A Baffling Illness Solving Medical Mysteries€¦ · Medical Mysteries Stress Medicine 6/23/2015...
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Medical Mysteries Stress Medicine 6/23/2015 www.stressillness.com David D. Clarke, MD 1 1 Solving Medical Mysteries Hidden Stresses and Unexplained Symptoms David D. Clarke, MD 2 A Baffling Illness 3 Psychophysiologic Disorder (PPD) Illness caused by past or present psycho-social stress. 4 Cause of Presenting Symptoms Landa, Psychosomatic Medicine, 2012. 30% 55% 15% Outpatient Primary Care PPD Organic Psychiatric 5 A Wide Range of Presentations 6 Women Undergoing Laparoscopy J Harrop-Griffiths, W Katon, et al. Obstet Gynecol 71:589-94. 1988. 0 10 20 30 40 50 60 70 No Pain Pelvic Pain % Childhood Sexual Abuse
Transcript of A Baffling Illness Solving Medical Mysteries€¦ · Medical Mysteries Stress Medicine 6/23/2015...
Medical Mysteries Stress Medicine 6/23/2015
www.stressillness.com David D. Clarke, MD 1
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Solving Medical Mysteries
Hidden Stresses and Unexplained Symptoms
David D. Clarke, MD
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A Baffling Illness
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Psychophysiologic Disorder (PPD)
Illness caused by
past or present
psycho-social stress.
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Cause of Presenting SymptomsLanda, Psychosomatic Medicine, 2012.
30%
55%
15%
Outpatient Primary Care
PPDOrganicPsychiatric
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A Wide Range of Presentations
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Women Undergoing LaparoscopyJ Harrop-Griffiths, W Katon, et al. Obstet Gynecol 71:589-94. 1988.
0
10
20
30
40
50
60
70
No Pain Pelvic Pain
% Childhood Sexual Abuse
Medical Mysteries Stress Medicine 6/23/2015
www.stressillness.com David D. Clarke, MD 2
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Costly and Frustrating
No definitive tests Frequent referrals & “mega-workups”
False positive tests
Serious illness is ruled out but the patient remains ill
Barrier to Good Outcomes #1
Physician AttitudePhysician Attitude
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Symptoms Relieved after a Nine Month Negative Work-Up
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A note from the Referring Physician
“Thank you for helping her. It is
reassuring to know that I didn’t
miss anything important.”
Barrier to Good Outcomes #2
Patient’s Reluctance to Accept Stress as a Cause of Illness
Patient’s Reluctance to Accept Stress as a Cause of Illness
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Gaining the Patient’s Trust and Cooperation
Reassurance that PPD Symptoms are NOT:
Due to Mental Illness Imaginary or Delusional An attempt to Deceive or Malingering Self-Inflicted
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Stress
Symptoms
PPD Symptoms result from aPhysiologic Process
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Stress Check-Up Part I
The Illness Chronology
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Stress Check-Up Part II
Current Stress
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Stress Check-Up Part II - a
Insufficient Personal
Time
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Stress Check-Up Part III
Childhood Stress
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Adverse Childhood Experience Study
Seven Factors Measured (n=18,000)
Abuse: 1. Physical 2. Sexual 3. Psychological
Household Occurrences: 4. Substance Abuse 5. Mental Illness6. Domestic Violence7. Householder Imprisoned
Medical Mysteries Stress Medicine 6/23/2015
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4+ ACEs vs Zero ACEs
Odds Ratios
IV Drug Use 11.0Suicide Attempt 9.5Alcohol Abuse 5.3Domestic Violence 5.0Multiple Somatic Sx 2.7COPD 2.4Obesity 1.8
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Stress Check-Up Part IV
Depression
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Stress Check-Up Part V
Post-Traumatic
Stress
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Stress Check-Up Part VI - a
Generalized Anxiety Disorder
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Stress Check-Up Part VI - b
Social Anxiety Disorder
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Stress Check-Up Part VI - c
Panic Disorder
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Barrier to Good Outcomes #3
Patients are often reluctant to accept referral to a
Mental Health Professional for a physical symptom.
Patients are often reluctant to accept referral to a
Mental Health Professional for a physical symptom.
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Three Useful Statements
Stress causes real symptoms.
I need a specialist to help uncover the cause.
I would like to refer you for a Stress Evaluation.
Stress causes real symptoms.
I need a specialist to help uncover the cause.
I would like to refer you for a Stress Evaluation.
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Treatment of Current Stress
Listing Your Stresses
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Treatment of Current Stress
Self-Care Time
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Treatment of Childhood Stress
Acknowledge Their Heroism
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The Mystery Solved
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Another Mystery:Linda’s 550 Days
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Somatic Expression of Rage
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The Talking Cure
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Stress Causes Real Symptoms
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Effective Treatment is Available
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www.PPDAssociation.org
www.stressillness.com
www.unlearnyourpain.com
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What if there was a blood test for PPD?
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Until there is a blood test…
“Wonderful.” (Yale)
“Truly remarkable.” (UNC)
“Extremely valuable.” (Berkeley)
“A spectacular accomplishment.”(OHSU)
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All earnings used only to support lectures.
