A morte, o sofrimento e a doença – um luto diferente

Abstract

Introduction: The Family Physician should have the ability to manage health problems in all their dimensions and use health resources efficiently as the patient’s advocate. Case Description: This report describes a 51 year-old man who was married and the father of three living children. His symptoms began in 2008 following the death of his son and an episode of reactive depression. In 2011 he had his first “seizure”. He consulted with a neurologist who diagnosed epilepsy and prescribed anticonvulsants in progressively increasing doses despite inconclusive investigations. In August 2012, he attempted suicide with a drug overdose saying “... I want to be near the boy.” He was then referred, for the first time, to a psychiatrist. In March 2013, he was re-evaluated by his family physician, because of the persistence of the symptoms. He was diagnosed with somatization/conversion and was again referred for psychiatric consultation. He was treated with sertraline and clonazepam, which contributed to the partial resolution of the “seizures”. Comment: This case emphasizes the importance of assessing all of the patient’s health issues in the biopsychosocial context. The loss of a family member is associated with increased vulnerability to develop psychiatric disorders, including suicidal behavior. It emphasizes the role of the family physician, who has the tools to manage health resources and the ability to guide the patient. In an era of sub-specialization, it is important that the family physician has the ability to use a holistic approach, focusing on suffering as well as the disease.