[Patient education by the physician--burden or opportunity?].
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Biomedical subjects
Publications and source records attributed to H Molinski.
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We present the diagnostic and therapeutic problems in a patient presenting with recurrent, refractory necrotising mastitis that was caused by artifacts.
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The development of psychosomatic symptoms should not be viewed exclusively under the aspect of anxiety or defense against anxiety. In another study, we have shown that affects other than anxiety can lead to functional obstetric disturbances (2). The insight that depressions, above all masked depressions can be the basis of many psychosomatic symptoms in obstetrics and gynecology paves the way for good therapeutic possibilities in many cases that have been resistant to therapy heretofore. Antidepressants often bring prompt relief from symptoms. Psychotherapy is possible in numerous cases following success in prescribing antidepressants.
The development of psychosomatic symptoms can not exclusively by explained by fear and rejection of fear. We showed in another paper that other emotions but fear can lead to functionae symptoms in obstetrics and gynaecology. The recognition of depressions and masked depressions as the basis for many psychosomatic symptoms in gynaecology can open therapeutic possibilities for many cases which were refractory to treatment. The prescription of antidepressant medication often results in rapid relief of the symptoms. Psychotherapy for the discovery and for restructuring becomes possible in many cases after a successful course of anti-depressant medication.
Psychopathology occurs much more frequently in cases of persisting than in juvenile acne. Moreover, a neurotic personality structure is much more common in cases of persisting than juvenile acne. When a neurotic structure is present, the juvenile acne patient maladjusts to the acne and develops neurotic symptoms. Such psychological consequences represent further stress and cause exacerbations, thus transforming the juvenile into persisting acne. The increased psychopathology in persisting acne is thus both a result as well as a partial cause. It is a link in a vicious circle. The typical pathological patterns of reaction in acne are described.
Women with only minor anatomical deviations may request plastic surgery in an attempt to compensate a feeling of inadequacy or humiliation. Psychological evaluation may be warranted to preclude a number of possible sequels: feeling of cold, shivering and shaking, lasting for days, with or without conjunctivitis and rhinitis vasomotorica; hypochondriacal and paranoid tendencies, mistrustfulness and misunderstandings in regard to the doctor. The doctor's assent to the operation and performing of the operation may increase the feeling of humiliation instead of alleviating it.
Obstetricians, so far mainly interested in mechanics, have lately understood that innervation and interplay of the propelling and retaining structures also depend on the affects and impulses acting during delivery. There is normal and pathologic obstetric behavior. The obstetric situations demanding action from the obstetrician are not rarely correlated or due to pathologic behavior at birth. This disturbed or disturbance-producing behavior at birth, however, is by no means always directly related to anxiety, in the sense of the generally accepted anxiety-tension-pain syndrome. Disturbed behavior at birth may also be related to many other affects which often, but not always, are secondary to anxiety or designed to defend against it: retentive, annoyed, perfectionistic, poor in contact, worried, inactive or confused behavior at birth. In practice knowledge of such affect-constellations aids the preventive efforts of the obstetrician. Theoretically the origin of this subgroup of functional disturbances of birth is interesting. Interpersonal psychiatry after Harry Stack Sulivan sees in the non-organic psychic disturbances and symptoms an interpersonal process and not any more characteristics of an isolated individual. Since the functional disturbances of obstetric physiology are in part related to, in part due to, affect-constellations and behavior, they confirm this concept of interpersonal psychiatry. Medicine likes to study physiologic processes as if they represented a closed system within the limits of an isolated organism. In fact, the course of many physiologic processes is determined by simultaneously active affects i.e. the concrete interpersonal situation. This view, increasingly accepted for the physiology of libido and functional sexual disturbances, also applies to part of the functional disturbances of birth.
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