Complex and Emotionally Demanding Patients Flashcards
What are histrionic patients?
Patients who:
- Have dramatic, emotional or overwhelming presentation
- May be seductive towards doctor (fear if not desirable then wont be taken seriously)
- Often appear emotional + flirtatious
What are dependent patients?
Patients who:
- Need an inordinate amount of attention yet don’t feel reassured
- Have needy, passive and clinging behaviour
- Cant make decisions without reassurance
- Can act entitled + superior to mask sense of helplessness + weakness
What are narcissistic patients?
Patients who:
- Have an excessive need for admiration
- Act as though they are superior to everyone including the doctor
- Lack empathy for others
- May be rude, arrogant, hostile, demanding
What are suspicious patients?
Patients who:
- Have a chronic, deeply ingrained suspicion that other people are unreliable/untrustworthy and want to cause them harm
- Likely to interpret neutral events as evidence of a conspiracy against them
- May behave in a hostile manner (sarcastic, argumentative, defensive)
- Are hypersensitive to criticism
What are help-rejecting complainers?
Patients who:
- Appear to only communicate through complaints and disappointments
- Often blame others
- Make people feel guilting for not doing/caring enough
- See themselves as self-sacrificing
- Respond with “yes, but…” when offered help
What are manipulative patients?
Patients who:
- Use lying and manipulative acts as means of communicating
- Malinger to gain external objectives (eg. insurance settlements, narcotic analgesia)
- May have history of using violence to obtain wishes or threaten self-harm to control doctor
What is somatisation?
When a patient with a psychiatric disorder/psychological difficulties presents with physical symptoms which are attributed (by the patient) to a physical cause, yet addressing the psychological issues reduces/eliminates the physical symptoms
Factors predisposing to the development of somatisation
- Childhood illnesses
- Family illness + consultation in childhood
- Physical illness in adulthood
- Experiences + satisfaction with medical consultations
- Illness in friends
- Publicity in TV + newspapers
- Knowledge of illness + treatment (eg. internet)
What is somatisation disorder?
History of at least 2 years complaint of multiple + variable symptoms that cannot be explained with any detectable physical disorders
What is hypochondriacal disorder?
Pre-occupation with fears of having a serious disease based on misinterpretation of bodily symptoms (symptoms lasting 6+ months)
What is conversion disorder?
Condition that presents as an alteration/loss of physical function suggestive of a physical disorder, but psychological conflicts/stressors precede the initiation or exacerbation of symptoms (not intentional!)
Types of symptoms in conversion disorder
- Motor symptoms (eg. weakness)
- Sensory symptoms (eg. sensory loss)
- Seizures or convulsions
- Mixed presentations
What is la belle indifference?
When a patient seems surprisingly unconcerned about their physical symptoms
What is body dysmorphic disorder?
Preoccupation with an imagined defect in appearance, or if a slight physical anomaly is present, the person’s concern is markedly excessive
What are the most common preoccupations with in body dysmorphic disorder?
- Nose
- Skin
- Hair
- Eyes
- Eyelids
- Mouth
- Lips
- Jaw
- Chin
