In various clinical departments of general hospitals, it is common to encounter somatic symptoms as the main complaint, but all have one or several psycho-psychiatric disorders in varying degrees. The actual common somatic symptoms are cardiovascular, neurological, digestive, respiratory, genitourinary, endocrine metabolic and cutaneous. The physiological changes resulting from the effects of psychosocial events on the somatic body are mutually causal, moving from quantitative to qualitative changes. In the literature, temporary physiological reactions are referred to as psychosomatic reactions; abnormal functioning or self-perceived somatic discomfort without organic lesions are referred to as psychosomatic disorders; and those with organic lesions are referred to as psychosomatic diseases. Since mind and body are mutually influential, physical diseases caused by psychosocial events are called primary psychosomatic diseases, while psychological disorders caused by physical diseases are called secondary psychosomatic diseases in the literature.
Psychosomatic medicine, also known as psychophysiology, is a theory of the correlation of many biological, psychological, and social factors in human disease and health, and will seek to elucidate in what ways and to what extent these factors work together in the onset, development, and regression of disease. Psychosomatic medicine is not a branch of psychiatry, but the foundation of medicine. It does not provide special techniques to determine various diseases, but rather follows existing medical methods to combine them organically from a theoretical basis. (Professor Shen Yu, a psychiatrist and member of the Chinese Academy of Engineering). Therefore, just because psychologists and psychoanalysis have played an important role in the development of psychosomatic medicine, it cannot be considered that psychosomatic medicine is only a branch of psychiatry or medical psychology. What psychosomatic medicine offers is a new way of thinking and approaching medicine. Its main contribution is to establish the concept of multifactoriality (heterogeneity) of diseases and health conditions: the occurrence, development and regression of human health conditions and diseases are influenced by biological, psychological and social factors and their interactions (etiology multifactorialism), not only by biological factors. Thus, psychosomatic medicine is a multidisciplinary intersection of biomedicine, psychology and social medicine. It strongly promotes the transformation of biomedical model to biological, psychological and social medical model.
1. In order to adapt to various physical, chemical, biological and psychological stimuli, the organism will produce a series of non-specific biological changes, causing the response of hypothalamus-pituitary-adrenal cortex-hormone secretion function.
2. There are three phases of adaptation
(1) A period of alertness, mobilizing a series of somatic and psychological reserve capacities to cope with and overcome this state of stress. The shock period can produce signs such as decreased blood pressure and body temperature, gastrointestinal ulcers, anuria, acidosis, decreased and then increased white blood cells, transient hyperglycemia followed by hypoglycemia, and adrenaline secretion. After entering the anti-shock period, the anterior pituitary gland secrete substances such as adrenocorticotropic hormone, mobilize the systemic stress capacity, the body’s resistance to increase, the appearance of thymic lymph gland atrophy, so that the body was immediately after the stress injury to produce defensive functions and responses to the period.
(2) Resistance period, the period when the body defends or resists stressful stimuli, thus restoring physiological or psychological balance.
(3) The period of exhaustion, when the organism exhausts its strain, thus causing complete Collapse. Presenting loss of compensatory functional performance and tending to death. Manifestations of anxiety, headache, general discomfort, and elevated blood pressure, which in turn, as mental stress continues to increase, lead to the formation of neurosis, hypertension, and serious psychosomatic diseases, and finally to death.
Mediating mechanisms of stress
The human being is commanded by the brain and has a biological and social nature, becoming an organic whole with this dual characteristic extremely well developed. Highly developed and infinitely creative mental activity is the most fundamental biological characteristic of human beings. The nervous system and the endocrine system under the integration of higher neural activity are the most important regulatory mechanisms of the human body to achieve the unification of mind and body and to maintain the balance of the internal and external environment. The regulatory mechanism of the nervous system is characterized by rapid and precise, while the regulatory action of the endocrine system is characterized by slow and extensive.
