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[Stress and the digestive system].

Functional disorders mainly occur in young, anxious hyperactive, sometimes obsessional patients and involve all parts of digestive tract: feeling of obstruction the upper oesophagus or dysphagia; aerophagia related to a slow gastric emptying or gastric fullness relieved by eructation; biliary vomiting and pain in right abdominal upper quadrant which might correspond to a form of migraine without headache; irritable bowel, characterized by abdominal discomfort and constipation. Obviously, the diagnosis of functional disorders required elimination of an organic disease by appropriate endoscopic investigations. Psychosomatic disorders mainly comprise gastroduodenal ulcers and inflammatory bowel diseases. Although psychologic profiles have been associated with gastro-duodenal ulcer, these are not necessary for the development of the disease. The role of emotional factors has decreased since very efficient anti-secretory drugs are available. Inflammatory bowel diseases, in particular ulcerative colitis is frequently associated to behaviour disorders. The patient is usually a young woman brought up by an overprotective family. It is generally recognized that attacks of ulcerative colitis may be triggered by emotional factors. Thus, Stress may interact with digestive tract. In some cases, as in patients with irritable bowel or distal ulcerative colitis, psychotherapy such as Schultz's Autogenous Training, improves the patient's condition.

Arousal↗

Psychosomatic aspects of changes in body weight during a long sea voyage.

The author, on the basis of his investigations, have shown the relationship between body weight changes and mental disease morbidity and other mechanism of adaptation to conditions of a long sea voyage. In author's opinion changes in body weight are an important adaptational mechanisms in conditions of long sea voyage. This mechanism is based on feedbacks in which dominated psychic mechanisms in the form of changes in personality dimensions. If the free regulation of the body homeostasis is disturbed and cannot be corrected by the body weight changes and personality dimensions then a further escalation of disturbances in homeostasis will lead to psychic or psychosomatic diseases.

Anxiety↗

[Psychosomatic disorders in the area of environmental medicine. Environmental medicine--environmental psychology].

In environmental medicine, we frequently see patients who have a very firm, sometimes fixated view of the nature of their disease, and they do not except the correction by the physician but only confirmation. Therefore, we face the task to undertake these patients a careful medical and psychological differential diagnosis. In a major number of cases, the symptoms are caused not by supported environmental effects but by an unknown diagnosis, and recognition and treatment would be impossible in case of an uncritical adoption of the patient's illness theory. Further, psychosomatic syndromes, which are well accessible by treatment procedures of psychosomatic medicine, can be diagnosed in many of those patients. This article demonstrates the different kinds of psychosomatic diseases in the area of environmental medicine and its appropriate therapeutic consequences.

Adult↗

Effects of some factors on the indication for surgical treatment of gastroduodenal ulcer disease.

The author of the present communication collected a variety of important information on 2,173 patients living permanently in Prague 4. In all of them the diagnosis of gastroduodenal ulcer disease was established between 1979 and 1988 incl. The results obtained by the currently applied therapy were not designated as satisfactory both by the patient and by his doctor. The predomination of conservative therapy was due to the introduction of new drugs which reduce markedly gastric secretion of HCl. On the basis of strict indications elective surgery was advised in some patients. In the acute stage of the disease (bleeding, perforation, stenosis) clearly defined criteria allowed to establish the indication for elective surgery. The answer to this question provides the author in the form of a scheme of the regimen which should be observed after a definite diagnosis. It was devised on the basis of the results of the present study, of reports in the Czech and international literature, as well as of our own experience. For the indication of surgical treatment is of great importance a high degree of responsibility of the doctor. This is reflected by the correct choice of the optimum surgical procedure. Good results obtained in the management of ulcer disease were due to the fact that attention was paid to the often neglected aspect of the psychosomatic character of this disease.

Czech Republic↗

[Acne vulgaris: morphologic, endocrinologic and psychosomatic aspects].

