O'Brien Rebecca Flynn, Kifuji Kayoko, Summergrad Paul
Tufts University School of Medicine, Division of General Pediatrics and Adolescent Medicine, The Floating Hospital for Children, Tufts-New England Medical Center, 750 Washington Street, Box 479, Boston, MA 02111, USA.
Adolesc Med Clin. 2006 Feb;17(1):49-77. doi: 10.1016/j.admecli.2005.10.007.
A variety of medical conditions can present, or be associated, with psychiatric symptoms. At times, these may be so prominent that they can overshadow the underlying pathophysiologic process that accounts for them. Thus, it is equally important for mental health providers to be alert to the possibility that adolescents whom they are treating may have symptoms related to a treatable medical condition as it is for primary care providers to conduct a targeted history and physical examination with their adolescent patients exhibiting psychiatric symptoms. Using the biopsychosocial approach, these two domains are not considered separately or hierarchically, but as highly interactive. In some cases (eg, adrenal insufficiency), appropriate and continued treatment of the underlying condition results in resolution of the psychiatric symptoms. In others (eg, SLE), treatment of the underlying condition may alleviate but may also exacerbate psychiatric symptoms. Therefore, comprehensive treatment of adolescents with psychiatric symptoms due to a medical condition may require the professional services of primary care, mental health, and specialty care providers, but their services should follow the collaborative model espoused throughout the other articles in this volume.
多种医学状况可能会出现精神症状，或与精神症状相关联。有时，这些精神症状可能非常突出，以至于会掩盖导致它们出现的潜在病理生理过程。因此，对于心理健康服务提供者而言，留意他们所治疗的青少年可能出现与可治疗的医学状况相关症状的可能性，与初级保健提供者对表现出精神症状的青少年患者进行有针对性的病史询问和体格检查同样重要。采用生物心理社会方法时，这两个领域并非被分别或分层考虑，而是被视为具有高度交互性。在某些情况下（如肾上腺功能不全），对潜在疾病进行适当且持续的治疗可使精神症状得到缓解。在其他情况下（如系统性红斑狼疮），对潜在疾病的治疗可能会减轻但也可能会加重精神症状。因此，对因医学状况而出现精神症状的青少年进行综合治疗可能需要初级保健、心理健康和专科护理提供者的专业服务，但他们的服务应遵循本卷其他文章所倡导的协作模式。
