Psychiatric Interviews for Teaching: Somatisation

[@quanang2548]

The essence of the psychiatrist skill and negotiating skill is at the ending part. It's very difficult to say it again that a part of the patient/client's pain is from the mind. Also, she showed much of empathy and understanding on the clients to...persuade her a to engage in a new approach. The whole ensuring things and calming is just to make her to believe 'Okay, let's do something different and we need to stay frequently for 3 months". Great work!

[@annhamer2734]

This interview made me remind of my cousin. He felt pain in his testicles and his doctor couldn't find any problem So, he got a referral to psychiatrist. On the day he was going to get the referral, a friend doctor of his doctor was in the office and thought my cousin might have a very rare kind of testicle cancer and both doctors agreed to have him tested for that. The result came positive, my cousin under radiation and chemo and other treatments. He survived and it never came back.

[@TheJosseph10]

seminoma?

[@muayadalnaabi2378]

can help me we write nursing care plan for this interview

[@hatirose7503]

very good , no confrontation, good rapport and informed consent on decision .

[@ellaneruda]

If this was real, I would want her to get tested for SIBO (small intestinal bacterial overgrowth). I had it and it was mistaken for anxiety. It was cured after a week of antibiotics.

[@Reticence9zen924]

The fact her tummy troubles started after she had some food poisoning or similar from Egypt suggests this might be the case.

[@N1Rguitar]

SIBO would be tested only under specific conditions that predispose for that, such as Crohn's, if she underwent gastrectomy or right hemicolectomy, etc. Without these predisposing conditions, it is likely to result in a false positive resulting in antibiotics administration which in turn may result in C.diff diarrhea.

[@user-bn4de4gi5p]

Espcially after a forgein country trip.. ur right...

[@SatumainenOlento]

@@N1Rguitar Yeah, Ella probably was lucky to be tested and treated. And again it was one misdiagnosis of anxiety in female patient.

[@Crystyna03]

@The Bald Med Student well, that's bad, you should test for SIBO anyways, I got it without any of the prerequisites you mentioned

[@Drakensoul]

That's what Dr. Brown was for. The patient already decided testing was inadequate, despite logic to contrary. By the time the patient arrives for this interview it is focused on psychiatric evaluation because the primary has already dealt with attempting to explain all of the tests that were done and the fact that all detectable organic conditions were ruled out. Here she is trying to elicit the cardinal symptoms of complex somatic symptom disorder, which is what the patient was referred for.

[@kdlofty]

A simple case of severe IBS that hasn't been correctly identified, leading to self doubt, lack of self esteem and confidence as well as fear.

[@luciedvorakova2167]

Symptoms started since Egypt food poising. That would indicate to me rather physical problem, not psychological, because in Egypt you should always suspect unusual exotic infections which may be tricky to diagnose. Worsening symptoms when lonely and improving when happy happens even with physical disease, think when you have flu, you often feel instantly a bit better when your partner/parent show love & care for you. Better example of somatisation would be unspecific tummy pain always before school exam, work deadline etc.

[@Craigdna]

I enjoy what you are showing people as it pertains to the different conditions that are out there. It is thought provoking as well as an engaging learning experience. The component of hyper sugarization (made up of course) and alcoholism, should be considered in the incorporation of all pathologies and conditions, though, as they are integral in pathologies. I men that not in the sense of shock value, but reality.

[@AnxietyAddict]

I pass VERY smelly wind. Barbara - 2015

[@rainblaze.]

nothing gets by you does it?

[@TJ-kk5zf]

she's great fun at parties

[@SassyMa_]

Dont we all darlin? Lol

[@beanthefish]

I pas VEERY smelly wind. ~Me 2021 ... 365/year 24/7

[@jamesj9998]

Health care is clearly better in Britain than in the US. My wife is this woman times 10. Even with great health insurance, you can't get a physician to spend 10 minutes with her, and there is NO mental health system here. See a psychiatrist and they will give you 3 minutes and another drug. This was helpful because we've had a number of docs say that it's a severe case of somatic symptoms disorder, but it's good to see how this therapist addresses it.

