Substance abuse, somatization, and personality disorders

Abstract

Neurologists are accustomed to dealing with difficult diseases. Our passion for deductive reasoning and the elegance of the localization process are what drew many of us to the field. When our skills in these areas fail, we become uncomfortable and assume that we are being faced with “a difficult patient.” Patients with substance abuse problems, somatization/medically unexplained problems, and personality disorders fall into this category. Through a series of illustrative cases (some real and some a composite) this chapter provides insight into the emergency diagnosis and management of difficult patients who present with pain as the major complaint.