Stress Medicine by Prof David Clarke (USA)

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Interventions and recognition for patients with Medically Unexplained Symptoms

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Stress Medicine by Prof David Clarke (USA)

  1. 1. 1<br />Solving Medical Mysteries<br />Hidden Stress & Unexplained Symptoms<br />David D. Clarke, MD<br />
  2. 2. 2<br />A Baffling Illness<br />
  3. 3. 3<br />Stress Illness<br /> Illness caused by past or present <br /> psycho-social stress.<br />
  4. 4. 4<br />The Third Illness Class<br />Psychiatric<br />Stress<br />Organic<br />
  5. 5. 5<br />Cause of Presenting Symptoms<br />
  6. 6. 6<br />A Wide Range of Presentations<br />
  7. 7. 7<br />Women Undergoing Laparoscopy<br />
  8. 8. 8<br />Costly and Frustrating<br />No definitive tests<br />Frequent referrals & “mega-workups”<br />False positive tests<br />Serious illness is ruled out but the patient remains ill<br />
  9. 9. 9<br />Symptoms Relieved after a Nine Month Negative Work-Up<br />
  10. 10. 10<br />A note from the Referring Physician<br />“Thank you for helping her. It is reassuring to know that I didn’t miss anything important.”<br />
  11. 11. 11<br />Gaining The Patient’s<br /> Confidence and Cooperation<br /> Stress<br />Symptoms<br />
  12. 12. 12<br />Two Simple Concepts<br />Stress Causes Real Symptoms<br />Effective Treatment is Available<br />
  13. 13. 13<br />Stress History Part I<br /> Current Stress<br />
  14. 14. 14<br />Stress History Part I - a<br /> Insufficient Personal Time<br />
  15. 15. 15<br />Stress History Part II<br />Childhood Stress<br />
  16. 16. 16<br />Adverse Childhood Experience Study<br />Seven Factors Measured (n=18,000)<br />Abuse: 1. Physical <br /> 2. Sexual <br /> 3. Psychological<br />Household Occurrences: 4. Substance Abuse <br /> 5. Mental Illness<br /> 6. Domestic Violence<br /> 7. Householder Imprisoned<br />
  17. 17. 17<br />4+ ACEs vs Zero ACEs<br />Odds Ratios<br />IV Drug Use 11.0<br />Suicide Attempt 9.5<br />Alcohol Abuse 5.3<br />Domestic Violence 5.0<br />Multiple Somatic Sx 2.7<br />COPD 2.4<br />Obesity 1.8<br />
  18. 18. 18<br />Stress History Part III<br />Depression<br />
  19. 19. 19<br />Stress History Part IV<br />Post-Traumatic Stress<br />
  20. 20. 20<br />Stress History Part V - a<br />Generalized Anxiety Disorder<br />
  21. 21. 21<br />Stress History Part V - b<br />Social Anxiety Disorder<br />
  22. 22. 22<br />Stress History Part V - c<br />Panic Disorder<br />
  23. 23. 23<br />Treatment of Current Stress<br />Listing Your Stresses<br />
  24. 24. 24<br />Treatment of Current Stress<br />Self-Care Time<br />
  25. 25. 25<br />Treatment of Current Stress<br /> Relaxation Technique<br />
  26. 26. 26<br />Treatment of Childhood Stress<br /> Acknowledge Their Heroism<br />
  27. 27. 27<br />Treatment of Childhood Stress<br />Writing<br />
  28. 28. 28<br />Treatment of Childhood Stress<br />Reading<br />
  29. 29. 29<br />Treatment of Childhood Stress<br />Support Groups<br />
  30. 30. 30<br />Treatment of Childhood Stress<br /> Mental Health Counseling<br />
  31. 31. 31<br />Treatment of Depression, PTSD & Anxiety<br /> Medication<br />
  32. 32. 32<br />Treatment of Depression, PTSD & Anxiety<br /> Mental Health Counseling<br />
  33. 33. 33<br />The Mystery Solved<br />
  34. 34. 34<br />Another Mystery<br />
  35. 35. 35<br />Linda’s 550 Days <br />
  36. 36. 36<br />Somatic Expression of Rage<br />
  37. 37. 37<br />The Talking Cure<br />
  38. 38. 38<br />Stress Causes Real Symptoms<br />
  39. 39. 39<br />Effective Treatment is Available<br />
  40. 40. 40<br />The Stress Medicine Specialist<br />Master’s Degree in Mental Health<br />Work in Primary Care<br />Available for “Instant Consults”<br />Mutual education with Primary Care<br />
  41. 41. 41<br />What if there was a blood test for stress illness?<br />
  42. 42. 42<br />Until there is a blood test…<br />“Wonderful.” (Yale)<br />“Truly remarkable.” (UNC)<br />“Extremely valuable.” (Berkeley)<br />“A spectacular accomplishment.” (OHSU)<br />www.stressillness.com<br />
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