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Psychosomatic correlations in psychiatry/Corelatii psihosomatice in psihiatrie.

The meaningful of the process of somatisation cannot reflect a simple relationship between a somatic disease and some psychiatric manifestations because this relation is more complex and it is necessary to discover the mechanism, the nature and the value of the somatic disturbance in the general functioning of the subject and which are the observable consequences and therapeutic involvement.

Even from the beginning of the medicine, there were two different theories regarding the concepts about diseases and their mechanisms. One of these concepts was described by Hippocrates and the School of Cos, which considered that a patient or a person with a disease must be seen like a whole along with his temperament and history. The disease is determined by a global reaction of a person, meaning body and spirit, an answer to all exterior or interior stimuli. Thus, the therapeutic intervention will recreate a harmony of the man with the own person and the ambient. This concept represents the beginning of the modern concept of psychosomatic.

The other concept is developed by Galen, which is focused on the notion of malady, caused by a clinico-anatomic lesion. This concept was used by Pasteur in the 20th century, when he launched the term of pathogenic agent and presented a specific aetiology for some diseases.

But, in any disease, even those with a unique aetiology, for example, an orthopaedic one, the stress can be involved, regarding the moment which determined the onset of a disease or the evolution and the prognostic of it.

In this context, the term of stress is represented by a moment when the whole organism suffered, the psychic and also each organ of the body, especially those like endocrine system, immunity, cardiovascular and respiratory systems or digestive system. There are some pathologies in which psychic stress has an important role among all the other etiological factors, like endocrine diseases, especially Basedow disease, infectious disease like tuberculosis or hepatitis, metabolic disease like diabetes mellitus, obesity, anorexia or neoplasia. Also, there are other diseases which had not a very clear relationship with psychosomatic like diseases with a specific anatomic and biologic lesion, functional diseases, somatic consequences of some disorders of the behavior or instincts, somatic diseases comorbid with an affective disorder. In psychiatry, modern nosology includes, for example, in the diagnostic of somatoform disorder, a lot of types of symptoms like pseudo-neurological diseases or chronic functional polymorphic diseases.

Thus, in 1967, Thomas Holmes and Richard Rahe tried to summarise all the stressful events with an impact in life of the individual and had involved an effort of adaptation. They realized a type of psychometric evaluation called Social Readjustment Rating Scale, with a list of 43 events of life, which are not necessary unpleasant, but determine changes in routine life. But, all of these kinds of tests were criticized, because they were too rigorous and did not take into account the period from the beginning of the life event and the onset of the illness. Also, it is not a correlation between the nature, the intensity of the life event and the nature of the illness, because it is important to consider also the coping mechanism of each individual.

All the individuals develop some coping mechanisms to life events, because it is necessary to adapt to stress, by cognitive or behavioral strategies. Also, there are some external resources represented by the familial, social or professional support or by the entire relational network. When this external system is dysfunctional, this can determine some somatic diseases.

To reflect all of these theoretical concepts in clinical practice, it is important to take into account the interaction of each individual with the medium and with the elements of his interior conflict; his internal and external resources; affective psychotrauma and stressful factors in a situational approach and also structural and functional elements from a dispositional approach. Also, we focus on the type of psychosocial factors, which determined a good physical health or can influence the onset or the evolution of a somatic disease.

C. G. Jung stated that "the body and the soul are not distinct principles, but represent the one and the same life". Therefore, we can conclude that it rarely occurs that a physical disease is not accompanied by a psychological complication and conversely, a physical suffering is often determined by a psychic one.

Correspondence:

ALEXANDRA BOLOS

"Socola" Clinical Psychiatric Hospital

No. 36 Sos. Bucium, code 700282, Iasi, Romania

Phone/Fax: +40 232 430 920

E-mail: alex_andra_bolos@yahoo.com

In cadrul procesului de "somatizare", nu putem vorbi numai despre o simpla relatie dintre o perturbare somatica si manifestarile sale psihice fara a preciza despre ce tip de somatizare este vorba, care este mecanismul de producere, impactul perturbarii somatice asupra functionalitatii generale a subiectului, care sunt consecintele observabile si implicatiile terapeutice.

Inca de la inceputurile istoriei medicinii, se afirma doua curente diferite, referitoare la conceptia despre boala. Primul curent este ilustrat prin Hipocrate si Scoala de la Cos, ce promoveaza o medicina care are in centrul sau omul bolnav in totalitatea sa, tinandu-se cont si de structura temperamentala a acestuia, precum si de antecedentele sale. Boala este considerata ca o reactie globala a individului, incluzand atat corpul, cat si spiritul, ca un raspuns la stimuli externi sau interni. In acest caz, interventia terapeutica urmareste sa restabileasca armonia pierduta, pe care o realizeaza omul cu sine si cu ambientul. Aceasta conceptie prefigureaza ceea ce avea sa devina conceptul psihosomatic modern.