[@SatumainenOlento]

Ok, go well trained and certified naturopath with good recommendations could be helpful. That will help to check that she eats appropriate way to Her needs. They are not that expencive and she gets seen and heard and she will feel better that way also. Be careful not to go wild with alternative treatments, because they do help for a moment, but most importantly she needs to get down to the bottom of the problem. If it really is somatic then she has something in subconscious mind which is not getting expressed. And as soon as it starts to come out, the healing begins. She does not need mental medication if she does not have mental symptoms at present. it can just suppress the symptoms further down and cause more physical symptoms. Something wants to come up, be expressed and FELT. What is wonderful about this is that as soon that emotion is FELT fully, it will dissipate and there is no need for more. You do not need to even know what it was all about. And it does not need to be that traumatic or anything major, but sometimes emotions just get stuck. It is also very traumatic to go to a doctor and not be heard about your symptoms. She needs counselling for that alone! (And right counselling, with a person who feels right and that she can spill all her secrets to!) And this is only beginning of a journey to recovery...There will be more to be done, but this is first aid and then when the first layers of symptoms starts to be more clear then you can go to the next layer and start working on deeper stuff. AND there might be need for more investigations by doctors, but that will become clear later. Also, rheumatologist opinion would be good too. And start tracking the symptoms down every day, every hour. You do it for your wife. That might give more insights to her, you and everybody who is part of your journey. Good luck!

[@lj6819]

I've had somatization disorder now for 12 years being diagnosed only 6 years ago. After hundreds of doctors appointments and multiple tests like m.r.i.s, ct scans, ultrasounds over that 12 year span, nothing has been found from these symptoms that I go through. I've tried meds, cognitive behavior therapy, acupuncture and almost everything in the book these past 6 years yet I still suffer from this debilitating disease. I applied for social security disability and got it right away as have just been crippled by this disease. Scary thing is that you don't know what's real and what's not. I was diagnosed with thyroid cancer last year even though I felt no symptoms for that one particular thing. It was found as I had an m.r.i. for swelling under my jaw. My shrink said to stay away from doctors while my doctor said if i'm dealing with real symptoms, i must follow up with a doctor. I feel real painful and destressing symptoms....what do I do? Any advice would be appreciated?

[@KeenanV]

My advice would be to visit and follow up with a doctor but make them aware of the diagnosis

[@Powerof123456]

this is what a visit to a psych doc should be. but in reality a visit is shorter than this video with a waiting time longer than 100,000 rewatches :/ mental health help is so awful these days

[@aojuri01]

'You have to have IBS to understand it'. Medicine does not have a cure for it or for other psychological and psychiatric disorders like schizophrenia amongst many others It has a poor understanding of these neurological disorders. It is often referred to as a functional disease, but my suspicion is that it is not entirely functional, it probably has physical causes as well. Anything that has a cause must also have a solution, that's the tricky bit. What is the lasting/permanent solution or cure?

[@SatumainenOlento]

Yes, there is coming up more information and studies about gut health effecting mental health. And more! Science is only on the beginning od discoveries.

[@faithoffaith]

I suffer from IBS and I once made an appointment with a Dr who wasn't my usual GP to ask about medication because the OTC ones wasn't working and guess what he said? 'IBS doesn't really exist, it's a psychological problem' so I replied 'I've been diagnosed with it and take medication but it isn't working.......His words 'Exactly' well I just stormed out I was furious!

[@DAN-qv4jx]

+faithoffaith IBS is from too many parasites in your intestines and stomach.

[@migerrancan554]

@@DAN-qv4jx I dont think this is true

[@samanthathompson9812]

I got told I had this problem many times and it variously turned out to be a) an arterial dissection b) a huge ovarian mass and c) a kidney infection. Each time it was "all in my head."

[@Jacklynofalltrades]

This happened to me, even Mayo thought I was fat and it was IBS. It took close to 11 years for GI doctors to figure it out, despite numerous small bowel obstructions and abnormal imaging. It turns out I have Crohn's disease, an autoimmune disease. This poor woman might be really sick.

[@annhamer2734]

I simpathise with the patient. What's the harm of doing more tests?

[@maryxoxo9]

It feeds the psychological problem of the patient.. the tests will never be enough. I feel for these patients too.. it must be agonizing to go through that daily. No one wants to live like that.

