Each somatic complaint should ...

Each somatic complaints should be assessed systematically in order to minimize unnecessary and expensive laboratory tests. Recommendations in the relative shenii laboratory and other special tests varies depending on symptoms. Some families may experience difficulties in connection with each test shown, and some may insist on specific tests that they seem to be necessary. Open and honest discussion about the reason for the designation or exclusion tests for can be very useful. Concern the patient and family can be reduced by a detailed explanation of the results of all tests and their value in identifying specific violations. Treatment of Resolution Establishing trust psychosomatic problems begin at the first interview. The physician must establish a relationship of trust to persuade the patient and his family that he understands the reality of the symptoms as well as what they are worrying discomfort and inconvenience. Doctors should also express the concern and welfare of patients in general, including his academic or social activity. Becoming a trust requires the provision of appropriate time teen and his parents to express their perspectives on the first and subsequent visits. When the doctor expressed his sincere concern, he should make a clear statement about inorganic nature of psychosomatic symptoms and to give clear guidance of action. For families who refuse to acknowledge the absence of organic causes, it is sometimes useful to explain that although it is now impossible to find an organic cause, but the symptoms you are having may be residual or early manifestations of the state which is in the process of healing. Recovery processes exhibit great demands on the body. And to facilitate this recovery process would be useful to reduce the external stressor effects (excessive academic load), and begin a gradual return to normal activities to help the body regain its strength. We believe that such an explanation makes it possible for some teenagers to save face and to help parents take the role of stress in sickness and in health. Graphic illustrations may be helpful in discussing this with the patient and parents. Must be defined and agreed treatment plan. Even after the apparent consent of some parents and adolescents raises the question "what if" receive any new symptom or existing symptom does not improve. They must be convinced. that any new symptom or manifestation of decree for an organic disease will be thoroughly investigated. In addition, there will be all clinically indicated diagnostic tests. Withdrawal symptoms Withdrawal symptoms or decline probably have the greatest importance for adolescents with chronic or recurrent pain. Many patients will try to use analgesics before seeking medical help. Analgesics should be used for temporary pain relief, and considered as part of the therapeutic process.

Putting is not sharp and open-ended questions ...

Putting is not sharp and open-ended questions to get information without the hassles of protective or reactive responses. For example, the possibility that some symptoms may worsen or triggirovatsya school stressors can be identified in the course of the conversation. The initial information about the connection between the symptom and the school can be obtained in the formulation of such questions: Pain is always there when you're in school or in the morning before school? Pain is always forcing you to abandon schooling? Follow the conversation can be directed to the identification of the extent to which the school is a source of stress for teenagers and as a teen responds to stress: · the way you walk to school? What assessment have you this year? - Do you think they are better or worse than last year? Why? • How do the last report card? • Which items are most difficult for you? What subject do you like most? · How many days have you missed this year? How you spend your day when you do not go to school? The answers to these questions will help identify the significant difficulties including evaluation of teachers, lack of schools and the possibility of secondary benefits of somatic symptoms. When a family history of treated adolescents with medically unexplained symptoms of view, we should examine if there was any history of similar symptoms in relatives or family members. Preceding a family disease associated with undiagnosed or serious illness can cause excessive parental concern about a minor complaint. The clinician should be alert to parental anxiety is manifested in such comments as "Aunt Doty had the same pain and she said it was from the head. They could not identify with her and that she died of cancer three months later. I would not want that to happen to my child. " In such cases, the parents should have more confidence in what must be considered and put a definitive diagnosis. Physical examination A thorough physical examination is an important part of the evaluation process. Parents must be convinced that what bothers them will be carefully examined to exclude the Physical causes of organic disease. Sometimes it can benefit the permit concerned parents watching the clinician when he is conducting a survey. Physical examination is usually normal in adolescents with psychosomatic complaints and, if possible, the clinician should point this out to his patient during the examination. For example, it sounds very convincing to inform the adolescent concern about possible cardiac causes of chest pain that his heart tones sound great, absolutely pure-Tide. Laboratory evaluation and other tests When teenagers go to the doctor, they and their parents usually rely on an organic explanation for somatic complaints. Many believe that for the detection of organic disease to conduct laboratory research.

The initial conversation should ...

