This paper deals with the importance, for everyday medical activity, of an integrated approach of the adolescent patient coming to consulting room. Often the doctor has to tackle bodily pains which may bring him very far from his patient's real problems: on the contrary, he has to adopt a comprehensive clinical point of view in order to face his adolescent patient following a holistic frame of reference. This never means to split body from mind or the patient himself from his familiar context.

The Authors discuss a clinical case which may better show this integrated approach: it regards an 18-aged boy, suffering from recurrent lipothymic attacks since 1991. His complex symptomatology included thoracic and abdominal pain, fits of dizziness, dyspnoea, diffuse tremors and perspiration. The patient usually had loss of consciousness which lasted for a long time and were followed by a period of hypersomnia together with retrograde amnesia. He was hospitalised and consulted a lot of physicians, who diagnosed the attacks as epilepsy, though all the medical examinations he underwent were normal. In fact, he was subjected to EEG, polygraphic studies of sleep cycle organization, CAT, investigations about glucidic metabolism, blood tests, ...: no examination showed any abnormality. The patient began a pharmacological therapy with high doses of benzodiazepines and barbiturate, but it didn't succeed. The boy's symptomatology was increasing in intensity and frequency and the quality of his life became very poor In fact, he usually had to turn to medical treatment for help about three or four times a week. Finally he made up his mind to consult a psychiatrist and to begin a psychotherapy, which has been lasting about twenty months.

As psychotherapeutic relationship was going on, it became possible - for the psychotherapist and for the patient himself - to look at the lipothymic attacks from a very different point of view: they were the bodily expression of a psychological pain which had its root either in the boy's adolescential problems and his domestic troubles. During the therapeutic path together towards the resolution of symptomatology, it was necessary for the psychotherapist to consider the whole interactive net which stayed behind the patient and which represents all his world. This was possible by the analysis of dreams the patient had and by a therapeutic approach of the boy on different integrated aspects (both on individual and on family's grounds). After some time, when his emotions could be understood by psychotherapeutic work and found a mental expression, they no longer needed a bodily conversion: so all the physical symptoms vanished and the patient could carry on his life as the unique person he is. A follow-up after ix months showed no more attacks.

The case shows how a holistic approach to patients prevents them from being split into body and mind as well as regarding the adolescent's net of relationships allowing the achievement of a wider and more useful therapeutic management.

M. T. Lovallo, C. Pontalti: "Epilepsy or psychosomatic disturbance? Mind-body interface in the adolescent: a clinical case". Paper presented at the First International Congress of Adolescentology, Assisi, Italy, October 22-24, 1993.

Key Words: Holistic Approach, Lipothymic attacks, Psychological pain.

M. T. Lovallo, C. Pontalti: Università Cattolica del Sacro Cuore, Facoltà di Medicina e Chirurgia - Via della Pineta Sacchetti, 644, 00168 ROMA - ITALY.