This document outlines a psychoeducational group for patients with medically unexplained physical symptoms (MUPS). It includes an initial assessment, follow up letters, and an 8-week program outline. The program aims to educate patients on MUPS and teach coping strategies. Sessions cover topics like the impact of stress, illness beliefs, pain management, and putting learning into practice. The goal is for patients to better understand and manage their symptoms.
Here are some ways psychologists have found to measure pain:
1. Self-report measures: Asking patients directly about their pain levels through clinical interviews, questionnaires or visual analogue scales. Though subjective, self-report is still the most direct way to assess a patient's pain experience.
2. Psychometric measures: Validated questionnaires like the McGill Pain Questionnaire that assess multiple dimensions of pain like intensity, quality, location. They provide a more standardized assessment than simple self-reports.
3. Behavioral observation scales: Rating scales that assess observable indicators of pain levels through a patient's behaviors, facial expressions, movements which can help when self-report is difficult or not possible as with children or impaired adults.
Edna b. foa barbara olasov rothbaum elizabeth a. hembree - prolonged exposu...ericaduran
This document provides an introduction to prolonged exposure therapy for treating PTSD. It describes the treatment's basis in emotional processing theory and exposure techniques. Prolonged exposure therapy uses psychoeducation, breathing retraining, in vivo exposure to trauma reminders, and imaginal exposure to the traumatic memory. The document reviews diagnostic criteria for PTSD and provides background on the prevalence and development of this evidence-based treatment program.
Beyond the Opioid Epidemic - Patient Centered Approaches to Pain ManagementMichael Changaris
The document discusses an integrative approach to pain management that includes both medications and non-medication strategies. It emphasizes that pain is a biopsychosocial phenomenon influenced by biological, psychological, and social factors. An effective treatment plan requires a collaborative, multidisciplinary approach that addresses the underlying causes of pain and develops skills to help patients better manage their pain and take back control of their lives from pain. Non-medication strategies like learning, exercise, stress management, and building a support system can help improve pain and function when used as part of a comprehensive treatment plan.
How to set realistic goals when you have chronic painJeannette Pforr
In this lesson, you will:
- Understand the trade-offs between getting good pain relief, and being able to reach your activity goals
- Learn the value of having a "pain action plan"
- Learn how to set up your own action plan
- Learn how to track your action plan
Current opiate prescription treatment has led to increased deaths, patients with marginal improvement in pain with minimal improvement in quality of life and high system utilization.
The integrated high-risk patient pain management clinics have been established to increase quality of pain care, stabilize high-risk patients and reduce impact of on primary care physicians and clinic utilization. These clinics are one aspect of a comprehensive plan to increase high quality pain care and reduce opiate deaths.
Mental Health – In this current period of data collection rates of
depression in all groups were reduced number of patients with mild MDD < 10%, number of patients with moderate < 7%, number of patients with severe depression < 7% and # of patients with all levels of MDD by 23%. The change in sample depression was significant with p =.01. 37% of patients had a score that indicates a likely full diagnosis of PTSD.
Polyvagal theory case vingette (health-ptsd-microagressions)Michael Changaris
This slide deck explores a hypothetical clinical case through the lens of poly-vagal theory, micro-aggressions, somatic experiencing and neurodevelopment sequencing.
Here are some ways psychologists have found to measure pain:
1. Self-report measures: Asking patients directly about their pain levels through clinical interviews, questionnaires or visual analogue scales. Though subjective, self-report is still the most direct way to assess a patient's pain experience.
2. Psychometric measures: Validated questionnaires like the McGill Pain Questionnaire that assess multiple dimensions of pain like intensity, quality, location. They provide a more standardized assessment than simple self-reports.
3. Behavioral observation scales: Rating scales that assess observable indicators of pain levels through a patient's behaviors, facial expressions, movements which can help when self-report is difficult or not possible as with children or impaired adults.
Edna b. foa barbara olasov rothbaum elizabeth a. hembree - prolonged exposu...ericaduran
This document provides an introduction to prolonged exposure therapy for treating PTSD. It describes the treatment's basis in emotional processing theory and exposure techniques. Prolonged exposure therapy uses psychoeducation, breathing retraining, in vivo exposure to trauma reminders, and imaginal exposure to the traumatic memory. The document reviews diagnostic criteria for PTSD and provides background on the prevalence and development of this evidence-based treatment program.
Beyond the Opioid Epidemic - Patient Centered Approaches to Pain ManagementMichael Changaris
The document discusses an integrative approach to pain management that includes both medications and non-medication strategies. It emphasizes that pain is a biopsychosocial phenomenon influenced by biological, psychological, and social factors. An effective treatment plan requires a collaborative, multidisciplinary approach that addresses the underlying causes of pain and develops skills to help patients better manage their pain and take back control of their lives from pain. Non-medication strategies like learning, exercise, stress management, and building a support system can help improve pain and function when used as part of a comprehensive treatment plan.
How to set realistic goals when you have chronic painJeannette Pforr
In this lesson, you will:
- Understand the trade-offs between getting good pain relief, and being able to reach your activity goals
- Learn the value of having a "pain action plan"
- Learn how to set up your own action plan
- Learn how to track your action plan
Current opiate prescription treatment has led to increased deaths, patients with marginal improvement in pain with minimal improvement in quality of life and high system utilization.
The integrated high-risk patient pain management clinics have been established to increase quality of pain care, stabilize high-risk patients and reduce impact of on primary care physicians and clinic utilization. These clinics are one aspect of a comprehensive plan to increase high quality pain care and reduce opiate deaths.
Mental Health – In this current period of data collection rates of
depression in all groups were reduced number of patients with mild MDD < 10%, number of patients with moderate < 7%, number of patients with severe depression < 7% and # of patients with all levels of MDD by 23%. The change in sample depression was significant with p =.01. 37% of patients had a score that indicates a likely full diagnosis of PTSD.
Polyvagal theory case vingette (health-ptsd-microagressions)Michael Changaris
This slide deck explores a hypothetical clinical case through the lens of poly-vagal theory, micro-aggressions, somatic experiencing and neurodevelopment sequencing.
Everything You Should Know About Physiotherapy, Massage Therapy And AcupunctureBody Restoration
1. The Fight Against Dementia – How Physiotherapy Can Help
2. How Physiotherapy Can Help You as You Get Older
3. How Massage Therapy Will Change Your Life
4. Massage Therapy: See how it can benefit your Mental Health
5. The Benefits of Acupuncture and How It Can Change Your Life
Find out more at http://stalbertphysiotherapy.com/service/acupuncture/
- The document discusses current evidence and perspectives on mind-body approaches to healing cancer and improving health outcomes. It explores how consciousness and the mind can influence physiology, stress, pain perception, and depression.
- Several mind-body interventions like cognitive therapy, meditation, biofeedback, hypnosis, and yoga have evidence for improving quality of life in cancer patients and treating other conditions. However, clinical studies have been inconsistent on whether they provide overall survival benefits.
- A comprehensive mind-body approach that addresses both conscious and subconscious aspects of healing may be needed to fully realize health benefits, though more research is still required to understand these relationships.
Cognitive behavioral therapy (CBT) is a short-term psychotherapeutic intervention that focuses on the role of thoughts, emotions, and behaviors in chronic pain management. CBT has been shown to improve quality of life and functioning for those with chronic pain by helping patients gain more control through a problem-solving approach. CBT treatment for chronic pain typically involves 6 to 12 sessions that assess the patient's history and current condition, build rapport, introduce the CBT chronic pain model, formulate case conceptualizations and treatment plans, implement cognitive and behavioral interventions, and provide follow up sessions to maintain progress.
