Advances in Psychosomatic Medicine最新文献

Consultation-liaison (C-L) psychiatry has an important role in the identification and management of psychological problems in patients with medical disorders in general hospitals. The diagnostic tools C-L psychiatrists are usually provided with may reveal to be limited because of particular psychosomatic syndromes and subthreshold psychopathology that are undetected by psychiatric diagnostic criteria. The Diagnostic Criteria for Psychosomatic Research (DCPR) were developed with the aim of providing clinicians with operational criteria for psychosomatic syndromes to overcome the limitations shown by the most often diagnosed disorders in medical settings as adjustment, somatoform, mood, and anxiety disorders. In a group of 66 consecutive C-L psychiatry inpatients, a consistent prevalence of 71% DCPR syndromes was found, particularly secondary functional somatic symptoms, persistent somatization, health anxiety, and demoralization. Their overlap rates with DSM-IV diagnoses showed that the DCPR syndromes were able to identify psychological dimensions (as somatic symptom clustering, anxiety triggered by the current health status, and a feeling state of hopelessness) that do not meet or are not detected by DSM-IV. Furthermore, the DCPR syndromes identified patients with clinically significant functional impairment. These results replicate previous findings in C-L psychiatry using the DCPR categories and pave the way for further research to clarify their mediating role in the course and the outcome variance of medical and psychological problems of hospital inpatients referred for psychiatric consultation.

There are substantial data supporting a strong relationship between cardiovascular diseases and psychological conditions. However, the criteria for scientific validation of the entities currently subsumed under the DSM-IV category of 'Psychological factors affecting a medical condition' have never been clearly enumerated and the terms 'psychological symptoms' and 'personality traits' that do not satisfy traditional psychiatric criteria are not well defined; moreover, it is difficult to measure these subtypes of distress and there is always the need for a clinical judgment. In recent years psychosomatic research has focused increasing attention on these clinical and methodological issues. Psychosocial variables that were derived from psychosomatic research were then translated into operational tools, such as Diagnostic Criteria for Psychosomatic Research; among these, demoralization, irritable mood, type A behavior are frequently detected in cardiac patients. The joint use of DSM-IV criteria and Diagnostic Criteria for Psychosomatic Research allow then to identify psychological factors that seem to affect cardiologic condition. There remains the need to further investigate if treating both clinical and subsyndromal psychological conditions can improve quality of life and reduce the risk of morbidity and mortality in these patients.

Eating disorders (EDs) are representative of the relationship between psychosomatic and psychiatric disorders and have complex interactions in the body, mind, and brain. The psychosomatic issues of EDs emerge in the alterations of the body and its functioning, in personality traits, in the difficulty of recognizing and coping with emotions, and in the management of anger and impulsiveness. The Diagnostic Criteria for Psychosomatic Research used by the authors of this chapter (alexithymia, type A behavior, irritable mood, demoralization) represent an innovative instrument with therapeutic implications. When alexithymia is diagnosed, greater efforts will be made to increase the patients' awareness of the emotions underlying disordered eating behaviors. Moreover, in a comprehensive intervention, the diagnosis of demoralization and irritable mood increases the therapist's understanding of the patients' cognitive and relational patterns and suggests the use of an antidepressant. Alexithymia and type A behavior describe more stable traits in relation with the patients' personality. From this viewpoint, psychotherapy may be focused on the identification and expression of feelings, giving particular attention to anger, which is often unrecognized, excessively controlled, and self destructive in patients with EDs. Lastly, the correlation between personality traits assessed with the Temperament and Character Inventory and the Diagnostic Criteria for Psychosomatic Research suggests that the strengthening of character through psychodynamic psychotherapy might be useful also for the psychosomatic cores of the disorder.

The Diagnostic Criteria for Psychosomatic Research (DCPR) are a diagnostic and conceptual framework that was proposed a decade ago by an international group of investigators. The DCPR's rationale was to translate psychosocial variables that derived from psychosomatic research into operational tools whereby individual patients could be identified. A set of 12 syndromes was developed: health anxiety, thanatophobia, disease phobia, illness denial, persistent somatization, conversion symptoms, functional somatic symptoms secondary to a psychiatric disorder, anniversary reaction, demoralization, irritable mood, type A behavior, and alexithymia. These criteria were meant to be used in a multiaxial approach. The aim of this work is to survey the research evidence which has accumulated on the DCPR, to provide specification for their development and validation and to examine the specific DCPR clusters. Their implications for classification purposes (DSM-V) are also discussed.