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The most attention and requires time doctor, no doubt, a thorough clarification of the nature, localization and dynamics of pain, the sequence of their appearance and relationship to the individual patient's symptoms caused him the most anxiety and fear - focus forming or already formed his hypochondriacal overvalued ideas.
Particularly important role played by the identification of pathological dynamics of feelings: the possibility of occurrence and their periodic amplification, a clear dependence on the impact of negative and positive emotions (as such or in connection with intellectual disabilities), diurnal and seasonal variations of affective and physical condition, their development during certain hours or against the background of certain situations: deterioration during or just before falling asleep, alone or when you call your doctor before radiological or electrocardiographic study, after unpleasant for the patient visits his or anxious TV shows on weekends and public holidays or evenings, after the departure of doctors from the department. Extraordinary diagnostic value acquires a statement of the circadian rhythm of pain, lethargy and general malaise: the gain or the appearance of them in the mornings and often with the approach of night, and a marked weakening them or even complete normalization of well-being in the afternoon.
Well-known difficulties in the classification of physical or mental complaints seem irresistible at a formal survey of a patient with local organic positions. Indeed, the presence of pain itself is not enough to judge the disease, and a psychiatrist cannot always distinguish between, for example, pain in the right iliac region of appendicitis or psychogenic - it requires the exclusion of organic pain. The same definition, the general "formula" out of context claims described essentially the same words, and often actively imposed by the doctor, such a possibility and in fact does not. Obligatory condition of differentiation of organic and psychogenic (or predominantly psychogenic) disorders remains with the careful refinement of the true nature of the patient's feelings (i.e., what he calls the pain): their location, features, time of their appearance, situation moments that contributes to their enhancement or weakening, and finally, exposure to certain drugs. |
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