A state of nerves ...

Abstract

Introduction: In everyday practice, physicians are often faced with patients with symptoms for which an organic medical condition or a physiological explanation cannot be found.These patients represent a challenge for the Family Physician due to the use of inordinate amounts of health care resources, the persistent request for medical investigation, the difficult acceptance of a non-organic disease, leading to treatment resistance and the perpetuation of symptoms. The aim of this case report is to review and illustrate the role of the Family Physician in the management of patients with conversion disorder, namely in the diagnosis, psychosocial context, doctor-patient relationship, therapeutic goals, pharmacological treatments, articulation with other levels of care and follow-up. Case description: Its described the case of a 35 years old woman, worker of an auto-service wholesale company, married, mother of one child, in stage IV of Duvalls family cycle, stage III of Graffars socio-economical scale, with family Apgar of 8 points. She has a history of depression/ anxiety disorders. She presents to the emergency department with acute onset paraparesis and naesthesia of the lower limbs, being admitted to the neurology department. After clinical evaluation, she is discharged with the iagnosis of conversion disorder in the context of stress in the workplace. Since then, the patient maintained frequent appointments ith the Family Physician in an effective doctor-patient relationship, in articulation with psychiatric, neurological and physiotherapeutic care. Comment:Considering the high prevalence of somatizing patients, the Family Physician must have the necessary skills for its proper dentification and management.A patient-centred approach, considering the psychosocial context, should be followed.The primary herapeutic modality for the treatment of all somatoform disorders is the doctor-patient relationship, based upon the legitimization of the symptoms, in a comprehensive, supportive and continuous approach, articulating with other levels of care.