Complex and Emotionally Demanding Patients Flashcards
What is a histrionic patient?
Dramatic, emotional and overwhelming style of presenting
Feel a need to be sexually desirable to be taken seriously
May be seductive, emotional, flirtatious
What is a dependent patient?
Some patients need an inordinate amount amount of attention, never feel reassured
Repeated urgent calls between appointments, demand special consideration
What is a demanding patient?
Difficulty delaying gratification, demand that their discomfort and problems be eliminated immediately
Often act entitled and superior, to mask their own sense of helplessness
They are easily frustrated and can be angry and hostile
What is a narcissistic patient?
Self-loving
Act superior to doctor
Initially may idealise doctor but soon changes to feelings of contempt for the doctors inadequacies.
May be rude, arrogant, hostile and demanding
What is a suspicious patient?
Chronic, deeply ingrained suspicion that other people are unreliable and untrustworthy and only want to cause them harm
They are likely to misinterpret neutral events as evidence of conspiracy against them
What is a help-rejecting complainer?
Only appear to communicate through a litany of complaints and disappointments
Often blame others (covertly)
They also make people feel guilty for not doing enough or caring enough
The may see themselves as self-sacrificing
What is a manipulative patient?
Appear to using lying and manipulative acts as a means of communicating
They may malinger to gain external objectives such as insurance settlements or obtain narcotic analgesia
They may also have history of using violence as a means of obtaining their wishes or use threats of self-harm to control doctors behaviours
What are the criteria for somatisation disorder?
History of physical complaints beginning before age 30 years
Criteria include 4 pain symptoms, 2 GI symptoms, 1 sexual symptom and 1 pseudo-neurological symptom
Despite appropriate investigations these cannot be attributed to anything medical, or seem in XS of physical illness
What is the dilemma that arises when treating patients with somatisation disorder?
Temptation to pursue countless investigations, based on knowledge that rare syndromes can sometimes present in unorthodox ways
Also temptation to do nothing
There may be great deal of anxiety about when to stop investigations and start treating psyschological disorder
What is hypochondriacal disorder?
Pre-occupation with fears of having a serious disease based on misinterpretation of bodily symptoms
Persists despite negative medical evaluation
Belief is not of delusional intensity
Symptoms last for six months or longer
What is conversion disorder?
What is a clue to patient with this disorder
(hysteria)
a condition that presents as an alteration or loss of physical function suggestive of a physical disorder
Psychological conflicts or stressors precede the initiation or exacerbation of the symptom
Symptoms are not intentionally produced but are the result of unintentional or unconscious motives
After apprpriate medical evaluation the condition cannot be explained by any physical disorder or known pathological mechanism
CLUE: Patients seems surprisingly unconcerned about the physical symptoms
What is body dysmorphic disorder?
preoccupation with an imagined defect in appearance or if a slight physical anomaly
The preoccupation causes clinically significant distress
What is factitious disorder?
Intentional production of physical or psychological signs or symptoms
Motivation is to assume to sick role
External incentives for the behaviour (i.e. financial gain) are absent
Give some examples of types of factitious disorder
acute abdominal type (ingesting foreign bodies) haemorrahagic type cutaneous type cardiac type respiratory type mixed and polysymptomatic type
What is factitious disorder by proxy?
Symptoms intentionally produced by parent or carer
The perpetrator, at least initially, denies inventing or causing the symptoms/signs
The symptoms/signs diminish when the child is separated form the perpetrator