The document discusses pain from several perspectives:
1. It defines pain, describes different types of pain (acute, chronic, neuropathic), and explains pain pathways and the gate control theory of pain.
2. Effective pain management is an important part of nursing care and involves comprehensive pain assessment, education to increase patient understanding and coping, and a variety of pharmacological and non-pharmacological pain interventions.
3. Unrelieved acute or chronic pain can negatively impact health, recovery, and quality of life so nurses must work to prevent and treat pain.
This document discusses the importance of pain assessment as a human right for all patients. It reviews various pain assessment scales that can be used with both verbal and non-verbal patients. These scales help therapists properly assess pain levels, ensure patient safety, determine ability to participate in therapy, and modify interventions. Pain assessment is crucial for diagnostic and treatment purposes, in accordance with ethical codes of various professions.
This document discusses PRN pain medication administration and management. It outlines objectives around offering PRN medications consistently based on evidence, using sedation and nonverbal pain scales, and properly documenting PRN medication administration in the Excellian system. Key recommendations include administering pain medications regularly to maintain therapeutic levels and using PRN medications for breakthrough pain. Proper documentation and timely administration of PRN medications can help effectively control pain.
The document discusses pain, including its definition, types, and pathways in the body. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is classified into acute, chronic, and prechronic stages. The pain pathway involves transduction, transmission, modulation, and perception of pain signals in the body. Psychosocial factors like anxiety, depression, learning, and attention can influence pain perception. The Gate Control Theory proposes that psychological factors interact with physiological processes at the spinal cord to regulate pain experience.
The document discusses theories of pain from both biological and psychological perspectives. It describes pain as serving an evolutionary purpose of generating behavior change through avoidance or help-seeking. While acute pain has a clear cause and is treated medically, chronic pain has strong psychological components. The Gate Control Theory introduced psychology into pain models, showing pain perception is mediated by interacting physiological and psychological processes. Later sections discuss psychological factors like anxiety, cognition, and behavior that influence pain experience and the role of multidisciplinary treatment including psychotherapy for chronic pain.
The document discusses pain, including definitions of pain, types of pain (such as acute vs. chronic), consequences of pain, pain assessment scales, and approaches to pain management. It notes that pain management may involve pharmacological approaches like opioids, non-pharmacological approaches like physical therapy, and interventional procedures like spinal cord stimulators. The WHO analgesic ladder is also summarized, which recommends treating mild pain with non-opioids, moderate pain with mild opioids, and severe pain with strong opioids by the clock and by mouth until the patient is pain-free.
Pushing the Point: Integrating Acupressure & Oriental Medicine in Psychiatric...Dr. Jaclyn Engelsher, DNP
With the rising costs of care, decreased
reimbursement for services, and shortage of
mental health clinicians, patients and
providers are increasingly researching and
incorporating integrative therapies as part of a
holistic care plan. A review of the literature
revealed a growing evidence base for the
integration of Traditional Chinese Medicine
(TCM) therapies with allopathic medicine. This
has prompted nursing schools across the
country to include education on TCM in their
curriculums, encouraged hospitals and clinics
to add TCM therapies to their list of
psychiatric services, and resulted in
development of new protocols for addiction,
PTSD, and pain management. Acupressure, a
component TCM, is a non-invasive, integrative
modality that can help alleviate common
symptoms such as stress, anxiety, depression,
mental fatigue, and insomnia, while reducing
barriers of cost, time, and deleterious
medication side effects frequently found in
PMH treatment. A basic understanding of TCM
theory is necessary for nurses to teach and
use acupressure effectively in the inpatient
and outpatient settings. The session will
review the function and energetics of common
acupoints easily integrated into
Psychiatric/Mental Health nursing practice,
provide a live demonstration of acupressure
techniques, and include supervised practice
time to develop beginning skills and
experience the benefits.
New directions in the psychology of chronic pain managementepicyclops
Lecture followed audience discussion on contextual cognitive behaviour therapy and acceptance and commitment therapy in the management of chronic pain from the West of Scotland Pain Group on Wednesday 5th December 2007. The speaker is Lance M. McCracken PhD, of the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases & University of Bath, Bath UK.
www.wspg.org.uk
Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
1 in 6 Americans live with persistent pain and approximately 50 million Americans have chronic pain. Chronic pain is identified by increased sensitivity to stimuli, pain from non-painful stimuli, pain outside the injury area, pain lasting longer than healing time, impairment exceeding injury findings, and pain in the absence of tissue damage. Psychosocial issues related to chronic pain include anxiety, anger, insomnia, medication misuse, sexual dysfunction, family dysfunction, and depression. Treatment involves patient education, graded exposure to movement and activities, relaxation techniques, cognitive reconstruction, and a home program with education, monitoring, postural awareness, relaxation, and graded activity.
This document discusses pain management at a San Diego service area. It notes that pain is the most common reason for medical appointments in the US, affecting 50 million people annually and costing $120 billion per year. Patient rights related to pain management are outlined. At-risk populations for under treatment of pain include those with addiction histories, the nonverbal, elderly, infants/children, and ethnic/racial minorities. Several pain scales are presented, including numeric, FACES, FLACC, and N-PASS scales. Pharmacological and non-pharmacological pain treatment options are mentioned.
Back In Action, Melanie Galbraith, Physiotherapist, Fremantle Hospital Pain M...ArthritisNT
This document summarizes key concepts in pain physiology and physiotherapy treatment approaches for chronic pain. It discusses how pain is influenced by both physical and psychological factors, and how the nervous system can become sensitized over time, making pain more widespread and movement more difficult. The summary describes how physiotherapy has traditionally focused on tissues but is now shifting to also target brain mechanisms through strategies like graded exposure, mirror therapy, and retraining abnormal sensory and motor maps in the brain.
The document discusses neonatal pain, including outdated views, facts about neonatal pain perception, pain pathways and development, effects of untreated pain, common painful procedures in NICUs, and how neonates respond to pain physiologically and behaviorally. It also covers factors affecting pain response, the development of pain assessment and treatment, common pain assessment scales, prevention and management of neonatal pain including pharmacological and non-pharmacological approaches.
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, discomfort, bloating, and changes in bowel habits without any detectable organic cause. IBS often begins after an infection or stressful life event. It affects 10.5% of people and is more common in women. IBS commonly co-occurs with other functional disorders and psychiatric conditions like anxiety. Early trauma, especially sexual or physical abuse, is linked to higher rates of IBS and other functional disorders. Cognitive biases and altered brain responses to pain and anxiety are also associated with IBS. Treatments like hypnotherapy, CBT and relaxation techniques can provide effective relief, though benefits may not be sustained long-term
Complementary and alternative approaches to pain relief during laborpharmaindexing
Even though delivery is a natural phenomenon, it has been demonstrated that the accompanying pain is considered severe or extreme in more than half of cases. Besides conventional approaches, such as epidural analgesia, many complementary or alternative methods have been reported to reduce pain during labor and delivery. Not every woman wants traditional pain medication. Many moms-to-be want their labor and delivery to be as natural as possible (and for women who are recovering from drug and alcohol abuse, analgesics are usually a no-no), but still as comfortable as possible.
- Pediatric pain management requires a multidisciplinary team approach to properly assess and treat a child's pain. This includes addressing physiological, sensory, cognitive, behavioral, and affective components of pain.