The nervous system plays a role in managing, dominating and regulating other systems and functions in the body in order to unify and adjust the whole body activities and adapt to the changes in the objective environment. The nervous system can be divided into two major parts: the central nervous system and the peripheral nervous system, the former of which is in turn the main organ for the generation of human mental activity and is mainly responsible for analysis, synthesis and induction.
The autonomic nervous system governs the activity of smooth muscles of internal organs (cardiovascular, digestive, respiratory, urinary tract) and the secretion of endocrine glands and sweat glands, etc. Its activity is carried out unconsciously and involuntarily, so it is called the autonomic nervous system. The concept of autonomy is limited; it is active under the innervation of the cerebral cortex and hypothalamus. Irrandom. Also relative, biofeedback techniques show that autonomic nerves are capable of random activity under certain conditions, which is the theoretical basis for biofeedback therapy.
Autonomic nerves are divided into sympathetic and parasympathetic nerves. The parasympathetic nerve is also called the vagus nerve, and the two basically play a mutually antagonistic role and achieve unified regulation and balance. They are mainly located in the viscera and blood vessels and are responsible for the nutritional regulation of these tissues, glandular secretion and smooth muscle diastolic function. External stimuli, through the sympathetic network entering the cranium, are transmitted to the autonomic center of the hypothalamus and produce dominant foci. Excitation of this dominant foci then travels down the sympathetic or parasympathetic nerves to the blood vessels of the viscera, where sympathetic excitation of the heart increases cardiac contractility and accelerates conduction. Conversely, vagal excitation depresses the heart. And make the stomach appear two different symptoms: when sympathetic excitation, gastrointestinal secretion and peristalsis are inhibited, with a series of symptoms such as dry mouth, lack of food and drink, abdominal distension and discomfort, burping and belching, vague pain in the epigastrium and even nausea and vomiting; when parasympathetic excitability is increased, there are symptoms similar to ulcer disease such as increased appetite, heartburn, acid reflux and belching, pain when hungry and relieved after eating. In fact, the sympathetic activity merely plays a strengthening role. In a calm environment, the parasympathetic nerves play a dominant role. When life is volatile and stressful, sympathetic nerves play an essential strengthening role. Stress leads to sympathetic hyperfunction, resulting in increased heart rate, increased blood pressure, decreased saliva production, accelerated breathing, and frequent urination.
Stress and neurotransmitters: (1) catecholamines, acute stress stimulus concentration is reduced. (2) acetylcholine (3) r-aminobutyric acid (4) substance P (5) opioids (6) thyrotropin-releasing hormone (TRH) are closely related.
Role of the neuroendocrine system
The endocrine system includes a system of humoral regulation formed by the endocrine glands and endocrine tissues in certain organs of the body.
There are three types of hypothalamic-pituitary-target gland axis, namely hypothalamic-pituitary-adrenal axis, hypothalamic-pituitary-thyroid axis and hypothalamic-gonadal axis. -pituitary-gonadal axis. These three axes have a complex relationship with each other, interacting and regulating each other. Through positive and negative feedback mechanisms between glandular secretion and the central nervous system, they regulate the inhibitory or excitatory effects of released hormones and prohormones.
Role of the immune system
Human immune function is divided into two categories: nonspecific and specific immunity. Non-specific immunity refers to innate or natural immunity, which is controlled by genetic factors and has relative stability; specific immunity is further divided into humoral and cell-mediated immunity. In chronic stress, the stronger the psychological pain, the stronger the suppression of immune function.
The human body’s response to psychological stress
Visual and auditory stimulation of the body produces not only sleep disturbances but also sensory overload, such as recognition disorders, illusions, hallucinations, temporal sensory disturbances, figure tilting, and delusions. Sensory overload is worse than sensory isolation and can also lead to amnesia.
Psychological stress also decreases the body’s resistance and increases the rate of respiratory disease infections.
