Lemogne Cédric, Pitron Victor, Rotgé Jean-Yves, Limosin Frédéric, Cathébras Pascal
Université Paris-Descartes, Sorbonne-Paris Cité, Paris, France. AP-HP, Hôpitaux universitaires Paris-Ouest, service de psychiatrie et addictologie de l'adulte et du sujet âgé, Paris, France. Inserm, U1266, Institut de Psychiatrie et Neurosciences de Paris, Paris, France.
AP-HP, service de psychiatrie d'adultes, GH La Pitié- Salpêtrière-Charles- Foix, Paris, France. Institut Jean-Nicod, UMR 8129, ENS/ EHESS/CNRS, IEC, PSL Research University, Paris, France.
Rev Prat. 2019 Feb;69(2):209-213.
The diagnosis of a somatic symptom disorder must be based on both a negative approach - eliminating another psychiatric or non-psychiatric disorder that would better explain the symptoms - and a positive one, which is, based on the search for characteristic thoughts, emotions or behaviours as well as biological or psychological factors that may promote, trigger or sustain the disorder. Additional tests and specialized medical consultations should not be prescribed solely to reassure the patient; they may actually worsen the condition. The management will move away from the outdated notion of "medically unexplained symptoms" to rely on: the acknowledgment of the painful, debilitating and involuntary nature of the symptoms; the proposal of a positive diagnosis acceptable by the patient and an explanatory model compatible with his or her representations, aimed at putting an end to dysfunctional health care utilization; the proposal of therapeutic objectives aimed at functional rather than symptomatic recovery; the negotiation of pharmacological (selective or mixed serotonin reuptake inhibitor if necessary) and non-pharmacological interventions, especially when it comes to limiting the factors that sustain the disorder; the coordination of the various healthcare professionals.
一种是消极方法，即排除另一种能更好解释症状的精神或非精神障碍；另一种是积极方法，即基于寻找可能促进、引发或维持该障碍的特征性思维、情感或行为以及生物学或心理因素。不应仅仅为了让患者安心而进行额外检查和专业医学咨询；实际上，这些检查和咨询可能会使病情恶化。治疗将摒弃“医学无法解释的症状”这一过时观念，转而依靠：承认症状的疼痛性、使人衰弱性和非自主性；提出患者可接受的阳性诊断以及与患者观念相符的解释模型，旨在终止功能失调的医疗保健利用；提出旨在实现功能恢复而非症状缓解的治疗目标；协商药物（必要时使用选择性或混合性5-羟色胺再摄取抑制剂）和非药物干预措施，特别是在限制维持该障碍的因素方面；协调各类医疗专业人员。