- It is important to believe the child's reports of pain, listen to parents and children, and consult other experts when needed. Treatment should be individualized and non-pharmacological options considered in addition to pharmacological interventions.
- Common opioid medications used for pediatric pain include morphine, hydromorphone, fentanyl, and methadone. Non-opioid options also have a role to play depending on the situation. Proper protocols and guidelines help ensure children's pain is well-managed
The document discusses neonatal pain, including that babies can feel and react to pain, validated scales exist to measure neonatal pain, and developmental aspects of pain perception in newborns. It also outlines non-pharmacological and pharmacological approaches to treating pain in newborns, emphasizing the need for comprehensive pain management strategies that minimize unnecessary pain in neonates.
The document discusses the relationship between the psyche (mind) and soma (body). It outlines how medical conditions can present with psychiatric symptoms, and how psychological factors can influence medical conditions and symptoms. Specific examples are given of psychosomatic disorders where psychological factors affect medical problems, like cardiovascular, autoimmune and gastrointestinal issues. The document also discusses somatoform and dissociative disorders where psychological factors cause physical symptoms without identifiable medical causes.
This document discusses psychosomatic medicine, which explores the relationships between social, psychological, and behavioral factors on physical health and quality of life. It addresses how patients often present somatic symptoms to doctors without an identifiable organic cause, which can be distressing for both parties. Psychosomatic medicine aims to understand these medically unexplained symptoms and how to best assess and treat the underlying psychological issues like depression or anxiety that may be contributing. Common conditions include somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder. The document examines the role of doctors in responding to patients' concerns and avoiding unnecessary or risky medical interventions when no underlying disease is found.
Everything You Should Know About Physiotherapy, Massage Therapy And AcupunctureBody Restoration
1. The Fight Against Dementia – How Physiotherapy Can Help
2. How Physiotherapy Can Help You as You Get Older
3. How Massage Therapy Will Change Your Life
4. Massage Therapy: See how it can benefit your Mental Health
5. The Benefits of Acupuncture and How It Can Change Your Life
Find out more at http://stalbertphysiotherapy.com/service/acupuncture/
- The document discusses current evidence and perspectives on mind-body approaches to healing cancer and improving health outcomes. It explores how consciousness and the mind can influence physiology, stress, pain perception, and depression.
- Several mind-body interventions like cognitive therapy, meditation, biofeedback, hypnosis, and yoga have evidence for improving quality of life in cancer patients and treating other conditions. However, clinical studies have been inconsistent on whether they provide overall survival benefits.
- A comprehensive mind-body approach that addresses both conscious and subconscious aspects of healing may be needed to fully realize health benefits, though more research is still required to understand these relationships.
Cognitive behavioral therapy (CBT) is a short-term psychotherapeutic intervention that focuses on the role of thoughts, emotions, and behaviors in chronic pain management. CBT has been shown to improve quality of life and functioning for those with chronic pain by helping patients gain more control through a problem-solving approach. CBT treatment for chronic pain typically involves 6 to 12 sessions that assess the patient's history and current condition, build rapport, introduce the CBT chronic pain model, formulate case conceptualizations and treatment plans, implement cognitive and behavioral interventions, and provide follow up sessions to maintain progress.
The document discusses pain from several perspectives:
1. It defines pain, describes different types of pain (acute, chronic, neuropathic), and explains pain pathways and the gate control theory of pain.
2. Effective pain management is an important part of nursing care and involves comprehensive pain assessment, education to increase patient understanding and coping, and a variety of pharmacological and non-pharmacological pain interventions.
3. Unrelieved acute or chronic pain can negatively impact health, recovery, and quality of life so nurses must work to prevent and treat pain.
This document discusses the importance of pain assessment as a human right for all patients. It reviews various pain assessment scales that can be used with both verbal and non-verbal patients. These scales help therapists properly assess pain levels, ensure patient safety, determine ability to participate in therapy, and modify interventions. Pain assessment is crucial for diagnostic and treatment purposes, in accordance with ethical codes of various professions.
This document discusses PRN pain medication administration and management. It outlines objectives around offering PRN medications consistently based on evidence, using sedation and nonverbal pain scales, and properly documenting PRN medication administration in the Excellian system. Key recommendations include administering pain medications regularly to maintain therapeutic levels and using PRN medications for breakthrough pain. Proper documentation and timely administration of PRN medications can help effectively control pain.
The document discusses pain, including its definition, types, and pathways in the body. It defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage. Pain is classified into acute, chronic, and prechronic stages. The pain pathway involves transduction, transmission, modulation, and perception of pain signals in the body. Psychosocial factors like anxiety, depression, learning, and attention can influence pain perception. The Gate Control Theory proposes that psychological factors interact with physiological processes at the spinal cord to regulate pain experience.
The document discusses theories of pain from both biological and psychological perspectives. It describes pain as serving an evolutionary purpose of generating behavior change through avoidance or help-seeking. While acute pain has a clear cause and is treated medically, chronic pain has strong psychological components. The Gate Control Theory introduced psychology into pain models, showing pain perception is mediated by interacting physiological and psychological processes. Later sections discuss psychological factors like anxiety, cognition, and behavior that influence pain experience and the role of multidisciplinary treatment including psychotherapy for chronic pain.
The document discusses pain, including definitions of pain, types of pain (such as acute vs. chronic), consequences of pain, pain assessment scales, and approaches to pain management. It notes that pain management may involve pharmacological approaches like opioids, non-pharmacological approaches like physical therapy, and interventional procedures like spinal cord stimulators. The WHO analgesic ladder is also summarized, which recommends treating mild pain with non-opioids, moderate pain with mild opioids, and severe pain with strong opioids by the clock and by mouth until the patient is pain-free.
Pushing the Point: Integrating Acupressure & Oriental Medicine in Psychiatric...Dr. Jaclyn Engelsher, DNP
With the rising costs of care, decreased
reimbursement for services, and shortage of
mental health clinicians, patients and
providers are increasingly researching and
incorporating integrative therapies as part of a
holistic care plan. A review of the literature
revealed a growing evidence base for the
integration of Traditional Chinese Medicine
(TCM) therapies with allopathic medicine. This
has prompted nursing schools across the
country to include education on TCM in their
curriculums, encouraged hospitals and clinics
to add TCM therapies to their list of
psychiatric services, and resulted in
development of new protocols for addiction,
PTSD, and pain management. Acupressure, a
component TCM, is a non-invasive, integrative
modality that can help alleviate common
symptoms such as stress, anxiety, depression,
mental fatigue, and insomnia, while reducing
barriers of cost, time, and deleterious
medication side effects frequently found in
PMH treatment. A basic understanding of TCM
theory is necessary for nurses to teach and
use acupressure effectively in the inpatient
and outpatient settings. The session will
review the function and energetics of common
acupoints easily integrated into
Psychiatric/Mental Health nursing practice,
provide a live demonstration of acupressure
techniques, and include supervised practice
time to develop beginning skills and
experience the benefits.
