Pediatric emergency medicine trisk 4206 4206
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (101.21 KB, 1 trang )
tumor is good news, even if the patient and family seem
disappointed or frustrated by the negative result. Being able to stop
or avoid initiation of medications that have real and potentially
significant side effects is also “good news.”
A patient’s presentation is very rarely ever 100% due to medical
factors or 100% due to psychological factors. Psychological factors
commonly impact the onset, severity, perpetuation, and/or recovery
from medical illness and psychological stressors often have
physiologic consequences. ED physicians may want to take as
much of an “agnostic” view of the cause of the symptoms as
possible (and acknowledging that a nonemergent medical illness
may have helped triggered the patient’s course) and focus instead
on the ways to promote recovery and return to functioning. The
framing of treatment interventions using the model of physical
rehabilitation can be particularly effective.
Clinical Considerations
Conversion disorder is defined by one or more symptoms of altered
voluntary motor or sensory function that are incompatible with recognized
neurologic or medical conditions and that cause significant distress and/or
impairment in functioning. The term “psychosomatic” symptoms or
“functional” medical disorders can be used to refer to symptoms in other
systems that meet similar criteria. Psychological factors can also frequently
contribute to the development, perpetuation, or exacerbation of the suffering
from underlying medical illnesses. In fact, it should be considered the
exception, rather than the rule, when there are NO psychological factors
impacting a patient’s illness.
Initial Assessment
There is no single finding or test result that can definitively rule in or out
conversion disorder or other psychosomatic symptoms. Clinical recognition
must be based on a thorough review of the history including prior testing
results, close observation and examination of the patient, and any further
testing as indicated. Conversion disorder and other psychosomatic symptoms
should also not be considered a diagnosis of exclusion. ED physicians
