Paleev N R, Krasnov V N
Klin Med (Mosk). 2009;87(12):4-7.
Progress in many clinical disciplines and neurobiology for the last decades give reason to reconsider some fundamental provisions of psychosomatic medicine and its relationships with somatopsychiatry. The universally accepted biopsychosocial model of the disease as proposed by V.N.Bekhterev implies involvement of psychological and psychosocial factors at early stages of many forms of somatic pathology. Intricate interplay between somatic and psychic components is exemplified by correlation of cardiovascular disorders and depression. Depression is diagnosed in 17-27% of the patients with coronary heart disease undergoing coronary angiography and in 16-45% of the post-infarction cases. Frequency of depression/hypertensive disease comorbidity is estimated at 30%. Similarity of pathogenetic mechanisms of cardiovascular diseases and depressive states is due to stress as their common provoking factor. Another important aspect of the relationship between medicine and psychiatry (disregarded until recently) is high frequency of somatic disorders in psychiatric patients. Cooperation of psychiatrists and representatives of different medical disciplines in such areas as research and practical health care is needed to address this problem.
在过去几十年里,许多临床学科和神经生物学的进展促使人们重新审视心身医学的一些基本观点及其与躯体精神病学的关系。由V.N.别赫捷列夫提出的被普遍接受的疾病生物心理社会模型表明,心理和社会心理因素在许多形式的躯体病理学早期阶段就会涉及。躯体和心理成分之间复杂的相互作用以心血管疾病与抑郁症的相关性为例。在接受冠状动脉造影的冠心病患者中,抑郁症的诊断率为17%至27%,在心肌梗死后病例中为16%至45%。抑郁症/高血压疾病合并症的发生率估计为30%。心血管疾病和抑郁状态发病机制的相似性是由于压力作为它们共同的诱发因素。医学与精神病学之间关系的另一个重要方面(直到最近才被忽视)是精神病患者中躯体疾病的高发生率。需要精神科医生与不同医学学科的代表在研究和实际医疗保健等领域进行合作来解决这个问题。