Somatisation.

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Presentation transcript:

Somatisation

Somatisation Somatisation is one of the most important single problems associated with a missed diagnosis of depression in primary care BMJ 2008;336:435-439

Somatisation What is it? Flipchart

Somatisation What are the difficulties? (what do you want to get out of this session?) Flipchart > aims and objectives

Problem based interviewing (PBI) The “reattribution” model

Reattribution model Four distinct stages Feeling understood Broadening the agenda Making the link Negotiating treatment

Disease illness model Key issue

Feeling understood …active listening What do I mean by active listening?

Feeling understood Take a full history Respond to mood cues elicit other associated symptoms ask about a typical pain day Respond to mood cues Clarification empathic comments probe mood state/thought content Explore social and family factors Check for biological symptoms Explore patients health beliefs Specific example Scale Carry out focussed physical examination

Reattribution model Four distinct stages Feeling understood Broadening the agenda Making the link Negotiating treatment Focus on broadening the agenda and making the link 16.30 Broadening the agenda 4m 20.46 Making the link 21m 41.35 Negotiating treatment 9m

Rehearsing the skills Eeek! Roleplay! 53.48 Broadening the agenda 6m 59.40 Making the link 2m 61.11 Negotiating treatment 5m

Exploring PBI further http://www.gp-training.net/training/theory/pbi/pbi.htm