1. Die Nicht-Benutzer stammten aus streng religisem Milieu; sie waren eher geneigt, an den huslichen Wertmastben festzuhalten; sie beschrieben ihre College-Freunde als mehr religis; und sie gehrten fter der katholischen oder einer der pietistischen protestantischen Religionen an. 2. Die Benutzer hatten eher Vter mit verhltnismig niedrigem Einkommen, aber relativ hohen beruflichen Stellungen. 3. Benutzer waren offensichtlich mehr krperlich krank und/oder verhielten sich wie Kranke. 4. Benutzer kannten mehr Freunde, die zur Beratung gegangen waren; sie schtzten, da ein hherer Prozentsatz von Studenten Beratung braucht und ein hherer Prozentsatz zur Beratung geht; sie rieten eher zur Beratung; und sie wurden eher als Vertraute benutzt. 5. Die Auffassungen und Bewertungen der Beratung waren unter den Nicht-Benutzern nur geringfgig negativer; weniger direkte Mastbe fr die Auffassungen erbrachten grte Unterschiede zwischen Benutzern und Nicht-Benutzern. 6. Erwartungsgem berichteten die Benutzer seltener von seelischem Wohlbefinden; beide Gruppen zeigten in ihren Symptomen und unangenehmen Gefhlen nur geringfgige Unterschiede, whrend die Anerkennung emotionaler Probleme die Benutzer von den NichtBenutzern strker unterschied. 7. Jene Nicht-Benutzer, die emotionale Probleme genauso hoch wie die Benutzer veranschlagten, kamen aus streng religisem Milieu und zeigten besonders negative Bewertungen von Beratung und Therapie. 8. Depression (nicht aber Gereiztheit oder Hufigkeit von Symptomen) zeigte eine bemerkenswert konditionierende Wirkung: Nur wenn Depression oder depressive Merkmale vorhanden waren, fhrte das Anerkennen emotionaler Probleme zur Suche nach Hilfe. 9. Bei allen Studenten fiel die Hufigkeit des Kirchenbesuches whrend der Collegezeit gegenber der Zeit vor ihrem Collegebesuch ab; jedoch korrelierte die Gre dieses Abfalls bei den Nicht-Benutzern positiv mit dem eigenen Bericht von Problemen, whrend diese Beziehung unter den Beutzern negativ war. 10. Nicht-Benutzer zeigten eine besonders geringe Bereitschaft, das Vorhandensein emotionaler Probleme ist ein bewutes und anerkanntes Bedrfnis nach Hilfe zu bersetzen.Les sujets de cette tude taient 125 tudiants masculins de 2me anne dans une grande universit de l'Ouest. Environ un tiers de ceux-ci taient des usagers de la clinique d'Hygine Mentale du campus, alors que les autres, les nonusagers ne la frquentaient pas. Des questionnaires envoys par poste couvraient les thmes suivants: donnes dmographiques, facteurs relatifs au milieu, vie ordinaire dans le cadre de l'universit, opinions et attitudes, impressions quant aux conseils et la thrapie, et divers aspects de l'adaptation des tudiants et de leur sant mentale.Les principaux rsultats, diffrenciant les usagers des non-usagers, taient les suivants: 1. les non-usagers venaient de milieux trs pratiquants au point de vue religieux; ils se conformaient davantage aux standards familiaux; ils dcrivaient leurs camarades comme tant plus religieux; et ils appartenaient de prfrence la religion catholique ou une des tendances protestantes pitistes; 2. les usagers avaient souvent des pres petits revenus mais avec des positions relativement leves; 3. les usagers taient plus attentifs aux signes de maladie physique ou au comportement maladif; 4. les usagers avaient plus d'amis qui avaient galement t suivis; ils estimaient qu'une plus grande proportion d'tudiants aurait besoin de conseils et devrait les chercher; ils taient aussi plus souvent pris comme confidents; 5. les impressions et valuations de l'assistance parmi les non-usagers taient peine moins positives; des mesures moins directes quant aux impressions provoquaient une plus grande diffrence entre usagers et non-usagers; 6. les usagers parlaient moins de leur sant mentale; cependant les symptmes et atteintes montraient peu de diffrence, alors que la reconnaissance de problmes affectifs sparait nettement les uns des autres; 7. ceux des usagers qui reconnaissaient bien leurs problmes venaient de souches solidement croyantes et faisaient preuve d'valuations nettement dfavorables en ce qui concernait l'aide et la thrapie; 8. la dpression (mais ni l'irritation ou la frquence des symptmes) apportait un lment dterminant: seulement lorsque une dpression ou des traits dpressifs taient prsents la reconnaissance des problmes affectifs amenait une recherche d'assistance; 9. tous les tudiants tmoignaient d'une diminution de la pratique religieuse entre l'poque universitaire et les poques antrieures; cependant chez les non-usagers cette diminution tait en rapport troit avec la reconnaissance de leurs problmes, tandis que chez les usagers le rapport n'tait pas significatif; 10. les non-usagers taient extrmement lents transposer la prsence de problmes affectifs sur le besoin d'aide reconnu et senti.
