This book presents case-based descriptions of models for the inclusive, multispecialty and multidisciplinary clinical care of complex cases. Cases range from primary care patients with complex systemic medical and psychiatric comorbidity, to those requiring specialty care, to those with potentially terminal illnesses. While each category and case has its unique requirements often necessitating different models of care, the commonalities in approaching complex clinical situations is underscored. Extended case narratives written by the treating physicians, summarizing both the course of clinical care and physicians' reflections on the challenges of managing complex patients, comprise the bulk of the book. Five additional chapters on systems issues associated with care of complex patients, together with a chapter on end of life considerations, a narrative analysis of the physicians reflections about complex patients, and a concluding chapter are prominently included to anchor the case narratives. Written by experts in the field, these descriptions form unique models for assessing and treating complex cases.
Integrated Care for Complex Patients is a useful guide for all health practitioners and health administrators who are responsible for clinically complex cases, including physicians in primary care and psychiatry, physician assistants and nurse practitioners, and psychologists.
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3 | (4) |
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2 Optimized Primary Care for Complex Patients |
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7 | (8) |
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3 Clinical Complexity: The Challenge of Complexity in Medical Practice |
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15 | (6) |
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4 Models for Managing Complex Cases in Both Inpatient and Outpatient Settings |
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21 | (8) |
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5 Primary Care Practice: The Structures and Methods Associated with Community-Based Primary Practice |
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29 | (18) |
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6 Community Care, an Optimal Setting for the Treatment of Complex Cases |
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47 | (6) |
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7 Introduction to Case Narratives and Narrative Analysis of Our Collected Cases |
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53 | (6) |
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8 Longitudinal Treatment of a Case of Panhypopituitarism, Pseudotumor Cerebri, and (Ultimately) Factitious (Munchhausen's) Disorder by Proxy |
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59 | (6) |
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9 A Boy with Poor Psychosocial Development and Eventual Psychotic Disorder: A Pediatrician's Struggle to Prevail in a Hostile Treatment Environment |
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65 | (8) |
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10 Development of a Major Substance Use Disorder From a Patient's Birth Through His Early Twenties |
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73 | (8) |
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11 Two Adolescent Brothers with Postviral Encephalitis Neurological Syndrome and Associated Psychological Overlay involving Parental Enmeshment |
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81 | (8) |
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12 An Adolescent Boy with Allergic Sensitivity and Anaphylaxis as an Infant, Crippling Parental Overprotection, and Unconfirmed Epilepsy |
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89 | (8) |
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13 Management of a Teenager with Anorexia Nervosa: a Family Medicine Perspective |
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97 | (8) |
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14 Man with Downhill Post-CVA Course Complicated by Loss of Wife's Support Due to Her Own Illness |
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105 | (6) |
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15 A Convoluted Treatment Odyssey of a Severely Drug-Addicted Bipolar Disorder Woman in Her Early 20s |
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111 | (8) |
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16 A Professionally Successful Man with the Midlife Onset of Severe Depression and Associated Suicidal Intent |
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119 | (6) |
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17 Escalating, Interrelated Systemic Medical and Psychiatric Illnesses with Unrelenting Suicidality |
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125 | (10) |
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18 Severe Anorexia Nervosa Requiring Hospitalization and Parenteral Feeding: Ethical and Legal Complications |
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135 | (8) |
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19 Sleep Apnea Treatment Refusal, Grandiosity, and Suicide |
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143 | (6) |
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20 Pain Management Progressing to Addiction in a Young Man with Quadriplegia |
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149 | (8) |
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21 Complex Regional Pain Syndrome (CRPS) and Progressive Medical and Psychiatric Deterioration |
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157 | (10) |
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22 End-of-Life Management Where There Is Family Opposition to Physician Recommendations |
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167 | (6) |
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23 Advance Care Planning for Patients with Current and Future Medical Complexity |
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173 | (18) |
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24 Narrative Analysis of Complex Patient-Clinician Interaction from Our Sample |
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191 | (18) |
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25 Reflections and Conclusions |
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209 | (4) |
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| Index |
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Steven A. Frankel, MD Director, The Center for Collaborative Psychiatry, Psychology, and Medicine Marin County, California
Associate Clinical Professor University of California at San Francisco School of Medicine San Francisco, California
Faculty, San Francisco Psychoanalytic Institute Psychiatric Consultant Kentfield Rehabilitation and Specialty Hospital Kentfield, CA
Until August 2017 James A. Bourgeois, O.D., M.D. Professor of Clinical Psychiatry Department of Psychiatry Director, Psychosomatic Medicine Division Langley Porter Psychiatric Institute University of California, San Francisco Weill Institute for Neurosciences 401 Parnassus Avenue San Francisco CA 93143-0984 415-476-9289; fax 415-476-7404 Email: james.bourgeois@ucsf.edu
As of August 2017 Chair, Department of Psychiatry Baylor Scott & White Health Central Texas Division Professor, Psychiatry, Texas A+M School of Medicine 2401 South 31st Street Temple, Texas 76508
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