Stress factors
Conditions essential for the formation of disease-causing stress factors: external conditions, the presence of objective events in life that are intolerable to the individual and of serious significance; internal conditions, the presence of certain predisposing qualities in the patient himself (mainly character defects).
1, personal life: (1) academic, pre-exam anxiety, post-exam failure, suspension and repetition; (2) employment difficulties, failure; (3) lost love, unmarried pregnancy, extramarital love, marital frustration (separation, divorce, sexual disharmony, heavy family burden); (4) children’s education conflict; (5) interpersonal relationship maladjustment, discrimination, misunderstanding, unjust treatment; (6) study, work, life (7) excessive burden; (7) special occupations, dereliction of duty, committing wrongful discipline, crime sentencing; (8) autism and loneliness, empty outlook on life, less fun; (9) bad habits and hobbies, smoking, alcohol, gambling; (10) personal conflicts of thought, suffering setbacks; (11) death of relatives and friends, etc.
2, the psychological response to disease: (1) suspicion of disease (suspicion of disease, diagnostic correctness); (2) worry about the prolongation of the disease, poor treatment; (3) concerns about drug reactions and tests, fear of medical measures (injections, surgery, interventional stents, etc.); (4) have personal privacy afraid to confide in the doctor; (5) worry about the disease led to their own education, work, family prospects and economic income treatment decline,; (6) Desire for family, relatives, friends, colleagues and neighbors to care; (7) poor personal health and adverse psychological reactions when hearing that others are seriously ill or deceased; (8) influenced by public opinion, books and magazines, social propaganda, etc.
Emotion doctrine
Emotions and feelings are the experience of attitudes held by people towards objective things and objects. The place of emotions and feelings in psychology. Emotions, feelings and cognitive processes are closely related. The cognitive process is the precondition and basis for the generation of emotions and feelings. With the knowledge of the properties of the thing itself, there can be a reflection of the relationship between the needs of the subject and the object, which gives rise to emotions and feelings.
The peripheral manifestations of emotions. There are obvious organismic changes and distinct states of physiological arousal. Changes in external expressions: changes in facial, body movements, and verbal expressions. Changes in internal organs: changes in muscles, blood vessels, internal organ activity, functional state in response to changes in emotions. Skin reactions: high secretion of sweat glands.
Intermediate mechanisms of emotions. Emotions and endocrine autonomic nerves. Anxiety and anger can cause tachycardia, frequent breathing, dilated pupils, increased blood sugar, gastrointestinal inhibition and spasm, increased red blood cells, accelerated blood sedimentation, increased blood pressure, cerebrovascular and coronary artery spasm, so that under panic, rage and excitement, anxiety can cause on-the-spot stroke, heart attack, sudden death from arrhythmia in patients with potential qualities.
Emotion and immunity. Involves emotions and their own defenses or altering the defenses of the organism and increasing the chances of infection.
Central mechanisms of emotions. Emotion regulation is a complex neurophysiological function that is the result of the interaction and influence of various functional areas of the brain.
The hypothalamus and the reticular formation of the brainstem are the primary centers that accomplish emotion regulation. The cerebral cortex, especially the frontal association area, is the highest integration center of emotional activity. The anatomical and functional correlation and consistency between the primary centers of emotional activity and the centers of the autonomic nervous system in the hypothalamus is an important material basis for the pathogenesis of psychosomatic disorders and psychotherapy.
Emotions and psychosomatic disorders. One view is that biologically speaking, emotions provide the energy that allows us to survive. However, today, society does not favor violent physical reactions, so that while we experience energy in terms of physiological changes, we do not have the opportunity to vent this energy behaviorally. The changes in the organism continue and as a result produce pathology. Another view is that psychosomatic disease arises when the physiological reactions in the emotions are too small or too large.
The human body has two major defense systems, biological and psychological, the former referring to the body’s biological immune system and the latter referring to the psychological role of the person’s benign emotional functions. The human body has an innate and acquired potential for mental and physical health, i.e., the power of positive emotions. Building positive emotions and self-confidence is the key to success or failure in psychotherapy.