New directions in the psychology of chronic pain managementepicyclops
Lecture followed audience discussion on contextual cognitive behaviour therapy and acceptance and commitment therapy in the management of chronic pain from the West of Scotland Pain Group on Wednesday 5th December 2007. The speaker is Lance M. McCracken PhD, of the Pain Management Unit at the Royal National Hospital for Rheumatic Diseases & University of Bath, Bath UK.
www.wspg.org.uk
Further reading:
DAHL, J., & LUNDGREN, T. (2006). Living beyond your pain using acceptance and commitment therapy to ease chronic pain. Oakland, CA, New Harbinger Publications.
http://www.worldcat.org/oclc/63472470
HAYES, S. C., STROSAHL, K., & WILSON, K. G. (1999). Acceptance and commitment therapy an experiential approach to behavior change. New York, Guilford Press.
http://www.worldcat.org/oclc/41712470
MCCRACKEN, L. M. (2005). Contextual cognitive-behavioral therapy for chronic pain. Progress in pain research and management, v. 33. Seattle, IASP Press.
http://www.worldcat.org/oclc/57564664
1 in 6 Americans live with persistent pain and approximately 50 million Americans have chronic pain. Chronic pain is identified by increased sensitivity to stimuli, pain from non-painful stimuli, pain outside the injury area, pain lasting longer than healing time, impairment exceeding injury findings, and pain in the absence of tissue damage. Psychosocial issues related to chronic pain include anxiety, anger, insomnia, medication misuse, sexual dysfunction, family dysfunction, and depression. Treatment involves patient education, graded exposure to movement and activities, relaxation techniques, cognitive reconstruction, and a home program with education, monitoring, postural awareness, relaxation, and graded activity.
This document discusses pain management at a San Diego service area. It notes that pain is the most common reason for medical appointments in the US, affecting 50 million people annually and costing $120 billion per year. Patient rights related to pain management are outlined. At-risk populations for under treatment of pain include those with addiction histories, the nonverbal, elderly, infants/children, and ethnic/racial minorities. Several pain scales are presented, including numeric, FACES, FLACC, and N-PASS scales. Pharmacological and non-pharmacological pain treatment options are mentioned.
Back In Action, Melanie Galbraith, Physiotherapist, Fremantle Hospital Pain M...ArthritisNT
This document summarizes key concepts in pain physiology and physiotherapy treatment approaches for chronic pain. It discusses how pain is influenced by both physical and psychological factors, and how the nervous system can become sensitized over time, making pain more widespread and movement more difficult. The summary describes how physiotherapy has traditionally focused on tissues but is now shifting to also target brain mechanisms through strategies like graded exposure, mirror therapy, and retraining abnormal sensory and motor maps in the brain.
The document discusses neonatal pain, including outdated views, facts about neonatal pain perception, pain pathways and development, effects of untreated pain, common painful procedures in NICUs, and how neonates respond to pain physiologically and behaviorally. It also covers factors affecting pain response, the development of pain assessment and treatment, common pain assessment scales, prevention and management of neonatal pain including pharmacological and non-pharmacological approaches.
Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by abdominal pain, discomfort, bloating, and changes in bowel habits without any detectable organic cause. IBS often begins after an infection or stressful life event. It affects 10.5% of people and is more common in women. IBS commonly co-occurs with other functional disorders and psychiatric conditions like anxiety. Early trauma, especially sexual or physical abuse, is linked to higher rates of IBS and other functional disorders. Cognitive biases and altered brain responses to pain and anxiety are also associated with IBS. Treatments like hypnotherapy, CBT and relaxation techniques can provide effective relief, though benefits may not be sustained long-term
Complementary and alternative approaches to pain relief during laborpharmaindexing
Even though delivery is a natural phenomenon, it has been demonstrated that the accompanying pain is considered severe or extreme in more than half of cases. Besides conventional approaches, such as epidural analgesia, many complementary or alternative methods have been reported to reduce pain during labor and delivery. Not every woman wants traditional pain medication. Many moms-to-be want their labor and delivery to be as natural as possible (and for women who are recovering from drug and alcohol abuse, analgesics are usually a no-no), but still as comfortable as possible.
- Pediatric pain management requires a multidisciplinary team approach to properly assess and treat a child's pain. This includes addressing physiological, sensory, cognitive, behavioral, and affective components of pain.
- It is important to believe the child's reports of pain, listen to parents and children, and consult other experts when needed. Treatment should be individualized and non-pharmacological options considered in addition to pharmacological interventions.
- Common opioid medications used for pediatric pain include morphine, hydromorphone, fentanyl, and methadone. Non-opioid options also have a role to play depending on the situation. Proper protocols and guidelines help ensure children's pain is well-managed
The document discusses neonatal pain, including that babies can feel and react to pain, validated scales exist to measure neonatal pain, and developmental aspects of pain perception in newborns. It also outlines non-pharmacological and pharmacological approaches to treating pain in newborns, emphasizing the need for comprehensive pain management strategies that minimize unnecessary pain in neonates.
The document discusses the relationship between the psyche (mind) and soma (body). It outlines how medical conditions can present with psychiatric symptoms, and how psychological factors can influence medical conditions and symptoms. Specific examples are given of psychosomatic disorders where psychological factors affect medical problems, like cardiovascular, autoimmune and gastrointestinal issues. The document also discusses somatoform and dissociative disorders where psychological factors cause physical symptoms without identifiable medical causes.
This document discusses psychosomatic medicine, which explores the relationships between social, psychological, and behavioral factors on physical health and quality of life. It addresses how patients often present somatic symptoms to doctors without an identifiable organic cause, which can be distressing for both parties. Psychosomatic medicine aims to understand these medically unexplained symptoms and how to best assess and treat the underlying psychological issues like depression or anxiety that may be contributing. Common conditions include somatic symptom disorder, illness anxiety disorder, conversion disorder, and factitious disorder. The document examines the role of doctors in responding to patients' concerns and avoiding unnecessary or risky medical interventions when no underlying disease is found.
An individualized, evidence based approach to musFrancescaDwamena
This document discusses an approach to medically unexplained symptoms (MUS) in primary care. It describes a case of a 34-year-old woman with intractable symptoms and outlines a 5-step approach physicians can take to diagnose and treat MUS: 1) establish a successful doctor-patient relationship, 2) help patients understand their illness, 3) help patients commit to participating in their care, 4) help patients set realistic goals, and 5) negotiate treatment plans including pharmacologic and non-pharmacologic elements. The case study demonstrates how applying this approach helped the patient achieve long-term goals like improved work and relationships.
This document is the January 2010 issue of the HCPJ (Healthcare Counselling and Psychotherapy Journal). It contains several articles on the topic of medically unexplained symptoms (MUS), including an editorial introducing the issue's focus on MUS, an article arguing for the need to address MUS to reduce illness burden and healthcare costs, and an article on exploring the meaning of MUS from a small qualitative study. It also includes articles on teaching doctors about MUS, different approaches to treating MUS, and the role of counselors and psychotherapists in working with MUS patients.
1) Medically unexplained symptoms are common in primary care, with around 19-21% of patients having persistent symptoms for over 3 months. However, doctors often do not adequately address the psychosocial factors underlying these symptoms.
2) A study found that while 61% of patients referred to emotional or social problems underlying their symptoms, doctors only indicated physical disease could be present in 67% of consultations and made empathic statements in just 16%.
3) Doctors tend to propose symptomatic management rather than addressing underlying causes. Focusing on validating patients' experiences, expanding explanations to include psychosocial factors, and focusing on functional impairment rather than just symptoms may help doctors better assist patients with medically unexplained symptoms
Medically unexplained symptoms by dr ajay nihalaniDr Ajay Nihalani
Medically Unexplained Symptoms (MUS) refers to medical symptoms that are not fully explained by physical illness. They can be caused by somatoform disorders like somatization disorder, conversion disorder, and hypochondriasis, which involve the person experiencing physical symptoms that cannot be attributed to medical conditions. MUS can also be linked to mental health issues like depression and anxiety, or be factitious in nature where physical symptoms are intentionally feigned or exaggerated. Somatoform disorders involve the person experiencing real physical symptoms, but their symptoms are considered to be linked to their psychological state rather than a physical disease.
