Complex symptom assessment....⬇️

 

 

Patients are usually referred to me by other medical and surgical specialists for the following reasons :

  • Your physical symptom(s) e.g. pain have proven to be resistant to conventional medical treatments 
  • Where it is difficult to make a formal medical diagnosis because the pattern of your physical symptoms and investigations do not match standard criteria
  • They are concerned that a deterioration in your psychological health is related to your symptoms (they will have discussed this with you prior to making the referral)
  • An assessment of psychological symptoms in multi-system disorders (e.g. diabetes, cancer, HIV ) where both physical and psychological symptoms can occur

I have specialist training in psychiatry relating to the following conditions but am happy to see patients with a variety of symptoms :

  • Persistent pain
  • Sexual dysfunction
  • Conversion / functional weakness
  • Medically unexplained symptoms in adolescence
  • Fibromyalgia
  • Chronic fatigue syndrome
  • Cancer (during diagnostic, treatment and survivorship phases)
  • Hepatitis
  • HIV
  • Non epileptic attacks 

Some people are reluctant to see a psychiatrist when their primary medical problems are related to symptoms located within the body. It is important to point out that all symptoms have to be perceived, processed and communicated via the brain and mind. If nothing else, a psychiatric assessment can exclude what are described as "functional" symptoms (see here for more details). Moreover, your specialist will have a much better understanding of you and this should allow for better treatment of your symptoms.

It is important to note that complex symptom assessments are only communicated to the referrer (i.e. your specialist) and confidentiality is assured

In most cases this will be a “one-off” assessment and opinion to assist your specialist and multidisciplinary team in the ongoing treatment of your symptoms. 

Please be assured that neither your specialist nor I will assume that your symptoms are “all in the mind” or that there is “nothing wrong with your body”. The aim is to collaborate with you, your specialist and others involved in your care (family and professionals) to arrive at a shared understanding of your symptoms. Thinking about symptoms in a different way may allow other treatment approaches and the possibility of improvement in quality of life.

 

About symptoms....

The simplest definition I can find of a symptom is “a change in functioning which is felt or noticed by a patient”. Symptoms have both a physical (somatic) and a thought/feeling (psychological) component. Most symptoms trigger some form of behaviour (see below).

In an linear world a patient experiences a symptom, thinks about it, decides on its importance and then decides whether or not to visit a medical practitioner. The medical practitioner, using his/her expertise, the assistance of technology and pattern matching in their own mind makes a diagnosis and initiates treatment. With the combination of medical treatment and many other factors (passage of time, support from others, compassion, reassurance, acknowledgement of suffering…to name a few) symptoms resolve and the patient returns to “normal” function.

Most doctors would agree that the seemingly straightforward process described above rarely occurs in the types of patients who are treated outside primary care (GP) settings. All manner of complications can occur along a patients' recovery journey. Some of these complications can be related to the person’s psychological functioning. As time progresses and a condition becomes more chronic, symptoms can become engrained and more resistant to treatment. To make things even more complicated, some forms of chronic illness can have permanent effects on a persons brain and mind (an in turn how we think and feel emotionally). 

Take a look at this short video which gives some ideas about why symptoms don't resolve (in this case persistent pain is the symptom).

 

The assessment process

The assessment will take the same form as a general psychiatric assessment and last about 50 minutes.  I will spend time exploring your symptoms and how they evolved over time. I will also explore your previous experiences of illness and treatment throughout your life.

I will pay some attention to particularly unpleasant experiences (trauma) throughout your life. In an initial assessment it will suffice for me to know only limited information about this i.e. the nature of the trauma and at what developmental stage it occurred. Rest assured that you will not be pushed to discuss unsettling experiences in detail. Exposure to severe trauma can sensitise a person to experience pain (and other physical symptoms) more intensely than those who have not experienced such profound trauma. Please take a look here for more information.

I will ask for your permission to review your medical notes and discuss this with your GP where indicated.

I will provide an integrative formulation and where appropriate, a diagnosis with recommendations for ongoing treatment.