Psychiatric symptoms among patients with acute abdominal pain.

Background: Abdominal pain is a common cause of visits to emergency facilities. It is related to psychiatric disorders in primary care, but it is unclear if this also holds in emergency departments.Objective: Is to explore potential differences between diagnostic groups in patients with acute abdominal pain in an emergency ward regarding concurrent somatic-and psychiatric symptoms, 'Length of stay' (LOS) and perceived health.Method: The patients (N = 137) were divided into three groups; organic dyspepsia, specific abdominal diagnoses, and non-specific abdominal pain. The Prime-MD results for extra gastrointestinal symptoms (outside the gastrointestinal tract), psychiatric symptoms, frequency of symptoms, self-reported health, and LOS within the month before admittance were compared between the diagnostic groups.Results: There was a significant positive correlation between the number of physical extra gastrointestinal and psychiatric symptoms (p < .001), especially regarding anxiety (p < .001) and depression (p = .002). Patients with organic dyspepsia reported significantly more total (p = .016), extragastrointestinal (p = .026) (chest pain; p = .017, dizziness; p = .004, palpitations; p = .005, insomnia; p = .005 and worries; p = .001), and summarized anxiety and depression symptoms (p = .001-0.002) besides poorer general health (p < .001) compared to other abdominal conditions. Also, organic dyspepsia patients needed longer hospital stay than the non-specific abdominal group (p = .002) but similar to the specific abdominal disorders group.Conclusion: Organic dyspepsia is accompanied by more co-occurring physical, anxiety and depression symptoms as well as poorer perceived health than other abdominal pain conditions and comparably increased LOS. This suggests that psychiatric consultations might be beneficial for diagnosing and treating psychiatric comorbidity in emergency care.

Providing high-quality fundamental care for patients with acute abdominal pain.

PURPOSE: Globally, acute abdominal pain (AAP) is one of the most common reasons for emergency admissions, yet little is known about how this patient group experiences the delivery of fundamental care across the acute care delivery chain. The purpose of this paper is to describe how patients with AAP experienced fundamental care across their acute care presentation, and to explicate the health professional behaviours, reported by patients, that contributed to their positive experiences. DESIGN/METHODOLOGY/APPROACH: A qualitative descriptive study, using repeated reflective interviews, was analysed thematically ( n=10 patients). FINDINGS: Two themes were identified: developing genuine, caring relationships with health professionals and being informed about one's care. Patients reported that health professionals established genuine professional-patient relationships despite the busy care environment but perceived this environment as impeding information-provision. Patients were typically accepting of a lack of information, whereas poor professional-patient relationships were seen as inexcusable. PRACTICAL IMPLICATIONS: To provide positive fundamental care experiences for patients with AAP, health professionals should establish caring relationships with patients, such as by using humour, being attentive, and acknowledging patients' physical pain and emotional distress; and should inform patients about their care, including allowing patients to ask questions and taking time to answer those questions. ORIGINALITY/VALUE: This is the first Australian study to explore the experiences of patients with AAP across the acute care delivery chain, using a novel method of repeated interviews, and to demonstrate how fundamental care can be delivered, in clinical practice, to ensure positive patient experiences.

Temperament and character in patients with acute abdominal pain.

BACKGROUND: Several conditions presenting with abdominal pain are associated with specific personality factors although it is unclear if this is true also in emergency clinic settings. OBJECTIVE: To study personality factors among patients with acute abdominal pain in an emergency ward. METHODS: Consecutive patients (N = 165) with abdominal symptoms at an emergency clinic were administrated the Temperament and Character Inventory (TCI). Three main groups were identified; specific abdominal diagnoses, (N = 77), non-specific abdominal pain, (N = 67) and organic dyspepsia (N = 21). TCI results were compared between clinical groups and a control group (N = 122). RESULTS: As compared to individuals with specific abdominal diagnoses and controls, those with organic dyspepsia were significantly more anxious (harm avoidance), (p = 0.003), and had lower ability to cooperate (cooperativeness) (p = 0.048 and p = 0.004 respectively). They were also significantly more unpretentious (self-transcendence) compared to individuals with specific abdominal diagnoses (p = 0.048), non-specific abdominal pain (p = 0.012) and controls (p = 0.004) and evidenced less mature character (sum of self-directedness and cooperativeness) compared to those with specific abdominal diagnoses and controls (p = 0.003). CONCLUSION: Individuals seeking care at an emergency clinic with organic dyspepsia showed a distinguishable pattern of personality features that distinguished them from the other comparison groups. Therefore an evaluation of personality factors may add a new dimension to the diagnostic investigation in the emergency care of abdominal pain and contribute to the optimization of the treatment of organic dyspepsia.

Patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode: a multi-stage qualitative case study.