A follow-up investigation of a group of general practice patients with psychiatric disorders is reported. Attention was directed particularly to those who reported symptoms but were not receiving medical attention. Assessment of an original cohort of 343 psychiatrically ill patients after three years, by means of a postal questionnaire and by questioning the practitioners concerned about the clinical state of each patient, identified 71 who either (a) had not consulted their doctors for six months or longer, or (b) had been regarded as psychiatrically well at the last consultation. 50 (72%) of these consented to interview and current psychiatric disorder was confirmed by interview in 34. The interviewers ratings of the severity of the current psychiatric disturbance were: severe, one case; moderate, 11 cases; and mild, 22 cases.
13 of these 34 patients fell into group (a) and 21 into group (b). In two of the latter cases the practitioners' erroneous ratings of recovered were due to lapses of memory on their own part; in the remainder they were due to the patient's failure to report their psychiatric symptoms at consultation. Their reasons for this failure are considered, together with those offered by patients in group (a) for non-consultation, under nine headings.
The findings are discussed. The severity of the symptomatology concerned is considered and compared with that of other sub-groups of the main survey. Some implications of the findings for medical care are suggested.
A self-selected sample of primary care physicians (general practitioners, family specialists, internists, obstetricians/gynecologists) in a southern county completed structured, precoded questionnaires on a random sample of their patients. Approximately 16% of the patients were diagnosed as having mental health problems. Most common were psychological problems coincidental to somatic disorders rather than psychosomatic or primarily psychological problems. Physicians tended to face and deal with the psychological problems by giving counseling. Drugs were prescribed for less than one-third of those with psychological problems and most of these were counselled as well. Few of these patients were referred to other persons or agencies for care. Neither rates of mental health problems nor treatment of them varied by age, race, sex, marital status, or social class. Age, sex and social class significantly affected various measures of extensiveness of the psychological problems and/or specific diagnosis while race and marital status remained nonsignificant.
The aim of the study was to determine the proportion of high-risk patients who received appropriate antianginal therapy in the prodromal phase prior to a myocardial infarction, as an indicator of medical care seeking behavior. To this end, 606 male infarct patients aged 29–65 years were retrospectively interviewed 17–21 days after acute myocardial infarct. It was found that 77% of all patients (465/606) suffered from anginal pain, but only 32% of the patients with angina pectoris were receiving antianginal therapy in the prodromal period before acute myocardial infarction. Patients not taking medication were significantly younger than those with antianginal medication; they were more often smokers; they were less often suffering from high blood pressure; they expressed more pronounced nonacceptance of the risk; their history of anginal pain was significantly shorter; and they belonged more often to the patient group with a first myocardial infarction. In stepwise logistic regression analysis, high blood pressure, older age and exhaustion were found to be associated with medical treatment before infarction in the patient group with first myocardial infarction. In patients with recurrent infarction, continued smoking and denial of the risk remained predictive of nonmedication.
A study was undertaken of the incidence and nature of psycho-social problems in the general hospital emergency unit, since this facility has become a major general health resource for the community, but is still uncertain about the breadth of its responsibilities. Psychiatric evaluations indicate that more than three quarters of the patients have significant psycho-social problems. Although the patient, attending physician, and psychiatrist agree that these are more likely to be severe than are physical problems, the former two tend to overlook them in favor of coexisting physical problems; the physician especially ignores social problems. The psychiatrist's sensitivity to more covert problems and social problems seems related to his attention to the broad background and functioning of the patient. Only the most overt and severe psychosocial problems receive specialized help either in the emergency unit or via referral to other specialized agencies. Some suggestions are offered for changes in policy, staff education, staffing and equipping, and inter-agency coordination and resource development to help the emergency unit fulfill its responsibilities to the psycho-social health needs of the community.
