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A management model for pediatric somatization.

Medically unexplained physical symptoms are common in pediatric settings, though little systematic research is available to guide the development of treatment efforts for pediatric somatization and somatoform disorders. This paper presents a management model for pediatric somatization based on principles distilled from the available pediatric and adult literature. Careful assessment, frank presentation of the diagnosis, and a cognitive-behavioral and rehabilitative approach are emphasized, along with aggressive psychiatric treatment of comorbid psychopathology. Well-designed empirical studies of intervention are needed that should examine efficacy as well as the relationship between symptomatic improvement, functional improvement, and comorbid anxiety and depressive symptoms.

Behavior Therapy↗

The medical model and psychiatric training.

The educational, sociologic and economic justifications for a recent decision to require an internship type of postgraduate experience in psychiatric training are discussed. There are many practical disadvantages to adding this requirement. Depending on the type of internship developed, such experiences may also impair rather than facilitate the trainee's progress as a clinician.

Attitude of Health Personnel↗

The manipulative patient.

"Manipulative" is a popular but often misused description of behavior seen in some patients who come to psychiatric attention. The authors suggest a definition of "manipulation" which can impart helpful information about symptoms, diagnosis, and treatment. They survey the differential diagnosis of manipulative behavior and consider specific treatment strategies.

Antisocial Personality Disorder↗

Psychosomatic illness in childhood and adolescence. Clinical considerations.

We describe a methodology for systematically approaching patients with difficulties of a psychological and social nature. Definitions are given for various types of psychosomatic difficulties, and their origins are linked to two theoretical perspectives; namely, the sick role model and family systems theory. An approach to the assessment of the individual with regard to school, peer, and family relationships is offered, and methods of gathering information associated with the presenting complaint are described. Approaches to treatment are reviewed, and appropriate applications are suggested.

Adolescent↗