AIM: To explore how patients with acute abdominal pain describe their experiences of fundamental care across the acute care episode. BACKGROUND: Acute abdominal pain is one of the most common conditions to present in the acute care setting. Little is known about how patients' fundamental care needs are managed from presentation to post discharge. DESIGN: A multi-stage qualitative case study using the Fundamentals of Care framework as the overarching theoretical and explanatory mechanism. METHODS: Repeated reflective interviews were conducted with five adult patients over a 6-month period in 2013 at a university hospital in Sweden. The interviews (n = 14) were analysed using directed content analysis. RESULTS: Patients' experiences across the acute care episode are presented as five patient narratives and synthesized into five descriptions of the entire hospital journey. The patients talked about the fundamentals of care and had vivid accounts of what they meant to them. The experiences of each of the patients were influenced by the extent to which they felt engaged with the health professionals. The ability to engage or build a rapport was identified as a central component across the fundamental care elements, but it varied in visibility. CONCLUSION: Consistent pain management, comfort, timely and accurate information, choice and dignity and relationships were identified as essential fundamental care needs of patients experiencing acute abdominal pain regardless of setting, diagnosis, or demographic variables. These were variously achieved and the patients' narratives raised areas for improvement in several areas.

Munchausen syndrome: case reports and literature overview.

Munchausen syndrome is a subset of factitious disorders with a number of distinguishing characteristics. This article presents three case reports and brief discussions to facilitate recognition. Management techniques are also presented.

Psychological factors in patients with non-specific abdominal pain acutely admitted to a general surgical ward.

Non-specific abdominal pain is the commonest reason for acute admission to a general surgical ward. The present study assessed the importance of specific symptom patterns, psychological and behavioural factors in a group of acute admissions and compared patients with appendicitis with those with no specific diagnosis. Psychiatric symptoms were no more prominent than in subjects with appendicitis as measured by psychological rating scales. Patients with non-specific abdominal pain had a poor symptomatic prognosis with continuing use of medical services. NSAP is best seen as a behavioural syndrome with repeated consultation over a long period before and after the index admission for both abdominal and other non specific symptoms.

[Psychological aspects of relaparotomy]. / Psikhologicheskie aspekty relaparotomii.

The authors analyse the importance of the psychological barrier in the choice of the method of treatment in performing relaparotomy. Proceeding from the fact that the surgeon's psychological barrier is an objective factor aggravating the results of management of postoperative complications, the authors suggest that the indications for relaparotomy should be considered collectively. They believe that the second operation should be carried out by another, more experienced surgeon of the department. The surgeon who performed the first operation acts as an assistant during the relaparotomy.

Further notes on Munchausen's syndrome: a case report of a change from acute abdominal to neurological type.

A rare case of Munchausen's syndrome beginning in early childhood is described. The diagnosis of Munchausen's syndrome was made at the age of 29 years, after the symptoms had changed from acute abdominal to neurological complaints, with feigned loss of consciousness, first ascribed to an encephalitis. Insight into the psychopathology of this patient is given by his biography, by assessment of a psychotherapist, who had treated him some years before, and by his observed profile in some psychological tests.

Pain insensitivity in schizophrenia. Case report and review of the literature.

We describe a schizophrenic man whose lack of pain and related objective signs of a perforated small bowel led to a delay in diagnosis and surgical intervention. A review of the literature suggests that both psychodynamic and specific biologic factors can produce atypical presentations in psychotic patients with illnesses in which pain is characteristically a prominent presenting symptom. While research into the cause of altered pain perception in psychotic patients is continuing, clinicians should maintain a high index of suspicion of serious medical illness when evaluating such patients.

Abnormal illness behaviour and anxiety in acute non-organic abdominal pain.

Of 105 patients admitted to a surgical ward with acute abdominal pain, 18 were considered to be without evidence of any organic aetiology for this symptom. These 'non-organic' patients were almost all female and differed from the 'organic' patients in state anxiety and in the illness behaviour questionnaire scales of psychological versus somatic perception, denial and affective disturbance. The two groups of patients could be differentiated on the basis of scores derived from the Illness Behaviour Questionnaire, and the State-Trait Anxiety Inventory.

Hospital admissions for abdominal pain in childhood.

From January to March 1980, a consecutive sample of 50 children admitted to hospital with acute abdominal pain provisionally diagnosed as appendicitis but who recovered spontaneously without a specific physical diagnosis was studied. The instruments used were a standardized parental interview and Rutter A(2) and B(2) questionnaires which are designed as screening devices to explore levels of emotional adjustment in children. A comparison was made with 43 children (controls) matched for sex and age from the same schools. Forty children suffering from acute appendicitis were studied in the same way. A significantly increased number of children in the nonspecific group obtained abnormal scores on the Rutter Scales compared with the control group (P less than 0.025). An unexpectedly large number (31%) of boys suffering from acute appendicitis obtained abnormal scores on the Rutter Scales. Postal follow up three months following discharge from hospital indicated that 8 (16%) of the nonspecific group were incapacitated to the extent of missing school. During the study, 15 children had a normal appendix removed at operation. Seven of them showed a significant degree of maladjustment.