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Organic brain dysfunction and the difficult patient.

C A Fulton, W E Bruce, J A Suddeth

    The Journal of Family Practice
    |June 1, 1983
    PubMed
    Summary
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    Difficult patients in family practice may have undiagnosed organic brain dysfunction, impacting cognitive skills and visual-motor coordination. This suggests potential misdiagnosis within the biopsychosocial model.

    Area of Science:

    • Neuropsychology
    • Family Medicine
    • Psychiatry

    Background:

    • Patients labeled "difficult" in family practice settings may present with undiagnosed neurological conditions.
    • The biopsychosocial model, while comprehensive, may overlook organic brain impairment when focusing on psychiatric or psychosocial factors.

    Purpose of the Study:

    • To investigate the presence of organic brain dysfunction in patients identified as "difficult" compared to "average" patients.
    • To assess cognitive skills and visual-motor coordination in these patient groups.

    Main Methods:

    • Matched-pair study design comparing 16 "difficult" patients with 16 "average" patients (matched for age and sex).
    • Assessment using two standard indicators of organic brain dysfunction, focusing on visual-motor coordination and verbal abstract reasoning.

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    Main Results:

    • Both groups exhibited impaired visual-motor coordination, with significantly greater impairment in the "difficult" patient group.
    • Difficult patients demonstrated significantly greater impairment in verbal abstract reasoning, indicating cognitive deficits.

    Conclusions:

    • Findings suggest underlying organic brain dysfunction in "difficult" patients, often unrecognised in clinical settings.
    • There is a risk of misattributing symptoms of organic brain impairment to psychiatric or psychosocial diagnoses within the current medical paradigm.