Theory of Personality Deficiency
People live in a complex and changing society and are bound to experience various life events. Every person is in a certain psychological stimulus and stress every moment, and accompanied by corresponding emotional changes, only on the basis of certain susceptibility qualities can develop psychosomatic diseases. Psychosocial factors are the external conditions, and character defects and other susceptibility qualities are the internal foundation. The combination of internal and external factors can produce psychosomatic diseases.
Personality is the core and most essential psychological characteristic of personality. It is the individual’s attitude and habitual behavior toward himself, others and the real environment. Personality has the psychological characteristics of uniqueness and relative stability. A sound personality is often a sign of a healthy character and good psychological condition; a physically and psychologically healthy person must be a person of sound character.
The patient’s personality traits can both serve as the basis for the pathogenesis of many diseases and can alter the pathological process of many diseases. The patient’s personality traits often determine the clinical manifestations of the disease more than the cause of the disease. Patients often experience disease based on their personality traits and establish certain forms of stress and reactions. The personality type is particularly evident in patients with chronic illnesses.
Somatic diseases leading to psychological disorders
(i) Organic brain injury
(ii) Genetic and degenerative diseases of the nervous system
(iii) Somatic diseases due to various causes
Somatic diseases can cause acute and chronic encephalopathy syndromes after affecting brain function and metabolism, manifesting as delirium, mania, impaired consciousness and reduced cognitive function, and clinically common are hepatic encephalopathy, pulmonary encephalopathy, uremic encephalopathy, dialysis encephalopathy and pancreatic encephalopathy, etc. These patients can have clinical manifestations of depression or anxiety before or after the occurrence of encephalopathy.
(iv) Drugs and toxins
Psychoactive drugs that commonly lead to physical and psychological dependence in patients include the abuse of opioids with central analgesic effects, benzodiazepines with central depressant effects, amphetamines and cocaine with central euphoric effects, cannabis with hallucinogenic effects, and the abuse of alcohol and organic volatile oil substances.
Transmigration of psychosomatic disorders
On the one hand, dialectical materialism holds that disease does not exist without a material basis. The material basis of functional changes in so-called organic diseases that have irreversible and detectable morphological changes in tissue, cellular or even subcellular structure is easily understood. Psycho-psychiatric disorders cannot be narrowly considered to have only morphological changes as the material basis of the disease. Structure determines function, and changes in the physiological, biochemical or psychological functions of the organism are the result of changes in the structure of molecules in the organism, leading to changes in enzymatic activity, changes in the concentration of trace substances, displacement of electrons and other changes in the movement of substances.
On the other hand, somatic diseases and psycho-psychiatric diseases are not diametrically opposed concepts; the distinction between them is relative and conditional. Spiro (1974) considered functional dyspepsia, duodenitis, mucosal erosion and duodenal ulcer as a continuum of progressively more severe pathologies. The dividing line between somatic and psycho-psychiatric disorders is not invariable due to differences in medical technology, observation methods and disease processes.
With advances in medical technology and increased awareness, some diseases originally considered psycho-psychiatric (many of unknown etiology) have found clear etiological and pathological changes and have been identified as organic diseases. The opposite fact also exists, at the same time. Once bitten by a snake, ten years of fear of snakes. The fear of snakes may originate from a snake bite; food poisoning causing gastroenteritis, which may later develop neurotic vomiting. That is, the patient’s symptoms originally had somatic disease etiology or morphological changes, but later the same symptoms no longer have somatic morphological changes, and the somatic disease becomes a psycho-psychiatric disease, such as depression and suicide in cancer patients.
