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Table 1 Protocol of a stepwise approach: problem-oriented interventions: social-emotional, eating, motility

From: An adolescent with significant emotional and medically unexplained complaints: case report and proposal of an intervention

Day Safety Social-emotional Eating Motility Autonomy
1 Bedside evaluation mental state antipsychotic medication Crying, retching Passive: infusion Sits in bed if supported  
2 Build alliance with family, establish supportive relationship with patient Nurse gets in contact with patient, offers contact, occupation at frequent short intervals Infusion Continued, able to sit alone in bed Patient decides when to stop (some minutes)
3 Weight control, check caloric supply nasogastric tube Breathing exercises by nurse, explore cognition: how does it feel in your stomach? Cognitive stimulation: school work at bedside Sensory input, water in mouth without swallowing, mashed soup via tube, initially administered by nurse, then by father Sensory input wash feet twice a day by father Breathe slowly for self regulation reflection on inner state
4 Weight gain, antipsychotic medication stopped Occupation continued, variety of tasks Continued Sits at bedside for a moment Crying diminishes
5   Continued variety of tasks, longer attention span   Continued Crying stops, is getting calm
6 Safe relationship to nurse Praised by family and professionals Active: able to swallow liquid   Active intake of food—very proud
7   Takes part in group painting   Sits in group at table  
8    Active: eats solid food nasogastric tube removed Passive: massage of legs; active: guided movements, relaxation exercises Expresses wish for favourite food, active movements of legs despite being anxious
9   Occupation for 1 h needle work fast, skilful   Able to sit in group for 1 h, stands with support Able to ask for material, persists on own ideas in painting, able to say no, assertive behaviour, confident
10     Some steps on her own without support  
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