"Sociosomatics": the contributions of anthropology to psychosomatic medicine

We report an unusual case of T 0 N 2 M 0 small cell lung cancer in a patient with Lambert-Eaton myasthenic syndrome (LEMS). A 52-year-old man began to notice muscle weakness in a left limb in January 1996, which was followed by muscle weakness in his left arm and fingers, appetite loss, and general fatigue. An electromyogram (EMG) showed the waxing phenomenon in response to high-frequency repetitive stimulation. Lambest-Eaton myasthenic syndrome was diagnosed, based on his symptoms and EMG findings. Chest computed tomography (CT) was done, and left paratracheal, tracheobronchial, subaortic, and hilar lymphadenopathy were found. No mass was seen in either lung field. Cytologic examination of the sputum and bronchial lavage fluid were done, but no malignant cells were found Small cell lung cancer was diagnosed after thoracoscopic resection of the subaortic lymph nodes. No metastases were detected by bone scintigraphy, abdominal CT, or magnetic resonance imaging of the brain. Complete response and resolution of symptoms were obtained by chemotherapy and irradiation.     

Conceptualizing and defining psychosomatic disorders.

The concept of psychosomatic illnesses as physical problems resulting from emotional stress is questioned as one that may have outlived its usefulness. A broader definition involving all behavioral concomitants of illness is suggested. The new conception encompasses (a) organic problems created by difficulties in learning and development rather than affect, (b) organic problems created by deviation in personality and character rather than affect, (c) psychological disturbance created indirectly by physical illness, and (d) psychological disturbance created directly by physical illness. Several illustrations of the newly defined types of psychosomatic disorders are given. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contribution of epidemiology to psychosomatic medicine

The G1 glycoprotein of California encephalitis (CE) virus plays a critical role in the infection of mosquito and mammalian cells. We found that CE virus enters baby hamster kidney (BHK-21) and Aedes albopictus (C6/36) cells by the endocytic pathway. Ammonium chloride, a lysosomotropic amine that prevents release of virus from endosomes, inhibited infection of both cell types when added within 10 min after viral adsorption. In addition, infected cells formed polykaryons when the extracellular pH was lowered to 6.3; optimal fusion occurred at pH 5.8 and 6.0 (C6/36 and BHK-21 cells, respectively). Two neutralizing G1 MAba, 6D5.5 and 7D4.5, inhibited low pH-induced syncytia formation without affecting viral attachment, suggesting a role for G1 in viral entry. Since viral fusion proteins have been demonstrated to undergo conformational changes at low pH, acid-induced changes in G1 and G2 were assessed. While both G1 and G2 demonstrated low pH-induced alterations in detergent binding, only G1 displayed an altered protease cleavage pattern at the fusion pH. These results indicate that the G1 protein of CE virus undergoes conformational changes necessary for low pH-mediated entry into both mosquito and mammalian cells.     

Psychosomatic medicine and transplantation medicine. Cooperation is useful and necessary

Transplantation represents a breaching of the bodily integrity of the patient, and can lead to anxiety, depression and an identity problem. In the post-transplantation phase also, the patient undergoes further stress associated with check examinations and treatment. Standardized surveys show that the fear of graft rejection remains with the patient for the rest of his/her life. The new situation also has an influence on partnership, family and the overall psychosocial setting. All this adds up to a need for psychosomatic care, support and, where indicated, appropriate treatment in every transplantation patient. The broad spectrum of possible measures available in this connection is discussed.     

The psychosomatic network: foundations of mind-body medicine

Research in the 1980s uncovered ubiquitous neuropeptide-receptor distribution in brain structures associated with emotional processing, and throughout many organ systems. This finding supported neuropeptides as biochemical substrates of emotion, and the neuropeptide-receptor network as a parasynaptic system crossing traditional brain-body boundaries. The medical relevance of these findings was affirmed by psychoneuroimmunology research: neuropeptides help to regulate immunocyte trafficking, there is bidirectional communication between nervous and immune system components, immunocytes produce neuropeptides, and nerve cells produce immune-associated cytokines. In the past decade, the concept of a unified psychosomatic network has been strengthened by animal and human research demonstrating relationships between behavior and neuropeptide-mediated regulation of immune functions. Research on emotional expression or disclosure in healthy human subjects as well as in cancer and HIV-positive patients has shown significant positive correlations with clinically relevant immune functions and/or positive health outcomes. Psychosocial interventions emphasizing emotional expression or active coping have evidenced survival benefits in breast cancer and melanoma. These findings suggest that emotional expression generates balance in the neuropeptide-receptor network and a functional healing system. Emotional expression is also a marker for psychospiritual vitalization, and further research should evaluate links between energy-based models of health and neuropeptide-receptor-based models under the rubric of an informational paradigm.     

Clinical applications of hypnosis to three psychosomatic disorders.

