A. General
Signs and Symptoms Warrant Further Assessment:
- Multiple
Emergency Department visits
- Stress related
illness:
- fatigue
- headaches
- abdominal
& pelvic pain
- chronic
pain or frequent use of pain medication
- sexual dysfunction
- palpitations,
dizziness, paresthesias, dyspnea
- frequent
vague complaints
- gastrointestinal
problems
- Drug and
alcohol abuse by patient or partner
- Depression
symptoms
- Anxiety
symptoms
- Suicide
attempts
- Self injury
- Post-traumatic
stress disorder
- Divorce
or separation
- Missed appointments
or limited access to routine care
- Lack of
independent transportation or finances
B. Diagnostic
Interviewing When General Signs of Distress Are Detected
- Simultaneously
evaluate organ-system and psychosocial factors as causative or
contributory.
- Talk with
the patient in private.
- Assure confidentiality:
"Our discussion will remain strictly confidential"
- Identify
or rule out violence as a possible sources of stress:
- "In
my experience these types of symptoms are sometimes caused or
made worse by stress. Are there any sources of stress in your
personal life, family life or at work?"
- "Are
you in any relationships where you are afraid for your personal
safety, or where someone is hurting you, threatening you, trying
to control your life, or forcing sexual contact?"
- "As
a child, adolescent or adult, has anyone ever physically hurt
you, forced sexual contact, or hurt your psychologically, for
example by telling you that you were worthless or unwanted?
- Identify
or rule out other sources of stress (violence may co-occur with
each):
- Major life
events (move; new job; etc.)
- Primary
depression or anxiety
- Death of
friend or relative
© B. Ambuel
& L. K. Hamberger, Family Peace Project, Family & Community
Medicine, Medical College of Wisconsin, 210 NW Barstow, #201, Waukesha,
WI, 53188, (414)548-6903. The Family Peace Project provides training
and consultation to professionals, organizations & communities.
Permission granted to copy this protocol for noncommercial use.
Your contribution to the Family Peace Project is tax-deductible.
Updated: 03/20/95 4:17 PM
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