Yoshihara Kazufumi
Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashiku, Fukuoka 812-8582 Japan.
Biopsychosoc Med. 2015 Mar 18;9:8. doi: 10.1186/s13030-015-0036-2. eCollection 2015.
Many reports have been published concerning how psychosocial stress influences the occurrence and progression of allergic diseases such as bronchial asthma and atopic dermatitis. As for asthma, a typical allergic disease often accompanied by psychosomatic related problems, the Global Initiative for Asthma (GINA), international medical guidelines for asthma, describes psychosocial problems as causative factors of poor asthma control and as risk factors for asthma exacerbation, even if symptoms are well controlled. However, because there is little high quality evidence for effective treatments for asthma patients with psychosocial problems, concrete assessments and treatments for such problems is scarcely described in GINA. Therefore, psychosomatic intervention for asthma patients is not effectively conducted on a worldwide scale. In contrast, the "Japanese Guidelines for the Diagnosis and Treatment of Psychosomatic Diseases" describe the assessment and treatment of psychosomatic disorders in detail. In the guidelines, psychosocial factors are classified into five categories; 1) Relation between stress and asthma occurrence or progression, 2) Relation between emotion and asthma symptoms, 3) Problems related to a patient's character and behaviors, 4) Problems of daily life and Quality of Life (QOL), and 5) Problems related to family relationships and life history. The employment of a self-administered questionnaire, the "Psychosomatic Questionnaire related to Asthmatic Occurrence and Progression", is useful for clarifying psychosocial factors and for setting up treatment strategies according to the problems identified. The Japanese guidelines have been proven to be useful, but empirical evidence for their effectiveness is still relatively limited. It will be necessary in the future to accumulate high-quality evidence and to revise the psychosomatic approaches in the guidelines that are universally valid.
关于心理社会压力如何影响支气管哮喘和特应性皮炎等过敏性疾病的发生和发展，已经发表了许多报告。至于哮喘，这是一种典型的过敏性疾病，常伴有心身相关问题，国际哮喘治疗指南《全球哮喘防治创议》（GINA）将心理社会问题描述为哮喘控制不佳的致病因素以及哮喘加重的危险因素，即使症状得到很好的控制。然而，由于针对有心理社会问题的哮喘患者的有效治疗几乎没有高质量的证据，GINA中几乎没有描述针对此类问题的具体评估和治疗方法。因此，在全球范围内，对哮喘患者的心身干预并未得到有效实施。相比之下，《日本心身疾病诊断与治疗指南》详细描述了心身障碍的评估和治疗。在该指南中，心理社会因素被分为五类：1）压力与哮喘发生或进展的关系；2）情绪与哮喘症状的关系；3）与患者性格和行为相关的问题；4）日常生活和生活质量（QOL）问题；5）与家庭关系和生活史相关的问题。使用一份自我管理的问卷“与哮喘发生和进展相关的心身问卷”，有助于明确心理社会因素，并根据所发现的问题制定治疗策略。日本指南已被证明是有用的，但关于其有效性的实证证据仍然相对有限。未来有必要积累高质量的证据，并修订指南中普遍适用的心身治疗方法。