[@MathMatheus0511]

@@maryxoxo9 the testing can also do harm sometimes.

[@allaamrauf8214]

@@maryxoxo9 Have you got proof for that?

[@allaamrauf8214]

@@MathMatheus0511 how?

[@akashnasrullah3067]

Is it illness anxiety disorder? It sounds like it when she says I feel like it’s cancer

[@josephtedesco9138]

All organic and physical testing negative. It gets better when she is outward focused and worse when she feels alone. Classic case of TMS or MBS. Read any book on Mind Body Pain Syndrome. Sarno. Schubiner. Education on "its all in your head" and "i cant see how my mind causes this pain" is paramount for her healing. These interpretations can and do block a person from accepting the treatment. She is clearly resistant to letting go her established fears and associative evidence. Well done GP! Great questioning and discovery.

[@Mortthemoose]

17 mins WOULD be a double appointment!

[@JeffreyWilliams-dr7qe]

Could be one of the Miserable Sideffects of Antipsychotics and there can still be more.

[@hanans.m2488]

great film, very helpful , but she mentioned that NHS running out of money which is in 2012 . hat if you had filmed at 2018 what would she have said about NHS and privatisation!

[@deboraholsen8443]

This actress was very good.

[@stephenmartin8331]

This is a guide on how to talk a patient out of medical treatment. Somatic illness is from unknown causes, which doctors often confuse with being made up or psychiatric. The doctors here are trying to convince this woman that she's not sick because they can't figure out what is wrong. My mother spent 15 years telling the doctors there was something wrong and they told her the same thing, until she ended up paralyzed and blind on one side. This is terrible medical detection and has become far too common.

[@SatumainenOlento]

Oh no! And what did they diagnose her after that?

[@ArianneSankar]

I don’t know whether this is a hypochondriac disorder, somatic symptom disorder or conversion

[@moviemakerwannabe]

Unexplained abdominal pain that is from cramping to stabbing pain. Being referred to a surgery. Constipation and diarrhea. She should be tested for one of the types of porphyria.

[@attheranch873]

What happened on the trip when it started besides being sick?

[@maddisian]

That's what I wanted to know too

[@emeraldsandrubies]

Sounds like IBS to me! A great probiotic worked for me!

[@blubbiblubblubb]

You can't be fucking serious, right? The patient is an actor and serves the purpose of showing medical students and doctors how to recognize somatization disorders.

[@emeraldsandrubies]

blubbiblubblubb You talkin' ta me?

[@DAN-qv4jx]

+emeralds andrubies I don't think psychiatrists know anything about "Probiotics"

[@BigMamou367]

Yes IBS. I've had it since I was 6. And probiotics did not help me.

[@yasweeter]

It's not IBS gosh

[@rumeysaeed1]

It is still discussed whether or not the IBS is a somatisation disorder

[@mjmallari796]

Thank you.

[@shivanidubenath4741]

Very informative video

[@markczarny7088]

Loperamide

[@Outpost31-midnightwatch]

This is disturbing as this lady sounds like she actually has IBS or something not a metal illness. Notice she traces it back to one event where she got sick in eygip. She may very well have contracted some type of permeant damage to her gastrointestinal system.

[@nunyastieger3541]

she could be my doctor

[@SassyMa_]

Good job doctor!

[@sezthet1]

How is this somatisation? Isn't it IBS?

[@yasweeter]

In this film, you see a GP talking to a patient who has repeatedly presented to the surgery for abdominal problems for which NO ORGANIC CAUSE HAS BEEN FOUND.

[@mattgardiner8854]

@@yasweeter IBS can't be identified by clinical tests. It's based on symptoms. This is certainly IBS. Notice that she said that the symptoms eased when her son was married and her mind was occupied. IBS is exacerbated by stress and tends to ease when stress is low.

[@6Fiona6_P_6]

Wondering if this patient was ever investigated for a possible food allergy? But it does sound like IBS. But people can have symptoms that are idiopathic. That doctors do every investigation they can but they still can't find out the answers to medical conditions. These doctors aren't fobbing their patients off, it's just medical science hasn't uncovered the reason patient Joe Blogs gets the pain or symptoms he Or she does. So these doctors are left with the inevitable rotten situation of treating their patients the best way they can ⚛️

[@TJ-kk5zf]

deleted scene from Woman Of No Importance

[@blubbiblubblubb]

Her smiling seemed inappropriate at times. Otherwise, excellent educational movie just like the others in this series.