This document discusses medically unexplained symptoms and related psychiatric diagnoses. It summarizes that somatization disorder, hypochondriasis, and somatoform autonomic dysfunction are psychiatric diagnoses related to medically unexplained symptoms. It also discusses that symptoms of generalized anxiety disorder can include both cognitive symptoms like worry and physical symptoms like tremors or difficulty breathing. Differential diagnoses for physical symptoms include endocrine, cardiac, respiratory, and neurological conditions, as well as vitamin deficiencies and substance use. The outcomes of depression, medically unexplained symptoms, and unemployment are shown together over time.
Guidance for commissioners of services for people with medically unexplained ...JCP MH
This guide is about the commissioning of comprehensive MUS services across the healthcare system. In developing this guide, we recognise that ‘medically unexplained symptoms’ is an unsatisfactory term for a complex range of conditions.
MUS refers to persistent bodily complaints for which adequate examination does not reveal suf ciently explanatory structural or other specified pathology. The term MUS is commonly used to describe people presenting with pain, discomfort, fatigue and a variety of other symptoms in general practice and specialist care. Whilst recognising that the phrase ‘medically unexplained symptoms’ can be problematic, it is nonetheless widely used, and an appropriate term to use in this guide.
This guide aims to: describe MUS and the associated outcomes: outline current service provision for MUS and detail the components of a high quality comprehensive MUS service, and highlight the importance of commissioning comprehensive MUS services.
An overview of research and practice of an innovative intervention based on research at the University of Hertfordshire.The clinic is delivered in the national health service in the UK.
The document summarizes some of the key changes between the DSM-IV and DSM-5 classifications of somatic symptom and related disorders. Specifically:
1) Somatoform disorders were renamed as somatic symptom and related disorders to better characterize these disorders.
2) The number of diagnoses was reduced to avoid overlap between categories. Diagnoses like somatization disorder and hypochondriasis were removed.
3) Somatic symptom disorder replaced other diagnoses and includes maladaptive thoughts and behaviors in addition to physical symptoms.
Chronic pain is debilitating to individuals and to our economy, yet most treatments are based on the assumption that it is due to a physical cause. Once it is recognised that chronic pain is caused by our brain and central nervous system as part of a protective stress-processing response, then as this process is reversible, full recovery is possible.
SIRPA Ltd was set up to train health professionals to integrate into their own work the pioneering SIRPA approach, where the emphasis is on recovering from chronic pain, rather than management.
www.sirpauk.com
Treatment of functional neurological symptoms - Sue Humblestone and Jasbir RanuMS Trust
This document provides an overview of a workshop on treating patients with functional neurological symptoms (FNS). The workshop aims to provide an interactive discussion on working with FNS patients, including defining FNS, group work, themes and tips for treatment, a presentation on an inpatient multidisciplinary treatment program, and a case study. The workshop covers topics like predisposing and maintaining factors of FNS, the range of impairments experienced by patients, questions from attendees, and resources for further information.
This lesson introduces complementary and alternative medicine (CAM) practices. It defines CAM as non-mainstream health practices used together with or instead of conventional Western medicine. Common CAM categories discussed are natural products and mind-body practices like meditation, yoga, and Reiki. The lesson highlights that over 30% of U.S. adults and 12% of children use CAM for issues like musculoskeletal pain, colds, and cancer treatment. People seek CAM for potential health benefits and comfort in addition to mainstream medical therapies.
This document provides an overview of key concepts in pathophysiology including definitions of terms like pathogenesis, morphology, clinical manifestations, and levels of prevention. It discusses how pathophysiology deals with cellular and organ changes that occur with disease and their effects on total body function. It also provides tips for studying pathophysiology effectively.
Edna b. foa barbara olasov rothbaum elizabeth a. hembree - prolonged exposu...ericaduran
An estimated 70% of adults in the United States have experienced a traumatic event at least once in their lives. Though most recover on their own, up to 20% develop chronic Posttraumatic Stress Disorder. For these people, overcoming PTSD requires the help of a professional.
As her final thesis topic for London College of Osteopathy and Health Sciences (LCO) Diploma in Osteopathic Manual Practice (DOMP) program, Dr. Fadila Naji examines the effects of osteopathy on patients' psychology.
This study examined the effects of reflexology on 21 menopausal women between ages 45-60. Participants received weekly 50-minute reflexology treatments for 10 weeks and completed pre and post-treatment questionnaires rating symptoms. Statistical analysis found significant reductions in hot flashes, sleep issues, mood changes, concentration/memory issues, headaches, heart palpitations, and itching. Overall, participants reported improved well-being and balance from the reflexology treatments. The study provides statistical support that reflexology can effectively relieve many distressing menopause symptoms.
This document summarizes and critiques research on psychoneuroimmunology (PNI) and claims that psychological factors can influence cancer outcomes. It finds that PNI research often relies on weak study designs, ignores negative findings, and overstates small or insignificant positive results. Better designed studies find little evidence that stress influences cancer or that psychosocial interventions impact survival time. The document cautions against overinterpreting immune system changes without considering the system's complexity.
1. The document discusses pain physiology and management, including the mind-body connection, pain pathways in the nervous system, and the gate control theory of pain.
2. It also covers chronic pain conditions, treatments like medications, cognitive-behavioral therapy, and managing pain behaviors.
3. Effective pain management requires multidisciplinary programs that combine treatments targeting cognitive, physical, and emotional aspects of pain.
The document discusses how hypnosis can help reduce postnatal depression and promote mental wellbeing during and after childbirth. It explains that hypnosis helps alleviate fear, tension, and pain during birth by promoting relaxation. Clinical evidence shows that hypnosis can significantly reduce the length of labor stages and decrease the need for pain medication. The document also outlines techniques taught in birth preparation classes like breathing, visualization, massage, and understanding the body's natural birthing process.
This document contains the syllabus for a 3-part online course on stress management techniques from Complementary and Alternative Medicine (CAM). The course will cover the basics of CAM and stress, causes and symptoms of stress, and specific CAM techniques for stress relief such as aromatherapy, acupuncture, yoga, and guided meditation. Students will participate in yoga, meditation, and other stress relief exercises during the lessons. The course aims to help students understand and manage stress through natural health approaches.
Transformative Moments- Short Stories from the Biodynamic Psychotherapy Room Elya Steinberg
This document summarizes key aspects of biodynamic psychotherapy and massage. It discusses how the biodynamic therapist receives feedback from the client's autonomous nervous system, objective observations of the body, and the client's reported sensations to guide treatment in real-time. The therapist aims to support the client's self-healing abilities by responding attunedly to changes in both client and therapist. A case study of a client, "Lily", is discussed, whose various pains represented conflicts between different parts of herself not in communication. The therapist aims to understand such conflicts retained in the body and mind.
