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Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders

ISBN: 978-0-470-63907-8
304 pages
August 2011
Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders (0470639075) cover image
More than 100 medical diseases—many common ailments—are capable of masquerading as mental disorders. This book shows clinicians how to identify patients who are most likely to have an underlying physical ailment and how to direct them to a targeted medical work-up. With guidance on working with patients during the referral process and afterward, as well as on integrating medical findings into ongoing therapeutic work, clinicians will benefit from the practical advice on recognizing signs, symptoms, and patterns of medical diseases that may be underlying a psychologically presenting malady.
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Acknowledgments ix

1 The Nature of the Problem 1

2 Laying the Groundwork 11

3 Characteristics That Make Somatic Diseases Difficult to Detect 21

4 Patterns in Time 61

5 The Clinical Interview 83

6 The History of the Present Illness 97

7 Specific Physical Signs and Symptoms 103

8 Classical Presentations—Focal Signs, Dementia, and Delirium 129

9 Specific Mental Signs and Symptoms 149

10 Important Aspects of the Patient Assessment—A Second Look 223

11 Extended Clinical Vignettes—Working With Patients 241

References 277

Author Index 281

Subject Index 283

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Barbara Schildkrout, MD, is a Clinical Instructor in Psychiatry at the Harvard Medical School. She has taught for many years at the Beth Israel Deaconess Medical Center and the Boston Institute for Psychotherapy. She is a board-certified psychiatrist and has had a private clinical practice in the Boston area for over twenty-five years.
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"Unmasking Psychological Symptoms: How Therapists Can Learn to Recognize the Psychological Presentation of Medical Disorders is designed to help therapists bridge the gaps in their expertise between psychology and medicine so as to prepare them to better understand their patients and have a higher index of suspicion about medical factors that may affect them. The tone and scope render Unmasking Psychological Symptoms an ideal read for therapists.... Schildkrout does an excellent job throughout the book of initially presenting information in the psychological manner that a therapist might typically consider it and then elucidating what the same information may suggest from a medical perspective. Her approach does not feel condescending to a nonmedically trained therapist but rather offers a different perspective that may simply result in a desire to be more thoughtful in clinical practice... Unmasking Psychological Symptoms makes an excellent companion to psychology and psychiatry textbooks, especially those related to health psychology and consultation–liaison psychiatry." (PsycCRITIQUES, May 16, 2012, Vol. 57, Release 19, Article 8)

"In this practical and easy to read volume, Unmasking Psychological Symptoms, Dr. Barbara Schildkout, an experienced psychiatrist, offers both medical and non-medical psychotherapists a much-needed overview of the complex interrelationship between physical and psychological disorders. She shows how psychological symptoms can easily mask underlying medical illness and mislead even those of us with the best training and intentions. She underscores the need to be vigilant in our clinical formulations, always on alert for signs and symptoms of medical disorders. One of the strengths of this volume is the author's use of abundant clinical vignettes to illustrate her points. She uses these cases to take the reader through important lines of inquiry that are essential for clinicians. Reading this volume will help us not be seduced by our psychological theories and lead us down the dangerous path of ignoring the contribution of underlying medical illness. I can wholeheartedly recommend this excellent volume to all who practice psychotherapy whether a student, early career professional, or experienced clinician."
Jeffrey J. Magnavita, Ph.D., ABPP; Diplomate in Clinical Psychology, American Board of Professional Psychology; Past President, Division of Psychotherapy, American Psychological Association; Member of the APA Clinical Treatment Guidelines Advisory Committee

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