PSYCHOSOMATIC MEDICINE

PSYCHO = MIND
+
SOMA = BODY
• Psychosomatic medicine poses and addresses critical questions about
relationships among mind, body, CNS and neuroendocrine functions
• Relationships between psychiatric illness and somatic organs were
postulated at least as long ago as ancient Greece
• Hippocrates theory ,,hysteria” : a deficit in voluntary muscular or
special sense function that was caused by an unconscious psychologic
conflict
• Hans Selye : General adaptation sy is the sum of all nonspecific
reactions of the body. It affects hypothalamic-pituitary-adrenal axis
thus increasment of “stress hormone” cortisol

• George Engel : All neuroregulatory mechanisms undergo functional

changes that depress body homeostasis and leave body prone to
infections and other damage

• Walter Cannon : Stress activates “fight-flight” response, when both is

unavailable psychosomatic disease occurs
• To make a diagnosis two criteria need to be meet:

1. medical condition is present

2. psychological stimuli is related to the initiation or exacerbation of
disorder

• Differential diagnosis must distinguish primarily physical disease with

psychiatric disorders(AIDS,MS,SLE) and solely psychiatric
disease(schizophrenia) from psychosomatic disease
• Etiology:
• genetics
• early traumatic experience
• stress factors: prolonged stress can lead to a diesase or excerabate its
symptoms

• Mechanisms:
neurotransmitters: increase of catecholamines, norepinephrine,
serotonin and dopamine
endocrine system: CRH from HT -> cortisol release
testosteron usually decrease
immune response: cytokines -> glucocorticoides
• Ranking of life-change stressors:
1. death of spouse
2. divorce
3. death of close family member
4. marital separation
5. serious illness
6. fired from work
7. jail term
8. death of close friend
9. pregnancy
10. business readjustment
• Franc Alexander described 7 basic psychosomatic diseases:
asthma, hypertension, hyperthyreosis, peptic ulcer, ulcerative colitis,
rheumatoid arthritis and neurodermatitis
• Therefore holistic point of view should be used in approaching this
conditions
• In cardiology there are well known type A and type B personality
• Each person has shock organ that is genetically vunerable to stress
• Some persons are cardiac reactors, others gastric reactors and others
skin reactors
• Аngina and coronary spasm could be observed in persons that are
aggressive and easily frustrated
• Arrhythmias are often seen in anxiety states
• Cateholamines are produced in acute stress:
Increase in BP and development of essential HT
• Syncope, hypotension due to vasovagal reflex in acute anxiety attacks
• Headache tension is seen in acute anxiety in corporative workers
• Neurodermatitis: Eczema in pt with multiple psychosocial stressors
(death,conflicts)
• Peptic ulcer disease is triggerd by bacterium or stress.
Seen in pt with similar psychological personality
(dependence/independence problems and high level of anxiety)
• Asthma seen in child is considered overprotected or on the contrary
suppressed cry for love and protection
• Musculoskeletal system: backache, myalgias and osteoarthritis
• Treatment
1. collaborative approach
2. psychotherapy
3. pharmacotherapy