Impressions of a common psychiatric entity.
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Surgical psycho-ophthalmology is the integration of ophthalmic surgery and medicine with basics in psychiatry and psychology, lest the psyche be forgotten amid the spectacular leaps in techniques and technology, or our judgment be veiled by our related psychodynamics [1]. Its scope encompasses a much broader spectrum than the conventional psychosomatic eye diseases. Besides due consideration of the psychological and physical conditions of patients, it increases the awareness of the surgeons' psychodynamics that reflect on our continuing judgment before, during, and after surgery. Further, surgical psycho-ophthalmology impacts on the indications, timing, planning, and performance of each individual operation and/or reoperation. It equally emphasizes both the psychologic priming of patients and attuning of the surgical team. In establishing and maintaining rapport with the patient, surgical psycho-ophthalmology helps to curb the growing problems of malpractice, iatrogenicity, and noncompliance. It also stresses careful weighing of the risk/benefit ratio in adherence to the surgical axiom: "primum non nocere". Despite all advances and ingenuity in contracted socket surgery, the challenge still remains. However, with the proper evaluation and management in the perspective of psycho-ophthalmology we may achieve success, not only in esthetics, but also in sight preservation, and even in life salvage.
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One hundred and four patients with a uterine myoma and 138 women without genital disease have been examined using clinical, psychological and electrophysiological methods. A psychoemotional tension syndrome was identified in 80.8%. It is suggested that uterine myoma should be classified as a disease of psychosomatic genesis.
Intestinal dysfunction resulting from psychological factors associated with vegetative disorders were found in 79% of relevant patients. It is stated that comprehensive program of screening persons suffering from psychosomatic intestinal diseases should involve diagnosis of psychopathologic syndromes, analysis of personal traits, factors of psychic trauma, internal pattern of the disease. The treatment technique affecting all the levels of the disease (central, vegetative and somatic) provides good therapeutic effect and normal psychological profile in the majority of patients.
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Recent studies indicate the relevance of psychological factors in the pathogenesis of primary fibromyalgia, although the results sometimes differ. Most of the studies investigated personality features and depression. Beyond these our study investigates defense mechanisms and illness behavior in primary fibromyalgia comparing them with those of psychogenic pain patients and with controls. All patients (fibromyalgia n = 47, psychogenic pain n = 63, controls n = 84) completed German adaptations of the Defense Mechanisms Inventory (DMI) and the Illness Behavior Questionnaire (IBQ) and the "Questionnaire of Psychosomatic Disease-Patterns" (FAPK). The two chronic pain groups show a high conformity: Reduced relation to reality, emotional vacancy in relationships, aggression restraint are the predominant personality features. Immature defense mechanisms and abnormal illness behavior are predominant. Somatic pain and its hypochondrical pursuit substitute the tackling of seemingly unsolvable life problems. Conclusions for the management of fibromyalgia patients are outlined.