Cel de al doilea concept isi are originea tot in antichitate, fiind sustinut de Galen. Conceptul acestuia se baza pe notiunea de maladie, careia i se conferea o existenta autonoma. Originea maladiei era autentificata de o leziune anatomoclinica. Aceasta teorie o regasim la inceputul secolului al XX-lea, cand Pasteur lansa termenul de agent patogen, fiind capabil sa prezinte o etiologie specifica unei anumite maladii. Desigur ca, in orice boala, chiar cu etiologie unica, de exemplu, in afectiunile ortopedice, exista implicatii, mai mult sau mai putin evidente, ale stresului psihic, atat din punct de vedere al circumstantelor de producere, cat si, mai ales, al evolutiei bolii, a carei vindecare poate fi intarziata de stresuri psihice ulterioare.

In acest context, stresul psihic reprezinta un moment de solicitare a intregului organism, chiar daca agresiunea agentului stresor se exercita, initial, asupra psihicului, deoarece acesta influenteaza activitatea intregului organism. Orice stres psihic va avea insa consecinte nu numai asupra psihicului individului respectiv, ci va fi resimtit de fiecare organ in parte, in special de glandele endocrine, sistemul imunitar, aparatul cardio-vascular, aparatul respirator, precum si de organele cu o bogata inervatie, cum sunt cele ale aparatului digestiv. Exista o serie de afectiuni somatice in care stresul psihic are o participare etiologica "prioritara", adica, in raport cu alti agenti etiologici, ocupa un rol dominant, si anume, bolile endocrine, in primul rand, boala Basedow, unele boli infectioase cu o componenta psihogena importanta, cum ar fi tuberculoza, hepatita, unele boli metabolice de tipul diabetului zaharat sau al obezitatii, anumite cazuri de neoplasm. Clasificarile nosografice contemporane din psihiatrie includ, sub numele de tulburari somatoforme, un intreg cortegiu simptomatologic, inclusiv tulburari pseudo-neurologice si tulburari functionale multiforme si cronice, legate de existenta unor conflicte subadiacente, dar fara o "punere in scena" precisa.

Astfel, in 1967, Thomas Holmes si Richard Rahe au incercat pentru prima data sa structureze evenimentele de viata cu impact in viata unui individ, fiind initiatorii unei liste de 43 de evenimente considerate ca fiind potential perturbante si care implica, din partea subiectului, un efort de adaptare. Ei au creat scala Social Readjustement Rating Scale. Ulterior, tot in acest sens, au fost elaborate si alte scale care incearca sa marcheze intr-un mod cat mai obiectiv perceptia subiectiva a evenimentelor ostile din viata fiecaruia. Discutiile si criticile care au existat ulterior, referitoare la rigoarea acestui tip de teste, s-au referit la aspectele legate de perioada de timp care a trecut de la producerea evenimentului trait si aparitia unor manifestari fizice sau psihice.

Oamenii dezvolta mecanisme de coping la diferite evenimente de viata, se adapteaza stresului printr-o serie de strategii cognitive si comportamentale. De asemenea, exista si o serie de resurse externe individului, reprezentate de suportul familial, social sau profesional si, astfel, atunci cand acest sistem extern de suport este disfunctional, poate determina anumite afectiuni somatice.

In cadrul concptului psihosomatic modern, apare o terminologie aparte care incearca sa nuanteze reflectarea teoriei in practica clinica. Astfel, trebuie sa luam in considerare interactiunea individului cu mediul sau, cu problemele sale de conflict intern, resursele sale interne sau externe, psihotraumele afective si factorii de stres intr-o abordare situationala, precum si elementele stabile structurale si modalitatile de functionare psihica in perspectiva dispozitionala. De asemenea, se evidentiaza si cunoasterea naturii tipului de factori psihosociali ce contribuie la mentinerea individului intr-o buna sanatate fizica sau, dimpotriva, intervin in declansarea si evolutia unei maladii somatice.

G. C. Jung afirma ca sufletul si corpul nu reprezinta principii distincte, ci sunt aspecte diferite ale intregii vieti a individului. Prin urmare, am putea concluziona faptul ca rar se intampla ca o afectiune fizica sa nu fie acompaniata si de manifestari psihice, iar pe de alta parte, o suferinta fizica sa nu fie determinata si de un stresor psihic.

Alexandra Bolos--M. D., Ph. D., Assistant Professor, "Gr. T. Popa" University of Medicine and Pharmacy, Iasi, Department of Psychiatry; Senior Psychiatrist, "Socola" Clinical Psychiatric Hospital, Iasi, Romania

Alexandra Bolos--M. D., Ph. D., Asistent universitar, Catedra de Psihiatrie, Universitatea de Medicina si Farmacie "Gr. T. Popa", Iasi; Medic Primar Psihiatru, Spitalul Clinic de Psihiatrie "Socola" Iasi, Romania

Corespondenta:

ALEXANDRA BOLOS

Spitalul Clinic de Psihiatrie "Socola"

Sos. Bucium nr. 36, cod 700282, Iasi, Romania

Tel./Fax: +40 232 430 920

E-mail: alex_andra_bolos@yahoo.com
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Author:Bolos, Alexandra
Publication:Bulletin of Integrative Psychiatry
Article Type:Editorial
Date:Mar 1, 2014
Words:1606
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