The Diagnosis of Persistent Somatoform Pain Disorder

According to the clinical diagnostic guidelines ICD-10 should be criticized in several ways:

1. Ignoring the organic substrate does not reflect the reality of the pain, even if they are primarily psychological or psychosocial reasons. With this diagnosis, the body-soul dualism Cartesian reflect that there is "real", that pain-related physical and imaginary, that is mentally induced pain. After the biopsychosocial model of disease different definitions would be more appropriate. The term "pain disorder" without "somatoform" when he was elected in the DSM-IV, not the fact that the "psychogenic" pain caused by organic substrates (may) have, although this is due to the current state of the science is often still not sufficiently known. The concept of persistent somatoform pain disorder according to the clinical diagnostic guidelines for ICD-10 exposed to the risk that should initially umdiagnostiziert as "somatoform" pain disorder is defined through the advancement of medical science, more and more, because of the organic substrate is detected, although at the same symptoms of mental and psychosocial factors involved as before.
2. Realization of psycho-physiological mechanisms, such as is the case with painful muscle tension (tension headaches), will lead to a different diagnosis of F45.4, which is the main code of non-psychiatric field, although psychosocial stressors known as triggers. This criticism is not mitigated by the fact that the ICD-10 pain described also not pure organic referred to as "somatoform".
3. In ICD-10, which is quite important differences between acute and chronic somatoform pain disappear. The suffix "persistent" ignores the difference between acute and chronic pain, such as that carried out in the DSM-IV. With the requirement for persistent pain pain disorders in ICD-10 is ignored so that last less than six months. In pain lasting psychological and social factors that are shorter also play an important role.

ICD-10 diagnosis of "persistent somatoform pain disorder" diagnosis is based on the same problematic "somatoform pain disorder" of the previous American Psychiatric diagnostic scheme DSM-III-R. This diagnosis is not suitable for many patients with chronic pain and does not apply to patients with acute pain, where both psychological and social factors in pain trigger or amplify.

DSM-III-R call for continued work with the pain for at least six months, while DSM-IV considers the pain itself as the main criteria for diagnosis. It was at that time not yet distinguish between acute and chronic pain.

Lump in the breast - Causes of Cancer

In Germany, one in ten women diagnosed with breast cancer in their lifetime. The survival rate has increased in recent years,

Behind the breast cancer revealed a number of very different diseases. Detailed information on the most common form of breast cancer, read the article "Breast Cancer".

Below comes to some special form such inflammmatorische carcinoma, Paget tumors, lymphomas and sarcomas of the breast.

As a breast infection: inflammatory carcinoma

This malignancy is a special form of breast cancer. It can come from both the channel and the lobules of. Only about 1-6 percent of all breast cancers affect the type of tumor. The patient is usually around the end of fifty. Scarcity of these tumors in men. As breast cancer is "normal", the exact cause of this disease is unknown. Quite aggressively growing cancer spread to the lymph early in the skin that clog the lymphatic vessels and cause backflow of lymph (lymphatic to refer to the chapter "Meet Chest"). As a result, swollen breasts.

Symptoms: Sometimes there is a node, but usually for a significant reddish or purple discoloration and crusting. It most often affects the lower part of the breast. Also pitting and grooving of the skin, called the typical orange peel. Breast pain is hot and can injure. By simultaneously taking breast swelling in size (pages difference!). Putting can be flattened or collected and scale. Fever is usually less. Each breast inflammation - especially if it occurs outside of breastfeeding - that does not subside after treatment with antibiotics after one or two weeks, the doctor will examine more closely, for example, to exclude inflammatory carcinoma.

Diagnosis: Outside lactation mastitis (puerperal mastitis is not, more on this in Chapter "cause: breast inflammation" in this paper) is rather unusual. Although mastitis, for example, occurs after breast surgery or irradiation, but then they usually develop in the temporal relationship with the treatment.

For the diagnosis of breast infection initially unclear usually mammogram. If the biopsy suspicious finding themselves are connected. If the result of inflammatory breast cancer, a detailed examination, such as breast, liver and bone system will still be necessary to determine precisely which occupies an area of ​​the tumor.

Therapy: The possibility of survival increases with current therapies. Chemotherapy before surgery, known as neoadjuvant therapy first increase after surgical treatment possibilities. Because the tumor can be reduced and withdrawn from the skin. This is an important prerequisite for surgery and wound healing. Is further therapy with specific antibodies are useful depending on the biological characteristics of the tumor. In general, breast operated after pretreatment. Word of the tumor is very good for that, breast-conserving surgery is possible. If not, the breast is removed. Lymph nodes also eliminates the surgeon. After surgery, chemotherapy is sometimes followed. As a rule, or agree with radiation therapy.