Recently, Professor Pan Guozong and others from the Department of Gastroenterology of Peking Union Medical College Hospital conducted an epidemiological investigation of irritable bowel syndrome (IBS) over a 14-year period, proposed diagnostic criteria, identified Shigella as the causative factor of IBS, and demonstrated the neuroimmune pathogenesis of the disease, among others. This pioneering study unified the study of the pathogenic effect of microorganisms with the influence of individual mental, neurological and psychological factors on the disease, and was highly evaluated by international experts. A standardized epidemiological survey found that the prevalence of IBS in adults in Beijing is nearly 1%. They found that Shigella enterica infection is the causative factor of IBS in the national population, and elucidated that the occurrence of IBS after acute intestinal infection depends not only on the intensity and duration of the infection, the immune status of the human body, but also on the regulation of individual psychiatric and neurological factors, and the influence of the interaction between human immune and neurological mechanisms. The group found that bacterial dysentery and mental emotions are risk factors for IBS, and observed that the longer the duration of dysentery, the higher the risk of intestinal dysfunction, revealing that intestinal infections cause the development of IBS by activating the immune mechanism. It was also found that the same psychological stimulus applied to IBS patients and volunteers had significantly different sensory thresholds for rectal distension, with IBS patients having much more sensitive visceral sensations. After the study group treated refractory IBS patients with low-dose antidepressants or psycho-cognitive therapy, 72% of the patients experienced symptom relief and significantly improved quality of life.
Classification of psychosomatic diseases in China
1. Cardiovascular system
Coronary heart disease, primary hypertension, acute myocardial infarction, sudden cardiogenic death, mitral valve prolapse, Raynaud’s disease.
angina pectoris, &;beta;-receptor hypersensitivity, emotional arrhythmias, neurogenic hypotension, primary circulatory hyperdynamic fatigue, cardiac migraine, early repolarization syndrome.
vascular neurosis, functional premature beats, paroxysmal ventricular and supraventricular tachycardia.
2.Digestive system
Ulcer disease, chronic gastritis, ulcerative colitis, chronic pancreatitis.
Acute gastric dilatation, gastric prolapse, allergic colitis, gastrointestinal neurosis, intestinal irritability combined with diffuse esophageal spasm, neurogenic vomiting, anorexia nervosa, neurological belching, hysterical globus pallidus, biliary dysfunction.
Gastric mucosal prolapse, chronic hepatitis, liver cirrhosis, cholelithiasis and cholecystitis, chronic appendicitis.
3.Respiratory system
Bronchial asthma.
Hyperventilation syndrome, neurological cough.
4.Endocrine system
Diabetes mellitus, hyperthyroidism.
Simple obesity, psychogenic polydrinking, psychogenic polyuria, polyhidrosis.
Cushing’s syndrome, Addy’s disease, simple goiter, hypothyroidism, thyroid nodules.
5.Nervous system
Migraine.
Autonomic dysfunction, vertigo, tension headache, cerebrovascular dysfunction love, facial spasm, writing spasm, psychogenic headache.
Epilepsy, disorientation seizures.
6.Sex and reproduction
Functional infertility and sterility, aseptic prostatitis.
impotence, hypersexuality, ejaculation, premature ejaculation, persistent penile erection, painful intercourse, painful ejaculation, non-ejaculation, cunnilingus, sexual neurosis, sexual psychosis, sexual intercourse aphasia.
Sexual frigidity, lack of orgasm, sexual aversion, venereal disease phobia, lust syndrome, alcoholic sexual impairment, habitual abortion.
7.Internal medicine
Rheumatoid arthritis, chronic rheumatoid arthritis, sciatica, facial nerve palsy, systemic lupus erythematosus, gout, allergic purpura, chronic infection and chronic inflammation, chronic pain, chronic fatigue, non-pathological weakness phenomenon, various allergies, psychogenic reactions, neurosis, systemic malignancies, especially gastric cancer, primary liver cancer, breast cancer, esophageal cancer and lung cancer.
