F W Silver | PubMed Health

PubMed1989

Depression. Management techniques in primary care.

Depression is a commonly encountered problem in primary medical care. In cases of mild reactive depression, supportive psychotherapy by the primary care physician may be sufficient treatment. Referral for specialized psychotherapy (interpersonal, cognitive, or behavioral therapy) should be considered when psychological risk factors are thought to play an important role in the patient's depression. According to recent clinical trials, specialized psychotherapy is as effective in treating depression as standard tricyclic anti-depressant therapy and can be used as an alternative to medication. When used in conjunction with medication, psychotherapy may enhance compliance and therapeutic efficacy.

Adult↗

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Management of conversion disorder.

Conversion disorder is a psychologically produced alteration or loss of physical functioning suggestive of a physical disorder. Conversion symptoms are often superimposed on organic disease and can be overlooked. Psychological techniques are central to the management of conversion symptoms. Principles of psychological management include the following: avoiding confrontation with the patient; avoiding reinforcement or trivializing the symptoms; reviewing results of tests and exams and creating an expectation of recovery; educating the patient by providing a benign explanatory model of symptoms; evaluating the patient's emotional adjustment and referring for psychotherapy when possible. Use of behavior therapy reinforcement and double-bind psychotherapy strategies may be helpful with more chronic or resistant symptoms, especially when there is a history of vague or excessive somatic complaints or significant secondary gain. Four case studies are presented to illustrate these principles.

Adult↗