The initial conversation should be conducted in conjunction with rditelem and adolescents. At this time, can be identified and discussed the boundaries of confidentiality. Joint participation allows the clinician to observe the parent-adolescent relationships and evaluate the quality of their relationships. During the first interview is useful to ask parents about what causes the greatest concern. For example, a parent can ask whether or not he is concerned about the fact that symptoms may indicate the presence of a particular violation. This information will enable the physician to focus on this concern and dispel the previously unspeakable fear of parents for serious life-threatening disease. If the parents expressed their concerns is important to talk with your teen alone, yet it is desirable to hold a final meeting on the type of feedback with parents and teens to ensure their understanding of the diagnosis and recommendations. History and overview of the symptoms complete medical history should be obtained from a teenager, including a thorough review of systems. It may be useful to know the perception of a teenager anamnestic facts before stated parents. Any discrepancy between the perception of the problem parents and adolescents may indicate a family conflict or poor understanding of family that should be investigated. Description of onset of symptoms and any associated signs or situations can reveal important reasons relating to the cause of stressors. Level of emotional distress teenager can be observed and evaluated during the interview. Psychosocial origins should be considered with special uduleniem vnimniya the possibility of recent events in my life that could cause stress. A list of life events may be useful in gathering such information and to clearly identify stressful events in a teenager or his family. Such a list may also indicate areas requiring intervention to reduce stress. While the relationship between stressors and psychosomatic symptoms may be apparent to an objective observer, many teens may not recognize the stressful nature of their circumstances. This situation is somewhat similar to the old Chinese proverb: "Do not intelligently ask a fish, what kind of water." The teenager, like a fish, can adapt to the conditions and do not recognize their stress. For example, an adolescent with chronic tension headaches may say that he is never in contact with his neveryaschimi parents and he does not receive from them any financial support. Typically, patients in such circumstances, they say that they are accustomed to them and that they will not interfere. When a teenager sees that he ignored his biological parents, such behavior usually causes parents to psychosocial distress, whether conscious or unconscious. Pressive feelings about stressors may play a role in somatic complaints and should be explored. It is important that the clinician examined daily routine adolescent including areas of potential stress.

Carter and coworkers have found ...

Carter and coworkers found that subjects with chronic fatigue often more than the control subjects, according to measurements of Child Behavior Checklist internalizing behaviors, withdrawal symptoms and somatization. Nonspecific symptoms of other nonspecific symptoms, including dizziness, syncope, or fatigue, often associated with family problems, stress, school problems and depression among high school students the school, attending school doctor. Also, hyperventilation and respiratory functional stridor are states in which there is no organic component, and as these problems often lead to psychological stress. Manifestation of symptoms and assessment of adolescents and their families often resort to care about the physical symptoms, which tend to be non-organic causes. Decision to seek medical care may reflect the severity of symptoms and duration of discomfort, provide meaningful symptom or the degree of anxiety of other family members. In many cases, physical symptoms associated with stressors exceed the capacities of adolescents to resist them, which is manifested in feelings of helplessness. Most visits about psychosomatic symptoms is likely a reaction to the psychosocial distress than an attempt to influence a doctor, that is the simulation. Simulation is regarded as being under the control of the patient's left is a deliberate false representation leniem or enhanced physical or psychological symptoms. Simulations can be used at the unwillingness to attend school in order to obtain unnecessary treatment. According to the authors' experience, most teens do not deliberately apply these symptoms in this way. Nevertheless, they can get a secondary benefit from their symptoms. For example, parents are less likely to punish children or teenagers because of their poor grades or behavior when they have competing somatic complaints, rather than in their absence. Thus, parents may inadvertently reinforce the symptoms and the inability of their fundamentals osvbozhdaya adolescents from normal duties. Planning representatives can meet the health of patients with psychosomatic problems during the initial onset of symptoms or after symptoms become chronic or recurrent. If this is the primary manifestation, doctors with large practices may be related time and being unable to adequately assess the psychosocial causes. In this situation the pro-cess evaluation may be initiated and planned follow-up visits after relatively short periods of time throughout the entire process of diagnosis. Under appropriate conditions, is more likely that physician will be aware of the chronic nature of symptoms and can be scheduled over a long initial meeting. The initial interview is usually a teenager with chronic symptomatic symptoms for the first time at the clinic accompanied by a parent.

Recurrent abdominal pain ...