This document discusses adaptive coping and stress management. It begins by defining stress as pressure experienced in response to life demands or stressors. It then discusses the general adaptation syndrome and its three stages of alarm reaction, resistance, and exhaustion. It also covers types of stressors and coping strategies. Adaptive coping helps deal with stress effectively while maladaptive coping occurs when conflict remains unresolved. Adaptive coping strategies discussed include awareness, relaxation, meditation, exercise, music therapy, adequate nutrition/sleep, and time management. Evidence-based stress management techniques taught include progressive muscle relaxation, autogenic training, guided imagery, and diaphragmatic breathing. The document ends with a problem-solving model and case vignette example of how stress
Dr. Michael Antoni of Sylvester Comprehensive Cancer Center discussed stress management for cancer patients at the 2011 WellBeingWell Conference in Miami.
What is biofeedback therapy and who can benefit? Biofeedback therapy is a non-drug treatment in which patients learn to control bodily processes that are normally involuntary, such as muscle tension, blood pressure, or heart rate........
The document critiques the medical model's overreliance on categories and ideals which fail to appreciate individual experiences and diversity. It also discusses the psychological model which links many medically unexplained symptoms to anxiety and depression. However, both models are limited as they do not consider the whole context of a person's life including culture, personal history, and well-being. The document proposes a Whole Context Approach which takes an integrated and reflexive view of a person holistically within their social context to better understand and address medically unexplained symptoms.
Innovation in mental_health_education_in_the_uk_henkpar
The document discusses developing skills for delivering integrated mental health care in primary care settings in the UK. It describes a workshop that aims to provide GPs experience with primary care focused education on redesigning services to meet individual patient needs. The workshop would teach practical techniques for managing anxiety and depression in 10 minute consultations and focus on using empathy, active listening skills and addressing both psychological and physical health needs in an integrated way.
The document outlines the new mental health strategy for England. It discusses the scale of mental health issues in terms of prevalence and costs. The strategy aims to transform mental health and well-being through mainstreaming mental health and achieving parity with physical health. The strategy's themes are improving services, outcomes, a life-course approach, choice, reducing inequality and improving efficiency. The objectives are more recovery, good mental health and outcomes, and fewer experiencing harm or stigma.
This document discusses how creative activities like music and performance can reduce stress and anxiety. It outlines the health benefits of singing, which can improve muscle tone, lung capacity, and release feel-good hormones. The document then provides exercises to warm up the face, body, and voice in preparation for a musical performance or crescendo. Contact information is given for Bernadette Whelan of Crescendo, an organization that empowers people through performance.
The document summarizes the Primhe Conference 2011, which focused on themes of primary care mental health including well-being, early detection, and treatment of medically unexplained symptoms. It discusses workshops that were held on medically unexplained symptoms and research being done to evaluate treatments. The remainder of the document consists of quotes from patients about their experiences and needs regarding mental healthcare and interactions with general practitioners.
1) Poor mental health has substantial personal, health, social, and economic costs in England, amounting to billions of pounds annually.
2) Investing in primary care mental health services, such as screening and treating depression and somatoform disorders, can provide good value by improving quality of life at a relatively low cost per QALY gained.
3) As the system moves towards more localized GP commissioning, there are opportunities but also challenges in obtaining the necessary economic data for decision making and ensuring resources are available for cost-effective primary care mental health services.
The WHO has launched the mhGAP Intervention Guide to help identify and manage priority mental health conditions. The Guide was developed as part of the WHO's mhGAP program in response to the large gap between needed and available treatment for mental disorders worldwide. It provides evidence-based recommendations for managing common issues like depression, epilepsy, and substance abuse through simple flowcharts and advice on psychosocial interventions and medication use. Over 150 experts contributed to the 100-page Guide, which is being implemented in several countries with WHO support and translated into many languages to expand access to care for mental, neurological, and substance use disorders globally.
The document summarizes the President's visits to two family medicine conferences in India, highlighting the complexity of family medicine in the country. In Chennai, the President attended the annual International Congress on Family Medicine organized by the Indian Medical Association's College of General Practitioners. In Mumbai, the President saw vast differences in wealth on display, from luxury skyscrapers to slums, reflecting the complications of India. The visits showed the President that family medicine in India navigates a complex environment.
This document discusses alcohol use and alcohol use disorders. It provides information on assessing acute alcohol intoxication, recognizing alcohol withdrawal symptoms, assessing harmful alcohol consumption, assessing alcohol dependence, and managing alcohol withdrawal. It also includes screening tools for assessing alcohol use such as the CAGE and AUDIT-C questionnaires. Management of alcohol withdrawal may include diazepam tapering, thiamine supplementation, and consideration of delirium.
This document discusses the importance of experiential and reflective learning for primary care physicians. It describes Kolb's experiential learning cycle and different levels of reflection. It also discusses portfolio-based learning and provides examples of content to include, such as learning logs, reflections on patient cases and educational events. The document provides guidance on identifying learning needs through methods like PUNs and DENs (patient unmet needs and doctor's educational needs), audits, and significant event analysis. Finally, it discusses how to develop a personal development plan to address identified learning needs through various learning activities and resources.
The document discusses dementia and primary care. It notes that the general practitioner (GP) is usually the first place people go if worried about dementia, so early detection by the GP is important. It provides information on diagnosing and treating dementia, including guidelines on prescribing medications. It also addresses dealing with behavioral issues like aggression, treating other illnesses, end of life decisions, and the ethics of caring for elderly demented patients in primary care.
This document discusses the treatment of depression with antidepressant medications. It covers the stages of acute, continuation, and maintenance treatment. It describes the mechanisms of action and side effect profiles of different classes of antidepressants including tricyclic antidepressants, selective serotonin reuptake inhibitors, monoamine oxidase inhibitors, and serotonin-norepinephrine reuptake inhibitors. Factors to consider in choosing an antidepressant and ensuring patient adherence are also discussed.
The document discusses mental health assessment in primary care. It introduces the Look, Listen, and Test (LLT) framework for psychiatric assessment. LLT utilizes existing observational and history taking skills in primary care. The physician looks at the patient, listens to what they say, and performs appropriate tests through questions or exams. It can help structure consultations and support a holistic view. The framework draws from the more extensive SCAN assessment but is briefer and more suitable for typical primary care consultations.
This document discusses scaling up care for mental, neurological, and substance use disorders globally. It aims to close the gap between needed and available care by increasing financial and human resources allocated to these issues, especially in low and middle income countries. It then provides details on schizophrenia, including prevalence, economic burden, increased mortality risks from physical health issues, positive and negative symptoms, treatment approaches including medications and their side effects.
This document provides guidance on assessing suicide risk. It discusses the importance of suicide risk assessment, risk factors for suicide, and tools like Beck's scoring system that can help with evaluation. It also offers tips for questions to ask about suicidal thoughts, plans, and history. The document emphasizes establishing rapport, asking direct but non-judgmental questions, and not minimizing distress when conducting an assessment.
The WONCA Culturally Sensitive Depression Guideline recognizes the challenges family physicians face in recognizing and managing depression in patients from diverse cultural backgrounds. It proposes a "look, listen and test" framework for mental health assessment, involving observing the patient, listening to their language and metaphors, and testing psychological functioning and physical health. The guideline acknowledges differences in how symptoms are described across cultures and the importance of interpreters. It aims to improve recognition of depressive disorders in primary care settings.
(1) Generalized anxiety disorder (GAD) is one of the most common mental disorders seen in primary care. (2) Effective treatments for GAD exist, including SSRIs, SNRIs, pregabalin, benzodiazepines, and cognitive behavioral therapy. (3) Guidelines recommend SSRIs, SNRIs, pregabalin, and benzodiazepines as first-line treatment options for GAD, with tricyclic antidepressants and other options as second-line treatments if first-line options are not effective or tolerated.
