title: [Integrated (biopsychosocial) treatment in the family practice: a pregnant patient with a sacral tumor and severe posttraumatic stress disorder].
abstract: In a 25-year-old woman pregnant for the second time after a successful first pregnancy, a locally aggressive, invasive sacrum tumour was diagnosed. The execution of the necessary but potentially mutilating surgical procedures was seriously hampered even during the preparative phase, in spite of the conscious wish of the patient to comply, by her severe psychiatric problems (posttraumatic stress disorder with dissociative symptoms). The Psychiatric Consultation Service took over the case management and an integrated (biopsychosocial) diagnostic investigation was carried out, involving analysis of the problems on four system levels: the biological, the psychological, the social and the health care level. An integrated treatment plan was drafted. By collaboration of the entire multidisciplinary treatment team conditions were secured under which patient would let herself be treated. In this way she was enabled to undergo the necessary procedures, with good results.
authors.affiliation: Academisch Ziekenhuis Vrije Universiteit, Amsterdam.
authors.forename: A D
authors.initials: AD
authors.lastname: Boenink
authors.forename: P
authors.initials: P
authors.lastname: Zandstra
authors.forename: F S
authors.initials: FS
authors.lastname: Spreekmeester
authors.forename: F J
authors.initials: FJ
authors.lastname: Huyse
authors.forename: W J
authors.initials: WJ
authors.lastname: van Ouwerkerk
authors.forename: P I
authors.initials: PI
authors.lastname: Wuisman
mesh_terms: D000328:Adult; D019033:Delivery of Health Care, Integrated; D004806:Ependymoma / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005194:Family Practice / Q000379:methods; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012017:Referral and Consultation; D013120:Spinal Cord Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D013313:Stress Disorders, Post-Traumatic / Q000150:complications / Q000628:therapy*