Physical Illness and Psychopathology

Sonino²

2009

The primary goal of psychosomatic medicine is the incorporation of its operational strategies into clinical practice. The traditional attitude toward disease and the functional/organic dichotomy were criticized by George Engel in the early sixties. Only recently, however, there has been increasing awareness of the limitations of disease as the primary focus of medical care. It is not that certain disorders lack an organic explanation; it is our assessment that is inadequate in most clinical encounters. The research evidence which has accumulated in psychosomatic medicine offers unprecedented opportunities for the identification and treatment of medical problems. Taking full advantage of clinimetric methods (such as the use of Emmelkamp’s two levels of functional analysis and the Diagnostic Criteria for Psychosomatic Research) may greatly improve the clinical process, including shared decision making and self-management. Endorsement of the psychosomatic perspective may better clarify the pathophysiological links and mechanisms underlying symptom presentation. Pointing to individually targeted methods may improve final outcomes and quality of life.

Section: Psychosocial Foundations Of Clinical Assessmentmentioning

confidence: 99%

Psychosomatic Assessment

Sonino²

2009

“…the deliberate omission of therapeutic, dietary and other measures necessary to sustain life or prevent the progress of pathology) may mask a major depressive disorder [97]. Examples include diabetic patients who stop taking insulin, those who resume strenuous work after myocardial infarction and those who withdraw from chronic hemodialysis [97]. …”

Section: Psychosocial Correlates Of Medical Diseasementioning

confidence: 99%

“…Lipowski remarks that once the symptoms of a somatic disease are perceived by a person, ‘or he has been told by a doctor that he is ill even if symptoms are absent, then this disease related information gives rise to psychological responses which influence the patient’s experience and behavior as well as the course, therapeutic response and outcome of a given illness episode’ [97]. The study of illness behavior, defined as the ways in which individuals experience, perceive, evaluate and respond to their own health status [118], has yielded important information in medical patients [119].…”

Section: Psychosocial Correlates Of Medical Diseasementioning

confidence: 99%

Psychosomatic Medicine: Emerging Trends and Perspectives

Sonino

2000

129

Developments have occurred in all aspects of psychosomatic medicine. Among factors affecting individual vulnerability to all types of disease, the following have been highlighted by recent research: recent and early life events, chronic stress and allostatic load, personality, psychological well-being, health attitudes and behavior. As to the interaction between psychological and biological factors in the course and outcome of disease, the presence of psychiatric (DSM-IV) as well as subclinical (Diagnostic Criteria for Psychosomatic Research) symptoms, illness behavior and the impact on quality of life all need to be assessed. The prevention, treatment and rehabilitation of physical illness include the consideration for psychosomatic prevention, the treatment of psychiatric morbidity and abnormal illness behavior and the use of psychotropic drugs in the medically ill. In the past 60 years, psychosomatic medicine has addressed some fundamental questions, contributing to the growth of other related disciplines, such as psychoneuroendocrinology, psychoimmunology, consultation-liaison psychiatry, behavioral medicine, health psychology and quality of life research. Psychosomatic medicine may also provide a comprehensive frame of reference for several current issues of clinical medicine (the phenomenon of somatization, the increasing occurrence of mysterious symptoms, the demand for well-being and quality of life), including its new dialogue with mind-body and alternative medicine.

“…Lipowski [43] remarks that once the symptoms of a somatic disease are perceived by a person, ‘then this disease related information gives rise to psychological responses which influence the patient’s experience and behavior as well as the course, therapeutic response and outcome of a given illness episode’ (p. 483). The study of illness behavior has important implications in clinical endocrinology [6].…”

Section: Rehabilitation In Endocrinologymentioning

confidence: 99%

Rehabilitation in Endocrine Patients: A Novel Psychosomatic Approach

Sonino¹,

2007

Long-standing endocrine disorders may imply a degree of irreversibility of the pathological process and induce highly individualized affective responses. The psychosocial impairment that is associated with incomplete remission from endocrine illness suggests the need for an innovative approach to treatment, introducing in clinical endocrinology the concept of rehabilitation, which in other fields of medicine is already established. This new proposal stems from a number of unresolved issues related to the high prevalence of psychosocial impairment in patients adequately treated for various endocrine conditions. Indeed, rehabilitation in endocrinology may be indicated in the following cases: (a) delayed recovery after appropriate treatment; (b) discrepancy between endocrine status and current functioning; (c) presence of a decline in physical and social functioning; (d) persistence of important comorbidity, with special reference to psychiatric disturbances; (e) assessment of abnormal illness behavior; (f) problems with lifestyle and risk behavior, and (g) potential role of stress in endocrine disturbances. The endocrine rehabilitation team should ideally include a trained clinical endocrinologist, a physical therapist and a psychologist, with opportunities for other specialist consultations. The goal of such service would be to ensure education, support and specific interventions, helping the patient and his/her family to achieve optimal coping with the difficulties of the recovery process. Due to its comprehensive psychosomatic characterization, this new approach would likely increase the chances of obtaining full recovery in a significant proportion of patients and has the potential of being cost-effective.