Recurrent abdominal pain Rekurentnaya abdominal pain is the most repeated somatic complaints among children and adolescents. Patients with normal gastro-intestinal disturbances including irritability syndrome colon (IBS) and dyspepsia suggest that high levels of stress they have a multiple somatic complaints that they often seek medical help. Recent data indicate that children and adolescents with recurrent abdominal pain may later be diagnosed with IBS. Adolescents and young adults with a history of childhood abdominal pain rekurenntnoy can continue to show higher levels of pathological behavior including pain, other somatic complaints and functional disorders than control subjects. Headache Headaches are a common complaint in children and adolescents and are often observed in association with abdominal pain. Muscle tension headaches, as well as occasional hroncheskie are common. Carlsson discovered that children and adolescents with rekurenntnymi headaches more likely to report psychological distress than the control without the headaches. Subjects with chronic rekurenntnymi headache or migraine coexisting with tension headaches, provide the highest level of psychological distress. Stressors such as marital problems of parents and family dissolution or divorce is associated with rekurentnymi headaches in adolescents. Chest pain Chest pain in adolescents is often a concern about the presence of underlying heart disease, but chest pain in adolescents is rarely associated with heart disease and most often due to idiopathic causes. Kostohondrit and musculoskeletal pain is the most common identifiable causes of chest pain in adolescents. Arousal and hyper-perventilyatsiya may be associated with chest pain and other somaticheskmi complaints. Stressful life events can be identified in many adolescents with chest pain in spite of reason. Musculo-skeletal pain musculoskeletal pain occurs in up to 20% of children and adolescents. Cherry and colleagues have reported that the stressors associated with school, family and personal expectations were common among the 100 patients (mean age 13 years), contact rheumatological center for chronic musculoskeletal pain. Most patients responded to the combination of Physical and okkupatsionalnoy therapy, coupled with interventions aimed at laying the basis for psychosocial reasons. Chronic fatigue Chronic fatigue may accompany the various states including psychosomatic problems, depression, and chronic fatigue syndrome. Chronic fatigue syndrome is a symptom complex consisting of a deep istoschyayuschey fatigue associated with various non-specific constitutional complaints. Although the cause of syndrome hroncheskoy fatigue in children and adolescents is probably multifactorial, stress and psychosomatic factors seem to play a role in some patients.

Adolescents who feel ...

Adolescents who feel socially isolated or who have difficulty in relationships with peers are more vulnerable for stress-related psychosomatic problems. Family support Family support may also alter the effects of stress on adolescent health. It is important to determine the not only the quantity but also the nature of support received by a teenager from his family. In families of young children with severe somaticheskmi symptoms commonly observed reaction of parents to their children's symptoms in the form of attention and special privileges that may contribute-vat increased symptoms and disability. In these families, the nature of support for the teenager may increase the dependence associated with the role of the patient, thus disrupting the development of competencies necessary for successful coping. Another important aspect of family environment includes a protrusion diseases and disorders abilities. Families of children with recurrent pain syndromes are characterized by high levels of morbidity and other family members. And, indeed, higher levels of somatization symptoms in parents were associated with significantly higher levels of somatization symptoms in children with rekurentnymi pain. In these families, parents can model the pathological behavior, increasing the likelihood that children will perceive such behavior, especially during times of stress, when the symptoms can provide them excusable reason to avoid problem situations such as examinations, or athletic competitions. Cognitive assessment of one of the ways in which individual and social resources can reduce the impact of stress, this is the way of their influence on individual interpretation or assessment of the stressor. Assessment involves determining the significance and severity of the stressor and also aware of his ability to overcome them. When the requirements associated with stress are realized as exceeding available resources can be triggirovany negative emotions and physiological reactions that occur in somatic complaints and the need to seek medical care. Thus, adolescents with low levels of competence and social support can evaluate the stressors as more threatening and their potential for confrontation is lower than that adolescents are more competent and having greater access to social support. Common psychosomatic symptoms Teenager assessing the situation as threatening may exhibit a variety of reactions in response to a stressful situation. These reactions of the organism can osoznovatsya and interpreted as discomfort or pain. Various body systems may cause sensations and symptoms including first-lovokruzhenie, fatigue, shortening of breath and syncope. Individuals can have a separate organ system in which they are most pronounced discomfort, such as the gastrointestinal tract or muscular-skeletal system. For example, adolescents who complained of abdominal pain, may be a higher sensitivity of the gastro-intestinal system. Laboratory studies show that acute stressors psihollogicheskie may violate the motility of the stomach, toknogo and large intestine in some individuals, it is not clear whether stress triggiruet dysmotility or violates individual stress tolerance to certain somatic sensations that others are regarded as normal and are ignored.

For example, social competence ...