The document discusses stepped care approaches for treating depression across different resource settings. It proposes a stepped care model with three steps - (1) primary care with specialist backup, (2) mainstream mental health services, and (3) specialized mental health services. Each step provides increasing levels of treatment options depending on available resources. The document emphasizes that primary care plays an important role in depression treatment using evidence-based interventions like antidepressants, talking therapies, and collaborative care approaches.
This document provides information on various types of psychosis, mood disorders, anxiety disorders, and obsessive-compulsive disorders. It defines key concepts such as psychosis, delusions, hallucinations, and discusses symptoms of mood disorders like depression. It also outlines diagnostic criteria for mania, generalized anxiety disorder, panic disorder, and obsessive-compulsive disorder. Common obsessive and compulsive behaviors are described.
The document discusses the importance of conducting a physical examination for patients presenting with mental health issues. It provides rationales for why organic causes should be considered, such as many past patients having underlying physical problems. It also lists potential organic causes for common mental health presentations like depression, anxiety, and psychosis. The document emphasizes tailoring the physical exam to the presentation and importance of thorough documentation.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
DECLARATION OF HELSINKI - History and principlesanaghabharat01
This SlideShare presentation provides a comprehensive overview of the Declaration of Helsinki, a foundational document outlining ethical guidelines for conducting medical research involving human subjects.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
10 Benefits an EPCR Software should Bring to EMS Organizations Traumasoft LLC
The benefits of an ePCR solution should extend to the whole EMS organization, not just certain groups of people or certain departments. It should provide more than just a form for entering and a database for storing information. It should also include a workflow of how information is communicated, used and stored across the entire organization.
The skin is the largest organ and its health plays a vital role among the other sense organs. The skin concerns like acne breakout, psoriasis, or anything similar along the lines, finding a qualified and experienced dermatologist becomes paramount.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
2. During this presentation we will
examine:
The outline of a psychoeducuative group
Different classifications of MUPS
An overview of theories of aetiology
What do Neuro-imaging studies have to offer?
An overall theory of MUPs
So what ? How might this be relevant to 10 minute
consultation?
hemfipsych.com
3. Initial letter to patient from GP
I am writing to let you know about a new course that we are
about to start that will be held here at the surgery. It is
called ‘Coping with Health Problems’. I know that you
have had a series of health problems and I thought that
this programme might be helpful to you
It will be run by … who has a special interest in working
with people with health problems in order to help them
cope with their illness.
The course consists of an initial assessment when a
comprehensive history will be taken along with few simple
and harmless tests. You will be told more about the
course and, if you both agree that it might be useful, you
will be invited to eight one-and-a-half-hour weekly group
meetings.
If you would like to attend simply contact….
hemfipsych.com
4. Assessment
Client’s attitude to the referral and the problem
Details of the illness
Present symptoms: Type of pain, Occurrence
What makes it worse and what makes it better
Thoughts accompanying pain
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5. Assessment
Coping Strategies
Consequences on life
Others response
History including previous treatments
General beliefs about the nature and meaning
of the symptoms
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6. Assessment
Biofeedback:EMG,GSR,Peripheral Temp
Medication Other treatments
Goals of treatment What would you like to
change?
Rationale for psychological treatment
(contribution of stress as a cause or effect.
Test out hypothesis of psychological element)
Description of course:
hemfipsych.com
7. Follow-up letter from group leader to
patient
Following our meeting on ….. concerning the effects of your
(symptom description), enclosed is the course outline that I
promised. The course will start on (date) at the … (directions) .
It will start at ... in … room. Each meeting will last for one and
a half hours.
As I explained when we met the course is a mixture of education
and self help. This means that in between each meeting an
exercise will be set which will help you to monitor your progress.
Before we meet I'd be grateful if you would have a think about what
you would like to gain from the course - try imagining yourself in
eight weeks time and think of what you would like to have
changed by then. You'll be able to discuss this in more detail at
our first meeting.
hemfipsych.com
8. Programme Outline
Week 1: General introduction , goal setting
and models of health
Introduction to the notion of coping
Hot cross bun
Goals on a flip chart
Introduction to self monitoring
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9. Programme Outline
Week 2: What happens when we are stressed
by health problems
Self monitoring review
Stress what is it?
Individual stress reactions to symptoms
Early experiences of illness
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10. Programme Outline
Week 3: Physical reactions to stress
Self monitoring review
Cave person exercise
Active progressive relaxation
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11. Programme Outline
Week 4: How do individual views of illness
effect health?
Review of self monitoring
How thinking and beliefs effect feelings
NATS and BATS
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12. Programme Outline
Week 5 : How does behaviour affect health: in
introduction to TA
Self monitoring review
How behaviour can maintain behaviour
How we interact with other people
TA overview – Ego states, transactions and
games
hemfipsych.com
13. Programme Outline
Week 6: Pain and Pain management
Review of self monitoring exercises
The relative nature of pain – the gateway
theory
Autogenic training
hemfipsych.com
14. Programme Outline
Week 7: Putting together the pieces
Open ended group for participants to bring own
agenda
So what?
hemfipsych.com
16. Exercise
Thinking of your childhood how was illness
managed in your family?
How did your parents respond to you/your
siblings when you were ill?
How did you respond to your parents/siblings?
How has this effected your current relationship
with illness?
hemfipsych.com
17. The Organic Genesis of Patient
Presentations (Kroenke and Manglesdorf 1993)
hemfipsych.com
20. Somatisation
A transient or persistent tendency to
experience and communicate psychological
distress in the form of somatic symptoms and
to seek medical help for them. It occupies a
continuum from a simple misinterpretation of a
subjective bodily sensation to an unwavering
belief that a physical disease is present
hemfipsych.com
21. Health Anxiety
Health anxiety OCD spectrum of ‘disorders’.
Obsessional preoccupation with the idea or the
thought of currently (or will be) experiencing a
physical illness.
Common health anxieties tend to centre on
conditions such as cancer, HIV, AIDs etc,
May fixate on any type of illness.
Also called illness phobia/ illness anxiety or
hypochondriasis.
hemfipsych.com
22. The Spectrum of MUPS
Duration: transient persistent
No. of Sx: one multiple
Insight: good none
Disability: none severe
23. Theories of Aetiology
Psychobiological
High levels of physiological arousal
Alexithymia
Cognitive/Behavioural
Somatisation is rewarded
Secondary gains reinforce symptoms
hemfipsych.com
24. Theories of Aetiology
Psychoanalytical
Real conflicts denied, suppressed or repressed
Anxiety displaced into physical symptoms
Sociocultural
Emotions expressed through physical
symptoms
Specific “culture bound” syndromes (Koro,
taijin kyofusho)
hemfipsych.com
25. • EP posits a theoretical framework to understand false
illness signaling
• An EP approach to somatisation asks whether false
illness signaling represents an innate psychological
mechanism triggered by situational exigencies
• Somatisation may represent a behavioural strategy
that bestows survival value
Theories of Aetiology
Evolutionary psychology (EP)
26. Theories of Aetiology
Early Trauma
High correlation with early trauma and MUPs
(Roelofs and Spinhoven 2006) (Salmon et al 2003)
hemfipsych.com
27. Theories of Aetiology
Attachment styles
Secure – reliable care giving as children, positive view
of self and comfortable depending on others
Dismissing – unresponsive caregiving, self reliant
others not to be relied on
Preoccupied – inconsistent caregiving, negative view of
self seen as unlovable and expecting others to view
negatively preoccupied vigilant
Fearful – needs not met when young negative view of
self and others approach and avoidant
High correlation with MUPS and preoccupied and
fearful AS hemfipsych.com
29. Theories of Aetiology
Dissociation
Higher levels of dissociative amnesia in
somatising patients (Brown et al 2005)
Linked to pseudo-seizures (Prueter et al 2002)
hemfipsych.com
30. Theories of Aetiology
Immune system
Activation of the immune system seems to
induce behaviour patterns that are similar to
the illness behaviour seen in depression and
somatisation (Rief and Barsky 2005).
