Kapfhammer H P
Klinik für Psychiatrie, Medizinische Universität Graz, Auenbruggerplatz 31, 8036 Graz, Österreich.
Nervenarzt. 2012 Sep;83(9):1128-41. doi: 10.1007/s00115-011-3446-9.
Somatoform disorders and functional body syndromes define a major, diagnostically heterogeneous group of patients with medically unexplained physical symptoms. Psychopharmacological approaches can be derived from the conceptualization of somatoform symptoms and syndromes within a biopsychosocial model. The survey presented focuses on randomized, double-blind and placebo-controlled studies. Antidepressants show a statistically and clinically relevant impact on many somatoform symptoms. In special reference to pain symptoms serotonergic and noradrenergic antidepressants seem to mediate a more favorable effect than selective serotonin reuptake inhibitors. For some functional body syndromes, e.g. irritable bowel syndrome and fibromyalgia, a major analgesic effect of antidepressants can be underlined as well. The empirical data for fibromyalgia, however, seem to be more convincing than for irritable bowel syndrome. Pregabalin holds an empirically well established position in the treatment of fibromyalgia. As yet there is no convincing psychopharmacological strategy for chronic fatigue syndrome. Probably due to the inherent relationships to anxiety, obsessive-compulsive and depressive disorders, both hypochondria and body dysmorphic disorder can be positively treated by serotonergic antidepressants as well.
躯体形式障碍和功能性躯体综合征定义了一组主要的、诊断上异质性的患者，他们有医学上无法解释的躯体症状。心理药理学方法可以从生物心理社会模型中躯体形式症状和综合征的概念化推导出来。所呈现的调查聚焦于随机、双盲和安慰剂对照研究。抗抑郁药对许多躯体形式症状显示出统计学和临床上相关的影响。特别针对疼痛症状，血清素能和去甲肾上腺素能抗抑郁药似乎比选择性5-羟色胺再摄取抑制剂介导更有利的效果。对于一些功能性躯体综合征，如肠易激综合征和纤维肌痛，抗抑郁药的主要镇痛作用也可以得到强调。然而，纤维肌痛的经验数据似乎比肠易激综合征更有说服力。普瑞巴林在纤维肌痛治疗中占据着经验上确立良好的地位。对于慢性疲劳综合征，目前尚无令人信服的心理药理学策略。可能由于与焦虑症、强迫症和抑郁症的内在关系，疑病症和躯体变形障碍也都可以用血清素能抗抑郁药进行有效治疗。
