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| A thorough physical examination should also be made with each new exacerbation of psychosomatic pain. Direct indication for re-investigation of somatic must be at the same time changed the nature of patient's complaints: the emergence of "brand new" unpleasant and painful sensations primarily beyond affective disorders or, at least suspicious, a qualitative change in the old feeling the same location. Necessary to consider the possibility of some physical pain on a background of more or less pronounced emotional disorders or long-term transformation, sometimes for many years, existed, but it is a reversible physiological dysfunction is irreversible structural changes: the transition of labile hypertension as one of the commonest forms of response of the individual to mental stress in stable, neurotic cardialgia. Permanent physical or neurological controls require, at last, and often "organo neurotic" status (a combination of psychogenic symptoms in viscera vegetative erased, often situational, depression with genuine organic disorders) and the so-called psychosomatic diseases (bronchial asthma, duodenal ulcer, ulcerative colitis, etc.). Ability somatogenic provocation of depressive states, on the one hand and a sharp worsening of somatic suffering from mood disorders - the other, requires a careful determination of the proportion of mental and physical disorders, for any worsening of clinical status of these patients (even when clearly the nature of endogenous depression and persisting in past in psychiatric hospitals). |
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