8.Obstetrics and gynecology
Functional uterine bleeding, menstrual disorders, premenstrual tension, psychogenic infertility, lobular hyperplasia of the breast.
primary dysmenorrhea, labor pain, postpartum pain and postpartum syndrome, amenorrhea, anovulatory cycle disorder, vulvar pruritus, pregnancy vomiting, gestational hypertension syndrome, cardiac abortion and preterm delivery, cardiac fetal distress, weak contractions, menopausal syndrome.
Postpartum lactation disorder, dyspareunia postpartum hemorrhage, acute vulvar ulcer, postmenopausal syndrome, post sterilization syndrome.
9.Pediatrics
Asthma, childhood ulcer disease, ulcerative colitis, childhood obesity, anorexia nervosa.
neurotic vomiting, enuresis, daytime dysuria, psychogenic fever, psychogenic dyspnea, intestinal dysfunction.
Pediatric epilepsy, stuttering, night terrors, pediatric neurosis, hyperactivity, suspicion of breast, pseudo-anemia, finger-sucking fetish, recurrent umbilical hernia pain.
10.Orthopedic injury and surgery
orthopedic and surgical pain, costochondritis, osteoporosis, breast disease, shoulder-hand syndrome, biliary system disorders, polyoperative disorders, suspicious disorders.
compensation syndrome, postoperative abdominal neurosis, postoperative intestinal adhesions, postoperative psychiatric disorders, psychosomatic disorders after general anesthesia, and psychosomatic disorders after prosthesis and organ transplantation.
11.Dermatology
Neurodermatitis, psoriasis, pityriasis, psychogenic purpura.
Pruritus, hyperhidrosis, sweat pimples, lichen planus, artificial dermatitis, burning tongue, plucking fetish, parasitic delusions, dermatodynia, spasmodic pruritus, syphilitic phobia, neuroectodermal exfoliation.
Eczema, baldness, vitiligo, nodular itchy rash, exudative discoid mossy dermatosis.
12.Ophthalmology
Primary glaucoma, central plasmacytoretinal chorioretinitis.
Ocular muscle fatigue, blepharospasm, low eye pressure syndrome.
Cataract, eyelid ptosis, retinal detachment, hysterical blindness.
13.Otolaryngology
Meniere’s disease, perennial allergic rhinitis, chronic rhinosinusitis.
Sudden deafness, neurological tinnitus, pharyngeal heterosensitivity, chronic pharyngitis, chronic laryngitis.
Chronic rhinorrhea, hard of hearing, recurrent oral ulcers, chronic diffuse external otitis, abnormal smell, stuttering, neurological aphasia, oral lichen planus, chronic tonsillitis.
14.Stomatology
Oral mucosal ulcers, recurrent adhesive and menopausal stomatitis, psychogenic toothache, oral neuralgia, jaw joint pain.
Intraoperative and postoperative psychosomatic problems in dentistry, chronic inflammation of periodontal tissue, chronic toothache, foreign body sensation in the mouth and gums.
15. Psychosomatic disorders manifested by neurological disorders and some psychiatric disorders
Somatization of neurological disorders.
Partial psychosis: reactive psychosis, adolescent psychosis, menopausal psychosis.
16.Occupational toxic psychosomatic disorders
Chronic heavy metal poisoning, organophosphorus poisoning, gasoline, ethanol, methanol poisoning.
17.Life related psychosomatic disorders
Work psychosomatic disorders: office automation syndrome, chronic fatigue syndrome, office aversion syndrome, ambulatory syndrome, occupational sitting disease, information overload syndrome, Monday reaction syndrome, weekend reaction syndrome, overwork death.
Life psychosomatic disorders: modern living room syndrome, living room mite pollution syndrome, furniture syndrome, high-rise syndrome, urbanization syndrome, household appliance syndrome, housewife syndrome, social reactions.
18.Physical and mental disorders of somatic diseases
Various physical diseases may usually appear as psychological disorders. What is also considered in the clinic is the patient’s pathological psychological state.