[@Kh4led4]

The smiling of whom you didn’t tell us.

[@klaussperger]

an ideal filmed and edited session.Even with this 'ideal' set up,do you really think my g.p.would spend 18 minutes on my 'somatized' belly pain??? Completely disconnected with the real world and ending up with patient dissatisfaction. Apart from the obvious I.B.S.,there was absolutely no understanding let alone explanation of the somatizing process.Pathetic

[@blubbiblubblubb]

The way I see it she was working in the same clinic/praxis as the GP the patient usually visits, but is a psychiatrist or at least has some training in that area. That being said, how much time a doctor will have for you really depends on where you live, how you are insured and whether or not the doctor thinks it is actually worth to invest this time. In many countries a doctor who is psychologically trained will in fact take even more time when first seeing a patient. If she is meant to be a psychiatrist (which she plays in the other educational movies), 45min is a regular duration for a first visit. On a sidenote, I've had 45-90min 2-3 times per week for 2 months as an outpatient with one psychiatrist (eventhough for a much more acute psychotic disorder).

[@klaussperger]

It says quite clearly that 'Barbara is visiting her g.p.'.also the room is set up as a g.p. office,not a psychiatrists.this is a British film of the n.h.s. I cannot talk about other countries.

[@PaulGarthAviation]

I know this is training video, but IBS can be tricky. As a hypnotherapist, the somatic sensations are rooted in subconscious known negative associations, and is not in the realm of logic/reason. EFT Tapping is also a great adjunct to break the pattern.

[@namanziu4211]

The rapport was damaged!!!

[@maxomatosis_]

coeliac?

[@madbros5613]

Why do psychiatrists ALWAYS have this patronizing attitude in their body language and the way they talk. They seem to think their IQ is atleast 3SD above their average paatient and their sanity level is beyond human.

[@maxwatson4545]

I think it's related more towards people of her ethnicity. I had a dentist once with this same demeanor; her expressions and attitude were almost identical, over the top sympathy to the point of patronizing.

[@franciscanishagomes3944]

Not all psychiatrists.

[@user-bn4de4gi5p]

This is a general practice medical dr... not a shrink.. why fo shrinks think is all mental, when someone can be seriously ill???

[@pavlovsdawg]

@@maxwatson4545 As someone who lives in an area densely populated with South Asians and has primarily white and South Asian doctors, I can assure you her attitude has nothing to do with her ethnicity and more to do with the nature of medicine and psychiatry. I’ve met doctors of all different races who are smug and those who aren’t. Remember they’ve been taught to convey confidence and dependability. It takes a great amount of skill and self awareness to come off as an eloquent, professional, authority on a subject whilst avoiding condescension (or more someone interpreting how you are think and speak as condescension). Some people are simply more skilled at doing so than others. The interviewer here seems kind and genuine. She’s not dismissive of the patient’s pain, seamlessly establishes informed consent, and frequently inquires about the patient’s feelings. I’ve got no idea why people are slagging her off.

[@rjuniper]

The way this shows the psychiatrist speaking to her patient comes across as deeply condescending. It is almost painful to watch. This woman has a complex disorder, and a complex mind, she is not a child. What doctors offer is limited. Testing is limited. Understanding of the body is limited. Understanding of the mind is limited. Period. When a patient presents with somatic issues, psychological assistance and care is needed. Most patients can sense they are being manipulated by this kind of approach, and it is fully understandable why, when being spoken to in this kind of way. In many cases of pain in the stomach and intestinal tract presenting as this disruptive, treatments must be explored intelligently and holistically, in ways that a browser at a "herb shop" would not necessarily be able to come by, or be educated on. Probiotics that are actually live and are of good quality are just one, though often extremely effective if not at least helpful. The RIGHT digestive enzyme, the RIGHT herb, for her, acupuncture and gentle exercise to relax the muscles, yes - the mind, and to promote digestive activity - there are complex reasons these happen simultaneously, to name just a few. To completely dismiss this is absurd and simplistic. Treatment should and must assess both simultaneously. The fact that the assimilation of treating body and mind is so under developed reflects incredibly poorly on doctors, while so many people like this woman, in real life, not a "misunderstood" woman who is acting, are truly suffering and are in fact not well, not only psychologically, but physically, with real issues that can - in actuality - apparently contrary to some academic thought - be addressed. Please, also know, that a very positive event in somebody's life, like a wedding, can make people with very serious chronic illness feel better and see improvement. This is truly ill considered and is of very poor depth.