25 male patients suffering from acne vulgaris were examined by means of endocrinological, morphological, and 5 psychometric procedures in order to check the correlations and interactions between the psychological and dermatological aspects of the disease. In comparison with a control group, the acne patients did not show any striking endocrinological abnormalities; we found no correlation between the extensiveness of the lesions and the level of DHEA sulphate. All the psychological tests yielded results deviating from those achieved by the representative controls, but they were comparable with those of other patients suffering from psychosomatic diseases. The individual feeling of being "disfigured" found its expression in self-consciousness, lack of trust in his/her own body, as well as the clinically relevant difference between his/her conception of self and the ideal of self. During times of enhanced psychosocial strains subjectively assumed by the patients, the lesions increased and the patients were disturbed in social interaction and communication. Surprisingly, we did not find any correlation between the clinical status and significant psychometric findings. Our results show that in acne vulgaris, the individual experience of wanting physical attractiveness, associated with a predominantly neurotic depressive personal structure, may play a central part in a disturbed process of interaction with the environment and suggest the influence of psychic factors in the pathogenesis of acne vulgaris.

Acne Vulgaris↗

The psychosomatic key as a core approach to the modern plagues of mankind.

The severest plagues of manking today, from myocardial infarction to cancer, are rising exponentially the world over. For the mechanistic medical science they are mostly 'mystery diseases', as well as a mystery is their uncontrolled exponential trend. Statistics reveal that they rise higher, the more a community is developed. But why? The too easy excuse of a higher 'concrete' pollution seems unreliable, where significant difference rates are recorded by different human groups in the same environment, but exposed to different values of 'psychosomatic involvement', or delta psi. The latter symbol, meaning 'the variation of psi tone induced by a stimulus-event', belongs to a highly predictive system of quantitative psychosomatics, which enables--through a logico-mathematical tool--the ascertaining of personal levels of delta psi. Since a chronic exceeding of its tolerance threshold seems to give rise to the whole set of psychosomatic diseases, cancer perhaps included, it is suggested that the said system may help in diagnostically clearing the matter, perhaps also in controlling it.

Cardiovascular Diseases↗

[Psychosomatic aspect of a choking lump sensation in the throat].

In order to elucidate the relationship between a choking lump sensation in the throat and psychosomatic status, the authors subjected 339 in-patients above 17 years of age with various kinds of otorhinolaryngologic diseases and evaluated their psychosomatic conditions by means of two questionnaires: Cornell Medical Index Questionnaire (CMI) and Maudsley Personality Inventory (MPI). According to the answer to one of the CMI questions "Do you often feel a choking lump in your throat?", the patients were divided into two groups: "Yes" group and "No" one. "Yes" group comprised 51 males (56.1 +/- 15.6 years old of mean +/- SD age) and 34 females (57.9 +/- 13.9 years old) and "No" group 170 males (57.7 +/- 14.3 years old) and 84 females (47.8 +/- 15.8 years old). The data were analysed for comparison between the two groups and the following results were obtained. Patients with benign and malignant oral, pharyngeal and laryngeal diseases were included in the "Yes" group with a significantly higher rate when compared to the patients with benign and malignant ear or nasal diseases. Patients in "Yes" group made significantly more complaints and judged to be significantly more neurotic and autonomic nerve dysfunctioning than those in "No" group. Therefore, diseases in the pharyngolaryngeal region more likely produces abnormal sensation in the throat as well as many other symptoms relating to the autonomic nerve function.

Adolescent↗

[Institutional organization of a hospital dermatology service with a responsibility for psychosomatic care].

Clinicians trained in dermatology and having submitted themselves to psychoanalysis have developed an original psychosomatic approach to skin disease at the Tarnier Hospital (Cochin-Port Royal University Hospital Center). Its mainspring is detection and management of the patient's distress. The author analyzes the conditions under which it was possible to carry out this experiment and the implications of this approach which is directed at achieving a change in the way the department is run rather than adding one more specialized appendage to the outpatient care activity.

Dermatology↗

[Patient cooperation as a problem in inpatient psychosomatic rehabilitation].

Patients insured under the pension insurance scheme are subject to a statutory obligation to cooperate in their remedial treatment. In in-patient psychosomatic rehabilitation, a number of problems arise in view of this cooperation, as the patients are hampered in their potential for compliance with this demanded cooperation due to the specific nature of their psychosomatic condition, their personality structure as well as their previous disease history. Moreover, cooperation in psychosomatic rehabilitation involves special requirements in terms of active participation, inner openness and readiness for psychosocial change. In psychosomatic rehabilitation, the patient's cooperation cannot be assumed as a matter of course, rather, it is a task of the treatment process itself, which by appropriate therapeutic means seeks to achieve the patient's motivation and a working alliance, hence to create the prerequisites for cooperation.

Ethics, Medical↗