For example, social competence is an individual resource that is changing the effect of stressors on adolescents. Among adolescent patients with chronic abdominal pain and high levels of stress among those with higher social skills were less likely to preserve the symptoms one year after the visit to the clinic than those with lower levels of social competence. Individual differences and abilities are not subjected to stress every teenager gives amplification of somatic symptoms. It is important to consider the context in which stress is manifested. Some factors change vohdeystvie stress on health and welfare of the adolescent. These moderators include individual and social resources. For example, social competence - is an individual resource that seems to alter the effect of stressors on the teenager. Among adolescent patients with chronic pain abdominanymi and high levels of stress in those with greater social competence are less likely to maintain their symptoms at 1 year after a visit to the clinic than those with lower social competence. Style overcome as a mediator between stress and disease Evidence emerged in the literature on adults suggests that high levels of stress personalyne resources affect the future well-being is mediated through a more adaptive coping strategies. Similarly, the process of overcoming can transfer ratio between the evils of life and psychosomatic problems in adolescents. Adolescents with lower levels of personal resources may have less effektvinye coping strategies as life stress and pain and other somatic symptoms. Takmi way to overcome inefficient it may be a mechanism linking stress and somatic stmptomy. Separate samples of overcoming pain were associated with psihosomaticheskmi smptomami in children and adolescents. In a study of patients with persistent abdominal pain in pediatric gastroenterology clinic, higher levels of somatization symptoms within 2 weeks after a visit to the clinic were predetermined types of overcoming pain vklyuchayushimi behaviorialnoe exception (cessation of activity), self-isolation, the inability to commit efforts to solve problems and lack of emotsionanoy expression. Also, adolescents and young adults who could not get rid of rekurentnoy abdominal pain for 5 years after the medical examination reported that the strategies they use to overcome the pain included self-exclusion, self-isolation and katastrofirovanie (guess the worst). Peer support Peer support is a buffer the effects of stressors on the teenager. Despite high levels of stress, teenage boys with high levels of peer support are given less psychophysiological symptoms when you contact the clinic than boys with high levels of stress without the support of peers. Importance of communication with their peers in the periods of adolescence, peers and the benevolence of their support may be a critical resource for assistance to adolescents in a successful battle with stressors.

In this article, the term psychosomatic ...

In this article, the term psychosomatic is used in relation to symptoms in which psychosocial factors play a major role. We particularly dwell on the symptoms for which organic data is not available or negligible. Nevertheless, it is important to recognize that stress and other psychosocial factors can exacerbate conditions such as diabetes, are associated with known organic diseases. And that adolescents with organic disease may have an additional life stress as a result of these conditions. The presence of defined organic lesion does not exclude the possibility that a teenager can experience significant levels of stress and that this stress may influence the course of the disease. Stress Stress can be defined as the requirement to adapt and overcome the difficulties usually in response to changing conditions of life. If the demand exceeds the ability to change and the resources that are manifested adverse effects of stress such as physical symptoms. Today, young people feel like normal stresses associated with adolescent development (physical change) as well as with unexpected stressful life events (breaking ties) that require adaptation and confront challenges. Both types of stressors should be considered when evaluating and maintaining. Relationship of stress with physical symptoms of stress components in health and disease, life stress, scores of empirical studies found a significant association between stressful life events and somatic symptoms of adolescents. Eg. among patients attending a clinic for adolescents, the greater number of stressful life events reported adolescents with functional somatic symptoms (head pain or rekurentnaya Abd-onal pain) than those suffering from certain organic diseases. Also, in another study adolescents, patients with high stress levels far exceed the number of psycho-physiological symptoms of those who have lower levels of stress. Other studies have found that greater stress implies the existence of adolescent symptom recurrence of abdominal pain. Life stress is also associated with psychosomatic smptomami among adolescents enrolled in school. Thus, there is considerable evidence linking stress with somatic symptoms in adolescents. Affect or emotional state of life stress may be associated not only with somatic symptoms but also with emotional distress. For example, agitation and depression often coexist with psychosomatic symptoms. Adolescents with recurrent pain developed without any connection to the medical data are characterized by levels of excitation and depression are higher than those of control subjects. It is important to take into account the context in which stress is transferred. Several factors determine the impact of stress on health and well being of adolescents. These include determining individual social resources.

How important is the direct and explaining ...