[@mykekhan2801]

Sorry

[@lindaleelaw5277]

Wheres her GP?

[@saudi.riytta2083]

They are acting

[@TJ-kk5zf]

very Rogerian

[@DyanaLekha]

hypochondrial disorder

[@eastbaysf]

She needs a high fiber diet,, one bowl of all bran or bran flakes fixed my jippy tummy.

[@cjh-bk4pn]

funny to me how seriously the British use the word "tummy". In America it's a very childish or cute sounding word.

[@Dragon34th]

My advice to her is: Try DR. Harold Shipman👈 😈👌 He loved patients who kept coming back.

[@bayanalyaseen41]

شو اسم الدكتوره

[@jimestes2563]

Sounds like H-pylori

[@larrytruelove7112]

I thought H pylori causes ulcers.

[@birdnest5814]

IBS

[@luispinero2835]

She needs a good diet. That s all

[@muhamadrickymulia412]

I think the proper diagnosis of this video are hypochondriasis not somatisation

[@TheKrouton]

Illness anxiety disorder (hypochondriasis) is a somatic disorder. Yes, this patient is probably preoccupied with their illness, indicating hypochondriasis, but they are also experiencing real physical symptoms, which is characteristic of somatisation.

[@DazMcK]

S for Symptoms (Somatisation), and C for Cancer (Hypochondriasis and specific illness preoccupation)

[@Pure_Imagination_728]

According to the DSM-5, there also exists the possibility of a comorbidity of disorders, so she most likely has both Illness Anxiety Disorder and Somatic Symptom Disorder or Conversion Disorder based on APA diagnostic criteria. Although Great Britain may classify psychiatric disorders differently than the American Psychiatric Association.

[@SatumainenOlento]

Or she has IBS 😊 And doctor just dismissed her like you all in this comment section.

[@RachelNitsche]

this video makes me angry. how about asking about food? let het write a foot an pain diary. could be gluten or fructose. not a single question about diatry. GPs. please stop playing therapists.

[@luciedvorakova2167]

This is a very bad somatisation example. No dietary questions, started since Egypt food poisoning, which would be more indicative of some hard to diagnose tropical infection, not somatisation... Unspecified tummy pain always before work deadline would be much better example of somatisation then this one.

[@cherylcampbell7495]

Constapation Raisin Bran cheese for runs. Smelly stop eating meat, chicken etc. dead things. Vegetables, fruit no gluten and all organic. I was going to say it’s your hubby, stress.

[@SatumainenOlento]

I have tried many different diets over the years which have been promoted "healthy". The truth is; no one diet fits for all! We are all different and our body is unique. Example, I get worse on vegetarian and vegan diets. I have to be grain free, legume free, sugar free, nightshade free and dairy free. That does not leave much space for variations. But this is how my body wants it. Like I said I have given them all very good extended try. In the end, it is my body which chooses.

[@LaymanAcademee]

Very cute dr

[@garymorgan3314]

Oh god no, not that!

[@tinamaslova6675]

That exessive nodding is so annoying and seems so fake! 😑

[@faithoffaith]

Barbara Roberts - "Hello there my name is Dr Beddie, I'm one of the new GPs in the practice - First of all what would you like me to call you?" Lol bit strange......

[@kristen-pr7kz]

It's for people that prefer some kind of other name or a nickname. May or may not have to do with gender identity.

[@faithoffaith]

A GP should know their patients name, don't they look up their medical notes!?

[@nicoleyordan8953]

Like Kris said, it has to do with the patient's preference. The record states the legal name, say "Donna Johnson", but a patient may prefer Mrs. Johnson, Donna, or even Don. It's part of the interview protocol for first time visits.

[@mjmallari796]

Thank you.