psychosomatic medicine history and current trends

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Psychosomatic medicine History and Current Trends

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Psychosomatic medicine

History and Current Trends

The term psychosomatic is derived from the Greek words psyche (soul) and soma (body). The term

literally refers to how the mind affects the body.

Major Conceptual Trends in the History of

Psychosomatic Medicine

Psychoanalytic

 Sigmund Freud (1900): Somatic involvement occurs in conversion hysteria, which is psychogenic in origin—e.g.,

paralysis of an extremity. Conversion hysteria always has a primary psychic cause and meaning; i.e., it

represents the symbolic substitutive expression of an unconscious conflict. It involves organs innervated only

by the voluntary neuromuscular or the sensorimotor nervous system. Psychic energy that is dammed up is

discharged through physiological outlets.

Sandor Ferenczi (1910): The concept of conversion hysteria is applied to organs

innervated by the autonomic nervous system; e.g., the bleeding of ulcerative

colitis may be described as representing a specific psychic fantasy.

 George Groddeck (1910): Clearly organic diseases, such as fever and hemorrhage,

are held to have primary psychic meanings; i.e., they are interpreted as conversion

symptoms that represent the expression of unconscious fantasies

Psychophysiological

Walter Cannon (1927): Demonstrated the physiological concomitants of some

emotions and the important role of the autonomic nervous system in producing those reactions. The concept is based on

Pavlovian behavioral experimental designs.

   Hans Selye (1945): Under stress a general adaptation syndrome develops. Adrenal

cortical hormones are responsible for the physiological reaction.

Sociocultural

 Karen Horney (1939), James Halliday (1948): Emphasized the influence of the

culture in the development of psychosomatic illness. They thought that

culture influences the mother, who, in turn, affects the child in her relationship with the child—e.g., nursing, child rearing, anxiety

transmission.

Systems theory

Adolph Meyer (1958): Formulated the psychobiological approach to patient assessment

that emphasizes the integrated assessment of developmental, psychological, social,

environmental, and biological aspects of the patient's condition. Basic concept of the

biopsychosocial model is implicit in his approach.

Current TrendsThe practice of psychosomatic medicine has evolved considerably since its early clinical origins and has come to focus on

psychiatric illnesses that occur in the setting of physical health care

In large part this evolution has occurred as a result of the increased complexity of medicine, the increased

understanding of the relationship of medical illness to psychiatric illness, and the greater appreciation of mind

and body as one. A key outcome of this has been the granting of subspecialty status for psychosomatic

medicine.

Importance

The extent of the burden caused by co-occurring mental and physical disorders represents a

tremendous public health problem.

Psychiatric morbidity is very common in patients with medical conditions, with a prevalence

ranging from 20 to 67 percent, depending on the illness.

Psychiatric morbidity has serious effects on medically ill patients and is often a risk factor for

their medical conditions.

In addition, depression and other mental disorders significantly impact quality of life and

the ability of patients to adhere to treatment regimens (e.g., in patients with diabetes

mellitus).

Failure to identify, evaluate, diagnose, treat, or achieve symptom resolution of psychiatric

morbidity in medical care settings results in significantly increased service utilization.

The Clinical Practice of Psychosomatic Medicine

The primary objective for psychosomatic medicine is the diagnosis and treatment of

psychiatric disorders in patients with complex medical conditions.

Summary of Clinical Problems in Psychosomatic Medicine

Psychiatric symptoms secondary to a medical condition: Delirium, dementia Psychiatric symptoms as a reaction to medical condition or treatments: Anxiety related to chemotherapy, depression related to limb amputation Psychiatric complications of medical conditions and treatments: Depression secondary to interferon treatment Medical complications of psychiatric conditions or treatment :Neuroleptic malignant syndrome, acute withdrawal from alcohol or other substance Co-occurring medical and psychiatric conditions: Recurrence of depressive disorder in setting of cancer treatment (conditions occur independently); schizophrenia in a patient with end-stage renal disease. Psychiatric/psychosocial assessment: Capacity evaluation; evaluation prior to organ transplantation

consultation-liaison psychiatrist