[A clinical study of psychosomatic cutaneous diseases].
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An interrelationship between neurotic and psychosomatic pathologies was analysed. Experimental modelling of psychosomatic diseases suggested a combined action of the neurotization and destabilizing of regulatory mechanisms of a corresponding visceral system. In contrast to a neurosis with hypertensive syndrome, an obvious suppression of the vascular system's self-regulatory mechanism was revealed in subjects with initial stages of hypertensive disease (PAH and HD-1). The data obtained suggested a hypothesis of different mechanisms for formation of a neurosis and hypertensive disease.
An outpatient clinic therapeutically situated between hospital and office of the general practitioner is to a particular extent suitable for research, teaching, diagnosis and treatment of psychosomatic diseases. The increasing importance of psychosomatic medicine, which is firmly rooted as a compulsory subject in the licensing regulations and as an insurance benefit as part of causal psychoanalytical psychotherapy, has also become better known to wide circles of the population. Our investigations emphasize the activities and problems of the psychosomatic advisory department of the Medical University Hospital in Munich.
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The assumption that specific factors of personality or unconscious conflict are causative factors in psychosomatic diseases was a guiding concept in psychosomatic medicine for a long time. An early paper of F. Alexander written in 1934 and a series of papers on the problem of specificity published in 1958 serve as examples to bring this important issue back to memory. The original problem seems to have been solved by exchanging specificity models by models of interaction of multiple factors and of multifactorial constellations. It is argued that the debate on specificity in psychosomatic medicine has implicitly been a debate on the scientific status of the psychoanalytic approach in psychosomatic medicine, and that these methodological issues are still vital to psychosomatic medicine.
The paper presents the contemporary conceptions of stress. Psychosomatic diseases have the composite etiology being made up of biologic and psychosocial factors, for instance stress. The contemporary medicine does not fully appreciate the important role of the psychosocial factors in the etiology of diseases. More and more physicians understand, the traditional, biologic model of the treatment of disorders as myocardial infarction, morbus uicerosus or tumoursis uneffective.
Based on the author's own work and a review of the literature, the hypothesis is made that potentially lethal disease does not usually occur in healthy animals or people but does so when covert or overt disease exists or when a predisposition for disease exists. The author supports this hypothesis in his assessment of the human literature on sudden death. Further support for the hypothesis is presented from 2 animal models being studied in his laboratory--stress-induced heart failure in the cardiomyopathic hamster and stress-induced sensitization of digitalis-toxic ventricular arrhythmias. This analysis suggests a different view from the classical one of what a psychosomatic disease might be.
In this paper, major trends in the recent applications of Clinical Psychophysiology are summarized. These clinical applications pertain to neurosurgical interventions, and to neurological, psychiatric, pediatric, and ophthalmological diseases. Other applications of Clinical Psychophysiology include psychosomatic diseases such as cardiovascular, gastrointestinal, respiratory and sleep-related disorders. The International Organization of Psychophysiology based on its Constitution and By-Laws (IOP, 1981, 1982) is promoting high scientific standards in the applications of Clinical Psychophysiology to various medical conditions.
Although, strictly speaking, they are not psychosomatic diseases, psychologic reactions to illness are both very common and often closely related to the psychopathological setting in which genuine somatizations occur. Thus, after a review of the possible meanings of the disease and its occurrence in the patient's life history and experience, the problem of reciprocal causal relationships between moral and psychologic distress, mental distress and objectivation of a disease is considered. From this discussion an opening towards slightly different theorizations on the psyche and soma, such as those which oriental medicines have always transmitted, is proposed.
A questionnaire submitted in 1986 to ward physicians in internal medicine in 9 out of 11 public hospitals (eight General Hospitals and the University Hospital) in the city of Hamburg documents their remarkable awareness of psychosocial problems. Noticeable, however, is the comparably low assessment of the prevalence of psychosomatic diseases. The desire for assistance through a psychosomatic consultation service is much greater than actual rates of request. The status of psychosomatic care is judged to be very unsatisfactory. The collected data and the broad agreement to integrate psychosomatic forms of organization into the care of medical in-patients lead to the conclusion that there is an encouragingly great readiness to co-operate. Considering the very different experiences found in already existing models, the results indicate the necessity of a more in-depth examination of the process of co-operation between somatics and psychosomatics.
Ulcerative colitis and Crohn's disease are chronic inflammatory bowel disorders of unknown etiology and unpredictable course, usually causing diarrhea and/or abdominal pain and sometimes associated with fever, weight loss, or extraintestinal manifestations. Psychological factors may relate to the onset and course of disease and certainly have important implications for the treatment of these chronic diarrheal illnesses. We review the literature on psychosomatic aspects of inflammatory bowel disease and discuss current thinking regarding presentation and management.
Psychoanalytic-psychosomatic hypotheses assume, among other things, that patients with psychosomatic diseases tend to represent conflict-laden object relationship experiences symbolically in the diseased organ of the body. This assertion was tested on 139 patients having inflammatory and irritable bowel diseases with the help of the repertory grid technique. Univariate analysis showed that this hypothesis not only applies to the primary object, but is also valid for the partner relationship. Neither gender nor illness behaviour affect the connections observed here. Although patients with irritable bowel diseases as well as those suffering from Crohn's disease or colitis ulcerosa, have differing pathogeneses, there is a comparable tendency in all three diagnostic groups to represent object relationships leaded with conflict symbolically in the diseased organ of the body. The finding that the physical and psychological condition of the moment in the sense of a reactive component like-wise has to intervening influence, leads to the supposition that, in accordance with theoretical assumptions, this is a general factor.
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Atopic diseases show many attributes and risk factors of psychosomatic diseases. The skin, on of our most essential organ of senses, is of considerable importance in the "dermatogenic state" of psychological and social development, as well as breathing. Children with atopic dermatitis and asthma bronchiale are very sensible and irritable. They divert their sick identity to the skin or to the lungs. Psychotherapy is therefore for many cases of atopic children and essential part of treatment, especially as a systemic therapy.