hemfipsych.com
31. Neuro-imaging studies: Irritable
Bowel Syndrome
Anterior Cingulate Cortex (ACC) as having a
role in the regulation of pain in IBS (Ringel et al
1999)
Uprated in chronic and downrated in acute
(Peyron et al 2000)
Association with CSA and dissociation (Salmon
et al 2003)
32. Neuro-imaging studies: Chronic
Fatigue Syndrome
Significant positive relationships were found for
cerebellar, temporal, cingulate and frontal regions and a
significant negative relationship was found for the left
posterior parietal cortex in CFS patients v controls (Cook
et al. 2007).
Increased activation in the occipito-parietal cortex,
posterior cingulate gyrus and parahippocampal gyrus,
and decreased activation in dorsolateral and
dorsomedial prefrontal cortices (Caseras et al. 2008).
hemfipsych.com
33. Neuro-imaging studies:
Fybromyalgia
Low stimulus pressure associated with 13
regions of brain activated compared with only
one in controls. (Gracely et al. 2002).
Greater activation in contralateral insular cortex
in both non painful warm and pain stimulus
(Cook et al. 2004).
34. Neuro-imaging studies: Expectation
(Nocebo effect)
(Rief & Broadbent 2007)
Expectation of symptoms leads to the
activation of brain areas corresponding to
symptom perception
Distraction from symptoms reduces brain
activity in perception areas
hemfipsych.com
35. The perception-filter model of
somatisation
(modified from Rief and Barsky 2005 in Rief and Broadbent 2007)
hemfipsych.com
37. The role of emotion
Emotion associated with profound physiological
changes
Often unconscious as bypasses frontal cortex
Often clients have limited language for emotions
Affect avoidance (having feelings, expressing
feelings and confusion about feelings)
hemfipsych.com
38. Common Safety Behaviours
Checking pulse
Hypervigilence of ‘symptoms’
Reducing activity
Symptom browsing on internet
Seeking reassurance from GP
Palpating parts of the body
Reducing food intake
Slowing down/speeding up
hemfipsych.com
39. Potential interventions: Behavioural
Reducing “boom and bust” mode
Reducing symptom-focusing behaviours
Anxiety management skills
Re-education re somatising precipitators and
perpetuators and treatment programme
Graded exposure (using exposure hierachy)
Identifying and reducing safety behaviours
hemfipsych.com
40. Potential interventions:
physiological
Relaxation exercises (diaphragmatic breathing,
APR autogenics)
Graded exercise
Moving specific symptom focused parts of
body
Diet
Substance use
hemfipsych.com
41. Potential interventions: Emotional
Identifying feelings
Developing language for feeling
Reducing feeling avoidance
Having conversation with symptom
hemfipsych.com
42. Development of ‘illness behaviour’
Often related to attachment styles
When GP and patient are together – two
attachment styles and illness behaviours are
interacting
hemfipsych.com
43. Attunement enables
affect-regulation
Like the securely attached mother, the
empathic psychobiologically attuned clinician’s
regulation of the patient’s affective-arousal
states is critical to transforming the patient’s
insecure nonconscious internal working model
that encodes strategies of affect regulation
Schore 2007 12
44. • B.. Background -What is happening in your
life at the moment?
• A.. Affect- How do you feel about that?
• T.. Trouble -What is the most troubling part
of..
• H..Handling - How are you managing
to deal with that?
• E..Empathy - That must be difficult for you.
The BATHE technique
(Stuart and Leiberman 2002)
45. Dos and Don’ts:
DO
Talk about coping
Use one designated GP
Schedule frequent, brief, regular visits not
contingent on new complaints.
Allow "sick role;" focus on function rather than
symptoms.
Explore psychosocial issues.
Prescribe benign treatments and enjoyment
time. hemfipsych.com
46. Dos and Don’ts:
DON’T
Suggest "It's all in your head.“
Pursue invasive diagnostic tests, medications
or surgical interventions without good
indications.
Refer excessively to specialists.
Focus on the symptoms themselves
hemfipsych.com
47. MUPS Further Reading
Bass, C Ed (1990). Somatisation: physical symptoms and psychological illness.
Blackwell Oxford.
Donohugue, P. & Seigel ,M. (1997). Sick and Tired of Feeling Sick and Tired,
Living with invisible chronic illness and Sage
Mayou, R., Bass,C. & Sharpe, M. (1995). Treatment of functional somatic
symptoms. Oxford University Press. Oxford.
Gill, D. (2007). Hughes’ Outline of Modern Psychiatry. Wiley & Sons (see
Chapter 9 on Physical Symptoms and Psychiatric Disorders)
Sanders, D., (1996) ofor Psychosomatic Problems. London: Sage Publicationst
Woolfolk, R. & Allen, L. (2007).Treating Somatization. A Cognitive Behavioral
Approach Guildford Press
Johnson,S. (2008). Medically Unexplained Illness. Gender and Biopsychosocial
Implications. APA
Journals: Journal of Psychosomatic Research, Psychosomatics
hemfipsych.com
Editor's Notes
The anterior cingulate cortex can be divided anatomically based on cognitive (dorsal), and emotional (ventral) components.[4] The dorsal part of the ACC is connected with the prefrontal cortex and parietal cortex as well as the motor system and the frontal eye fields[5] making it a central station for processing top-down and bottom-up stimuli and assigning appropriate control to other areas in the brain. By contrast, the ventral part of the ACC is connected with amygdala, nucleus accumbens, hypothalamus, and anterior insula, and is involved in assessing the salience of emotion and motivational information. The ACC seems to be especially involved when effort is needed to carry out a task such as in early learning and problem-solving.[6] Many studies attribute functions such as error detection, anticipation of tasks, motivation, and modulation of emotional responses to the ACC.[4][5][7]
The parietal lobe integrates sensory information from different modalities, particularly determining spatial sense and navigation. For example, it comprises somatosensory cortex and the dorsal stream of the visual system. This enables regions of the parietal cortex to map objects perceived visually into body coordinate positions.
It is an integral part of the limbic system, which is involved with emotion formation and processing, learning, and memory, and is also important for executive function and respiratory control.
The parahippocampal gyrus (Syn. hippocampal gyrus)[1] is a grey matter cortical region of the brain that surrounds the hippocampus. This region plays an important role in memory encoding and retrievaL
DL-PFC serves as the highest cortical area responsible for motor planning, organization, and regulation. It plays an important role in the integration of sensory and mnemonic information and the regulation of intellectual function and action. It is also involved in working memory. However, DL-PFC is not exclusively responsible for the executive functions. All complex mental activity requires the additional cortical and subcortical circuits that DL-PFC is connected with
HANDLING&gt;&gt;&gt;
The locus of control returns to them.