How important is the direct and clarifying conversation with adolescents shows a recent U.S. study, which gives an idea of ??the current situation of adolescents in the United States, and whose data speak for themselves: Every 3 seconds a teenager zaberemenivaet. Every 1-2 minutes a teenager giving birth. Every 78 seconds a teenager attempts suicide. Every 90 minutes, killing one teenager or young preprinimaet attempted suicide-properties. More than 1 million teens a year run away from home. Every 20 minutes a teenager dies in a traffic accident. Based on the article Gadner W. und Gadner J. Verweigerung, Abwehr, Widerstand - die Problematik der Gesprachsfuhrung mit Jugendlichen. Ein Leitfaden fur die Praxis. / / Radiat.prax. 55, (1999), 721-728. Translated from the German - M. Bogdanov article was published on the website http://www.medafarm.ru

Psychosomatic problems and stress in adolescents

Stress - is a universal phenomenon in the lives of modern teenagers, affecting their health and well-being. High levels of stress may be associated with distress and somatic symptoms, forcing the teenager to seek medical help. Pediatricians and other professionals involved in adolescent health, often found in patients with these symptoms and can not adequately explain the state of an organic cause. Diagnosis and management of these teenagers is a lot of problems and requires awareness of the role of stress and other psychological factors in the development and preservation of the patient's symptoms. The purpose of this discussion - to give the clinician an idea of ??links between stress and somatic symptoms in adolescents and to determine methods of evaluation and treatment of such symptoms in adolescents, which among other things are important medical or psychiatric conditions. Psychosomatic disorders Psychosomatic disorders are usually defined as those in which psychological factors are components in the development of an aggravation or continuation of disease. The relative term "somatization" refers to the tendency to report physical symptoms that have no pathophysiological basis, or significantly exceed what can be identified on the basis of objective medical data. Psychosomatic symptoms and somatization differ from the simulation, in which the patient truthfully report their feelings and do not consciously use these symptoms to manipulyarovaniya or control others or situations. The teenager and his family are usually related to the symptoms of organic disease and, therefore, seek medical help. Symptoms vary in severity and duration, may be acute or chronic, and thus may or may not have organic disease. Since the primary symptoms are caused by psychosocial factors, the focus of intervention on these factors are very important for improving the symptoms. It should be noted that the term psychosomatic is increasingly replaced by terms such as psychophysiological, and biopsychosocial biobehavioralny - a term increasingly reflect the increasingly understanding that psychosocial and biological factors are indivisible and interdependent aspects of all diseases.

Further, the teenager should ask ...

Next, adolescents should be asked to submit their family members, if any, to accompany him. It basically raises the question of what to prefer - whether a teenager is alone or with family members. Questions should be relevant to the conversation from turning into a conversation or no value conversation. Therefore, there is a need to establish and explain who actually have problems: the patient or his parents. At this stage, it is very important not to judge and criticize, until you have trusted relationships. You can only criticize specific activity, which has been described, but never himself a teenager. The conversation should not be a report, the Rapporteur has taken it upon themselves to moral evaluation, the respondent, thus allows recognition of a number of feelings of guilt. The competence of adolescents should always get proper respect. A doctor in his behavior should preferably be neutral, not companionable, but not a reflection of their parents. This puts the interviewer's neutral behavior with respect to the teenager in an adult situation which is outside the family and relationships. The central place is occupied by a hearing. However, some difficulties, since there are still prejudices in the conduct of a teenager. Under the hearing process is understood the absolute attention and total concentration on the conversation. From this empathic behavior is necessary to abandon the written fixation during the conversation, because they can distract from an understanding of the overall situation. You should not ask any direct or personal questions. Form of questions directed as a matter of course, to any situation. The question should always have an open end. The conversation in no case should not turn into an interview in a journalistic sense, which are trying to talk with the interviewee. This should not be questioning this, as this respondent is under pressure, and the interviewer is concerned mainly with their own issues, not those that puts the patient. The purpose of the conversation in an ideal - a study of how adolescent perceives a certain situation, as well as further insights into their experiences. Talking always helps to talk to both partners. The physician must adapt in a speech to the teenager so he could understand it. The physician should emphasize the positive and combined with the positive part. CONCLUSION The purpose of a doctor is to understand the problems the patient or his adolescent experiences specific situation. A prerequisite for this is a basic understanding of the stages of development during puberty and adolescence, as well as together in order to experience difficulties, anxieties and fears. And to assess the patient's perspective it is obligatory knowledge of frequent somatic Ms-Laubach at this time. Outdoor climate conversation in which the adolescent feels equal and taken seriously, raises confidence, and provides an approach to the patient.