Malt Ulrik Fredrik, Malt Eva Albertsen, Blomhoff Svein, Refnin Inge
Psykosomatisk avdeling Rikshospitalet 0027 Oslo.
Tidsskr Nor Laegeforen. 2002 May 30;122(14):1379-84.
Functional somatic illness is a clinical concept used to define medically unexplained somatic symptoms considered to express psychological distress. Functional somatic illness may express underlying psychiatric disorders (e.g. fibromyalgia due to non-fearful panic disorder, irritable bowel syndrome due to bipolar disorder). Sustained physiological activation caused by stressful life events combined with catastrophic thinking may be another cause. Functional somatic illness may also be caused by classic conditioning of physiological responses that may have been triggered by biological or emotional stimuli. Operant conditioning may also be a cause. The therapeutic alliance relies on acceptance of the reality of the subjective complaints, without a priori acceptance of the patient's attribution of the cause of the symptoms. We recommend initial exploration of the patient's own ideas about aetiology, including appropriate medical tests. The physician should then change the agenda to a biopsychosocial perspective and identify current stressors and psychosocial variables that reinforce symptoms. Only a few randomised trials have been performed. They suggest that psychological treatment should be systematic and structured, with a focus on information, alternative ways of perception, and problem solving. Active forms of physiotherapy and psychopharmacological drugs may be of some benefit in selected patients.
功能性躯体疾病是一个临床概念，用于定义那些被认为表达心理困扰但医学上无法解释的躯体症状。功能性躯体疾病可能表现为潜在的精神障碍（例如，由非恐惧性惊恐障碍引起的纤维肌痛，由双相情感障碍引起的肠易激综合征）。应激性生活事件与灾难性思维相结合导致的持续生理激活可能是另一个原因。功能性躯体疾病也可能由生理反应的经典条件作用引起，这种条件作用可能由生物或情感刺激触发。操作性条件作用也可能是一个原因。治疗联盟依赖于接受主观诉求的现实，而不是先验地接受患者对症状原因的归因。我们建议首先探索患者自己关于病因的想法，包括进行适当的医学检查。然后，医生应将议程转向生物心理社会视角，识别当前强化症状的应激源和心理社会变量。仅进行了少数随机试验。这些试验表明，心理治疗应该是系统且结构化的，重点在于信息、不同的认知方式和问题解决。在某些特定患者中，积极形式的物理治疗和精神药物可能会有一些益处。
