Yoshimasu Kouichi
Department of Hygiene, School of Medicine, Wakayama Medical University, Kimiidera, Wakayama, Japan.
Curr Drug Abuse Rev. 2012 Dec;5(4):291-303. doi: 10.2174/1874473711205040004.
There are five major patterns which explain the associations between somatic symptoms and substance-related disorders (SRD) in patients without organic disorders. They are withdrawal somatic symptoms, somatic symptoms related to co-morbid mental disorders, those related to co-morbid infectious diseases, functional intractable somatic symptoms (including somatoform disorders), and symptoms associated with intoxication. Those somatic symptoms that occur according to those five patterns might overlap each other, making it difficult for physicians to precisely grasp the associations between somatic symptoms and SRD. This results in a very complicated formation of various kinds of symptoms (syndrome). Furthermore, the clinical and social features of those patterns of associations differ between legal and illicit substances users. It should also be noted that such somatic symptoms associated with SRD may be affected by social factors such as cultural backgrounds or legal restrictions on such substances. Those factors differ according to each country, area, or community whose cultural backgrounds are somewhat specific. In those areas, psychosocial factors such as stigmas, prejudices, or feeling ashamed of one's mental disorder (including SRD) also differ. Thus, it is important to take into account the effects of social or psychosocial backgrounds when evaluating and studying the associations between somatic symptoms and SRD. When clinicians confront patients with somatic symptoms and suspected SRD, they should presume which association pattern is the most significant problem for the patients, based on those psychosocial and biological information obtained from the patients themselves and their surroundings. This procedure might give an opportunity to clinicians for elucidating complicated associations between somatic complaints and SRD.
有五种主要模式可解释无器质性疾病患者的躯体症状与物质相关障碍（SRD）之间的关联。它们分别是戒断躯体症状、与共病精神障碍相关的躯体症状、与共病传染病相关的躯体症状、功能性顽固性躯体症状（包括躯体形式障碍）以及与中毒相关的症状。按照这五种模式出现的那些躯体症状可能相互重叠，这使得医生难以精确把握躯体症状与SRD之间的关联。这导致了各种症状（综合征）的非常复杂的形成。此外，合法和非法物质使用者之间，这些关联模式的临床和社会特征有所不同。还应注意，与SRD相关的此类躯体症状可能会受到社会因素的影响，如文化背景或对此类物质的法律限制。这些因素因每个国家、地区或社区而异，其文化背景具有一定的特殊性。在那些地区，诸如耻辱感、偏见或对自身精神障碍（包括SRD）感到羞耻等社会心理因素也有所不同。因此，在评估和研究躯体症状与SRD之间的关联时考虑社会或社会心理背景的影响很重要。当临床医生面对有躯体症状且疑似SRD的患者时，他们应根据从患者自身及其周围环境获得的那些社会心理和生物学信息来推测哪种关联模式对患者来说是最主要的问题。这一过程可能会给临床医生一个机会来阐明躯体主诉与SRD之间的复杂关联。
