Pediatric emergency medicine trisk 4207 4207
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should look for risk factors, signs, and symptoms that positively support the
diagnosis.
Patients and their families may not often acknowledge significant
stressors. In some cases, the patient might not be fully aware of the presence
or impact of a potential stressor. That being said, a thorough history
including a detailed psychosocial assessment can often help the ED
physician identify likely contributing factors. Patients and their families
should be interviewed individually and together. Information gathered from
the interview that would support a diagnosis of conversion disorder is listed
in Table 126.28 .
TABLE 126.28
HISTORICAL FEATURES OF A PSYCHOSOMATIC DIAGNOSIS
Temporal relationship between onset of symptoms and psychosocial
stressor
Families who accept physical illness but not psychological symptoms as a
cause for disability, have a strong belief that there is a single
undiagnosed explanation for the symptoms, and/or lack faith in the
medical system
Reinforcement of the medical symptoms and functional impairment via
increased sympathy and attention from family/friends, increased
attention from medical providers, and/or avoidance of stressful
situations such as school attendance
Traumatic life events or significant family or psychosocial stressors
Physical illness/disability in the family (which can provide an “illness
model” to the patient)
Personality/coping styles that include a difficulty or avoidance of
verbalizing feelings; introspectiveness; poor self-concept; pessimism;
“Good kids” who are people pleasers and reluctant to burden others with
their stress
Comorbid psychiatric illnesses such as depression and anxiety
History of prior unexplained or functional medical symptoms
