Download ABC of Psychological Medicine (ABC Series) by Richard Mayou, Michael Sharpe, Alan Carson PDF

By Richard Mayou, Michael Sharpe, Alan Carson

This booklet presents either the facts and the information to permit medical professionals to enhance their review and administration of the mental and behavioural facets of the most typical difficulties offering ordinarily remedy. It summarises the hot learn facts and gives good judgment counsel on how mental and psychiatric features of disorder may be addressed in the clinical session.

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All services that see trauma emergencies need management plans for psychological as well as medical care. This includes planning for major events in which there are many victims and for the much commoner road traffic and other incidents in which there are often several victims, some of whom may be severely injured and who may well be related or know one another. Emergency departments and primary care need procedures for helping the patients and for supporting the staff that are involved. Treating avoidance and phobic anxiety x Diary keeping—Encourage detailed diary of activity and associated problems as a basis for planning and monitoring progress x Anxiety (stress) management—Relaxation, distraction, and cognitive procedure for use in stressful situations x Graded practice—Discuss a hierarchy of increasing activities; emphasise importance of not being overambitious and need to be consistent in following step by step plan Compensation x Simulation of disability and exaggeration are uncommon in routine clinical contacts x Many victims want recognition of their suffering as much as financial compensation x Innocent victims of trauma are generally slower to return to work than those victims who accept that they were to blame x Financial and social consequences of trauma and blighting of ambitions may be considerable and are often unrecognised x Compensation procedures and reports may hinder development and agreement about treatment and active rehabilitation x Compensation may allow interim payments and funding of specialist care to treat complications and prevent chronic disability Head injury x Assessment should involve questions about possible unconsciousness and post-traumatic amnesia x Cognitive consequences of minor head injury are often not recognised x Minor impairments may be obscured in clinical situations but be disabling in work and everyday activities x Recovery may be prolonged x Complaints of confusion and poor memory can be due to depression x Specialist assessment may be needed Relatives’ needs Immediately after severe or frightening trauma x Make comfortable x Inform relatives of trauma in a sympathetic manner x Practical assistance x Clear information Later x Information about injuries, treatment, and prognosis x Discuss effects on everyday life x Discuss needs for practical help and availability x Ask about possible psychiatric problems and indicate help available Types of trauma x Occupational—Return to work often slower than in other types of injury.

Such comments may suggest that the patient’s relationship with the doctor may reflect poor quality parental care or emotional deprivation in childhood. They are important for two reasons: firstly, the doctor may take these remarks personally, become demoralised or angry, and retaliate, which will destroy the doctor-patient relationship; and, secondly, the attitudes revealed may require more detailed psychological exploration. Finally, iatrogenic factors may intervene that are beyond the treating doctor’s control.

Support for doctors General practitioners managing patients with CMFS should arrange ongoing support for themselves, perhaps from a partner or another member of the primary care team with whom they can discuss their patients. A doctor and, for example, a practice nurse can jointly manage some of these patients if there is an agreed management plan and clear communication. Referral to psychiatric services Not all doctors will consider that they have the necessary skills or time to manage these patients effectively.

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