Reviews outcomes and methodological soundness of studies of hypnosis in the treatment of skin disorders, headaches, and asthma. Some studies focused on changing physiological functions, others on increasing insight in their patients, and others on altering patients' perceptions of their symptoms. Methodological weaknesses included lack of control groups, nonrandom assignment of patients to treatment conditions, and confounding of treatment effects or lack of control for placebo effects. Additional weaknesses centered around the use of single outcome measures and the failure to assess the specific roles of mediating variables. Most studies showed positive treatment effects. However, there was equivocal evidence that hypnosis can directly influence autonomic functioning. Hypnosis may be valuable in facilitating one's capacity to gain insight into how one's symptoms developed and are maintained. In addition, hypnotic procedures have resulted in some success when used to indirectly alleviate symptoms by altering how individuals perceive their disorders and how these disorders affect their lives. (42 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Planning and implementation of research projects in psychosomatic medicine

Based on experiences of the author in planning and realization of scientific studies the different phases and steps of research process are discussed. Especially in the phases of reflecting and planning of a study, a lot of essential preliminary tasks are quite often missed. Failures in these initial phases of a scientific study lead to difficulties in collecting and evaluating of data. Important steps in the different phases of a project are reported in an overview. Finally some typical failures and faults in psychosomatic research made by physicians and social scientists are mentioned.     

Mood disorders. Prevalence and course of unspecified functional disorders from the epidemiologic and psychosomatic viewpoint

Subjective complaints or somatoform symptoms beyond the case threshold (ICD-diagnoses) occur in 12% of the normal population. In recent studies prevalence is at least 17% in primary care. Somatoform complaints (e.g. headache with 38.7%) or non-specific common symptoms (e.g. feeling of inner restlessness with 41.3%) are much more widespread. Mostly, several symptoms together are forming a multiple somatoform syndrome. As well known from other psychogenic disorders, spontaneous long-term course of somatoform symptoms is variable due to the psychic co-morbidity (in particular anxiety and depression) and a strong tendency to symptomatic shift. The long-term course of total impairment by additional psychogenic symptoms is rather bad in somatoform disorders. Clinically significant personality traits and traumatic influences during early childhood development are correlated with somatoform disorders. Within the traditional role patterns of the relation between physician and patient, somatoform complaints often communicate or indicate a psychodynamic conflict. In this case, a psychosomatic/psychotherapeutic approach in primary care or a specialized psychotherapy is indicated.     

疾病无大小中医药调养"治未病"十要

在社区诊疗"治未病"的过程中,着手切入点是个关键问题,疾病无大小,在病与不病之间辩证施治,通过四诊八纲,辨清寒热虚实表里,调养扶正祛邪达到治病目的.治病必求其本,树立整体观念.     

Behavioral medicine approaches to gastrointestinal disorders.

Behavioral research in gastroenterology has grown exponentially over the last decade. Controlled studies demonstrate that psychotherapy, stress management, and hypnosis are effective for irritable bowel syndrome, and behavioral treatments are preferred over medical management for some types of fecal incontinence and vomiting. For peptic ulcer disease, interest in behavioral treatments has declined. However, a new syndrome, functional dyspepsia, is now recognized, in which ulcerlike symptoms occur without ulcer and frequently in association with psychological symptoms. For inflammatory bowel disease, stress management training has produced inconsistent outcomes. Newly recognized disorders for which behavioral treatments are needed include constipation associated with inability to relax the pelvic floor muscles during defecation, functional rectal pain (proctalgia), noncardiac chest pain, and aerophagia (excessive air swallowing). (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Behavioral medicine approaches to somatoform disorders.

This article reviews the research evidence for the efficacy of cognitive-behavioral therapy (CBT) for somatoform disorders. Randomized controlled studies support the efficacy of individual CBT for the treatment of hypochondriasis, body dysmorphic disorder (BDD), and undifferentiated somatoform disorders including medically unexplained symptoms, chronic fatigue syndrome, and noncardiac chest pain, and group CBT for the treatment of BDD and somatization disorder. On the basis of this review of the existing research and a theoretical model of the processes involved in somatoform disorders, the authors offer suggestions for future research and effective treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Behavioral medicine approaches to gastrointestinal disorders.

Approximately half of the patients who consult gastroenterologists are diagnosed as having functional disorders for which behavioral medicine techniques may be the most effective treatment. Research has already established that biofeedback and habit training are the best available treatments for 2 common types of fecal incontinence and that behavioral management of life-threatening rumination syndrome in children is superior to alternative medical and surgical treatment. Preliminary studies suggest that biofeedback and stress management training will also provide effective methods of treating irritable bowel syndrome, peptic ulcer, and esophageal spasm. Promising areas of research include behavioral training techniques for fecal incontinence in demented geriatric patients, treatment of irritable bowel syndrome, and biofeedback investigation of the basic physiology of the gastrointestinal system. (87 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Geriatric psychosomatic disorders and psychotherapy of the elderly. Current concept and approaches to treatment

In a geriatric acute hospital, a minimum of 20% of the patients aged 60 or older fulfilled the case criteria for a psychogenic illness. Previously published epidemiological investigations had presented similar results. However, due to the limited theoretical training and treatment experience, psychotherapists continue to show extreme reluctance to formulate an indication for psychotherapy in elderly patients. The paper gives an overview of current concepts in development psychology for the second half of life drawing attention to the role of physical aging processes as an "organiser" of development. Sexuality in late life and approaches to dealing with chronic pain are presented as somatic-psychosomatic aspects of aging that challenge present old age stereotypes. Taking typical symptoms into consideration, a basis is established for the discussion of a differentiated therapy indication for elderly patients. Emphasis is on psychoanalytical and cognitive behavioural psychotherapy methods. Finally, perspectives of research are presented.