Dizziness is a common symptom that often remains unexplained despite extensive medical evaluation. Psychiatric disorders are usually considered only after all medical causes of dizziness have been ruled out. Sixty-five patients referred to an otolaryngology practice received a structured psychiatric interview, an otologic evaluation, and a dizziness questionnaire modified to assess psychiatric symptoms. They were divided into four diagnostic groups: psychiatric diagnosis only, otologic diagnosis only, both diagnoses, or neither diagnosis. Eleven questionnaire items were significantly associated with diagnostic groupings. Stepwise discriminant function analysis utilizing age, gender, rapid/irregular heartbeat, extremety weakness, nausea/vomiting, and difficulty with speech resulted in correct group classification for 70% of subjects. The presence of dizziness symptoms like vertigo or lightheadedness was not significantly different between groups. This study suggests that assessment of psychiatric and autonomic symptoms should accompany, not follow, otologic evaluation of dizziness. These symptoms may be more important diagnostically than dizziness quality.
EPIDEMIOLOGY, having long outgrown its classical definition as the study of epidemics, is now defined as the study of all the variables relating to the occurrence of diseases in populations; Morris1 has further suggested that the epidemiologic approach may be used to study the operation of health services. Since family practice is one of the health services, this approach may be utilized to determine the current content, availability and distribution of this service.Definition
Perhaps the most useful definition of the term family practice has been given by the Committee on Preparation for General Practice of the AMA, in a report to the House of Delegates approved in June, 1959. This Committee defined family practice as "that aspect of medical care performed by the doctor of medicine who assumes comprehensive and continuing responsibility for the patient and his family regardless of age." He is generally the first physician consulted
This article has no abstract; the first 100 words appear below.
THE recognition of the importance of emotional stress in the genesis of certain disorders has been a fruitful concept so far as it has promoted the treatment of the patient as a whole. But if it is uncritically applied it may stifle the scientific investigation of disease mechanisms either as the result of attributing etiologic responsibility to the emotional accompaniment of any serious disorder or as the result of assuming that clinical entities of unknown etiology must be psychogenic in origin. The psychiatrically oriented physician is usually involved in a restricted type of practice, which furnishes no representative sample for . . .
*Presented at a meeting of the Springfield Medical Club, Springfield, Massachusetts, February 15, 1956.
Source Information
SPRINGFIELD, MASSACHUSETTS
†Physician, Springfield Hospital.
A G.P. practising in a rural area of Scotland with access to the use of a cottage hospital discusses his workload and trends in the practice comparing the two decades 1949-58 and 1959-68. A moderate change in emphasis is shown from home visits to surgery consultations. Figures also show that the number of days off work or school increased greatly in the second decade together with the total amount of institutional treatment. Disease trends show an increase in respiratory illness, digestive system complaints, mental diseases and diseases of the circulatory system but a decrease in septic conditions (probably due to better hygiene), diseases of the bones and organs of movement, and communicable diseases.
Relationship of psychiatry to internal medicine
- L Hamman
HAMMAN, L. : Relationship of psychiatry to internal medicine, Ment. Hyg. 23, 177, 1939.
An approach to neurosis in general practice The etiology of psychoneurosis encountered in the practice of internal medicine, New Engl The prevalence of psychiatric illness in general practice
- M G Jansen
- G P Reynolds
JANSEN, M. G. : An approach to neurosis in general practice, Med. J. Aust. 2,422, 1954. REYNOLDS, G. P.: The etiology of psychoneurosis encountered in the practice of internal medicine, New Engl. J. Med. 203, 312, 1930. CROMBIE, D. L.: The prevalence of psychiatric illness in general practice, (Co/'. gen. Pratt.) Res. Newsletter 4, 218, 1957.
Mental hygiene and its relationship to the medical profession Use of medical services and neurosis, general practitioners consultations
- L H Ziegler
- J H F Brotherston
- S P W Chave
ZIEGLER, L. H.: Mental hygiene and its relationship to the medical profession, J. Amer. med. Ass. 97, 1119, 1931. 32. BROTHERSTON, J. H. F. and CHAVE, S. P. W.: Use of medical services and neurosis, general practitioners consultations, Brit. J. prev. sot. Med. 10, 200, 1956.
Some psychosocial factors associated with illness behavior, and selected illnesses Views, problems and potentialities of the clinic After everyone can pay for medical care; some perspectives on future treatment and practice
- S V Kasl
- S Stoeckle
- J D Zola
KASL, S. V. and COBB, S.: Some psychosocial factors associated with illness behavior, and selected illnesses, J. chron. Dis. 17, 325, 1964. STOECKLE, J. D. and ZOLA, I. K.: Views, problems and potentialities of the clinic, Medicine 43, 413, 1964. STOECKLE, J. D. and ZOLA, 1. K.: After everyone can pay for medical care; some perspectives on future treatment and practice, Med. Care 2, 33, 1964