Koekkoek Bauke, van Tilburg Willem
Institute for Professionalization, Gelderse Roos Mental Health Care, Wolfheze, The Netherlands.
BMJ Case Rep. 2010 Nov 29;2010:bcr0220102739. doi: 10.1136/bcr.02.2010.2739.
This case report offers a different perspective on a patient with a long-term non-psychotic psychiatric disorder that was difficult to specify. The patient, a man in his 50s, was unable to profit from outpatient treatment and became increasingly dependent on mental healthcare - which could not be understood based on his history and psychiatric symptoms alone. By separating symptoms from illness behaviour, the negative course of this patient's treatment is analysed. Focusing on ineffective chronic illness behaviour by the patient, and mutual ineffective treatment behaviour by the clinicians, it becomes clear that basic requirements of effective treatment were unmet. By making a proper diagnosis, clarifying expectations and offering a suitable therapy, ineffective illness behaviour was diminished and this 'difficult' case became much easier for both patient and clinicians. The illness behaviour framework offers a useful, systematic tool to analyse difficulties between patients and clinicians beyond psychiatric symptoms or explanations.
本病例报告从一个不同的视角呈现了一位患有难以明确诊断的长期非精神病性精神障碍患者的情况。该患者为一名50多岁的男性，无法从门诊治疗中获益，且对精神卫生保健的依赖日益增加——仅根据其病史和精神症状无法理解这一情况。通过将症状与疾病行为区分开来，分析了该患者治疗的消极过程。关注患者无效的慢性病行为以及临床医生相互无效的治疗行为后，很明显有效的治疗基本要求未得到满足。通过做出正确诊断、明确期望并提供合适的治疗，无效的疾病行为减少了，这个“棘手”的病例对患者和临床医生来说都变得容易得多。疾病行为框架提供了一个有用的、系统的工具，用于分析患者和临床医生之间超出精神症状或解释之外的困难。
