The Psychopathology of Functional Somatic Syndromes
http://www.100md.com
《新英格兰医药杂志》
This book summarizes many recent studies of illnesses characterized by symptoms that, as yet, have no clear pathophysiology: chronic fatigue syndrome, fibromyalgia, Gulf War illness, irritable bowel syndrome, and premenstrual dysphoria. Although the clinical manifestations of these illnesses are not identical, they have in common increased sensitivity to pain, sleep disturbance, difficulty with concentration, and labile mood. Indeed, many patients meet criteria for several of the illnesses.
The book cites hundreds of recent publications and will serve as a road map for anyone interested in these common and perplexing illnesses. For each illness, Manu presents a synthesis of the literature regarding clinical manifestations, the prevalence of psychiatric diagnoses, personality profiles, "abnormal" behavior associated with the illness, cognitive testing, and neurobiologic (e.g., neuroimaging, neurotransmitter, and neuroendocrine) studies. Because it involves many different disciplines, pulling together this large and complex body of literature was no small task.
Manu's review is thorough. Although he has previously argued that these syndromes are probably manifestations of a primary affective disorder, in this book he concludes otherwise. In particular, he notes that a substantial portion of patients with these disorders do not have a mood disorder.
Manu cites many studies indicating that patients often believe that they are suffering from an "organic" illness, even though no well-recognized organic illness has been diagnosed, and he suggests that this constitutes "abnormal illness behavior." He also states that the literature supports a connection between the "functional somatic syndromes" and somatization disorder. However, the literature he cites indicates that most patients with these syndromes do not meet the criteria for somatization disorder.
Indeed, if symptoms have an organic basis, then they cannot be said to stem from a somatization disorder, and a patient's belief that his or her suffering is due to an organic illness cannot be called "abnormal behavior." Hence, the central question: Do these functional disorders have an organic basis? What is the evidence? Manu summarizes many neurobiologic studies that have found objective, biologic abnormalities in patients with these syndromes (e.g., abnormal patterns on magnetic resonance imaging and on single-photon-emission computed tomography; abnormal responses on the testing of several hypothalamic–pituitary axes), in contrast to matched, healthy subjects and patients with psychiatric disorders, particularly major depression.
Perhaps the most interesting question raised by this book is this: What are "functional somatic syndromes"? The question is never explicitly addressed or answered. For many physicians, the word "functional" implies an illness that probably has no biologic cause, with symptoms that reflect a weakness of character or outright malingering. The literature summarized in this book argues that such inferences are unfounded. Indeed, in my view, the continued use of the term "functional" by mental health professionals perpetuates an archaic notion of mind–body dualism. The symptoms of these "functional" illnesses probably have biologic underpinnings, even though the articulation of a patient's suffering clearly is influenced by personal experiences and cultural values. Although we are a long way from identifying the precise pathophysiology of these illnesses, there is considerable evidence that they have an underlying biologic basis.
Anthony L. Komaroff, M.D.
Harvard Medical School
Boston, MA 02115(Peter Manu. 299 pp., illu)
The book cites hundreds of recent publications and will serve as a road map for anyone interested in these common and perplexing illnesses. For each illness, Manu presents a synthesis of the literature regarding clinical manifestations, the prevalence of psychiatric diagnoses, personality profiles, "abnormal" behavior associated with the illness, cognitive testing, and neurobiologic (e.g., neuroimaging, neurotransmitter, and neuroendocrine) studies. Because it involves many different disciplines, pulling together this large and complex body of literature was no small task.
Manu's review is thorough. Although he has previously argued that these syndromes are probably manifestations of a primary affective disorder, in this book he concludes otherwise. In particular, he notes that a substantial portion of patients with these disorders do not have a mood disorder.
Manu cites many studies indicating that patients often believe that they are suffering from an "organic" illness, even though no well-recognized organic illness has been diagnosed, and he suggests that this constitutes "abnormal illness behavior." He also states that the literature supports a connection between the "functional somatic syndromes" and somatization disorder. However, the literature he cites indicates that most patients with these syndromes do not meet the criteria for somatization disorder.
Indeed, if symptoms have an organic basis, then they cannot be said to stem from a somatization disorder, and a patient's belief that his or her suffering is due to an organic illness cannot be called "abnormal behavior." Hence, the central question: Do these functional disorders have an organic basis? What is the evidence? Manu summarizes many neurobiologic studies that have found objective, biologic abnormalities in patients with these syndromes (e.g., abnormal patterns on magnetic resonance imaging and on single-photon-emission computed tomography; abnormal responses on the testing of several hypothalamic–pituitary axes), in contrast to matched, healthy subjects and patients with psychiatric disorders, particularly major depression.
Perhaps the most interesting question raised by this book is this: What are "functional somatic syndromes"? The question is never explicitly addressed or answered. For many physicians, the word "functional" implies an illness that probably has no biologic cause, with symptoms that reflect a weakness of character or outright malingering. The literature summarized in this book argues that such inferences are unfounded. Indeed, in my view, the continued use of the term "functional" by mental health professionals perpetuates an archaic notion of mind–body dualism. The symptoms of these "functional" illnesses probably have biologic underpinnings, even though the articulation of a patient's suffering clearly is influenced by personal experiences and cultural values. Although we are a long way from identifying the precise pathophysiology of these illnesses, there is considerable evidence that they have an underlying biologic basis.
Anthony L. Komaroff, M.D.
Harvard Medical School
Boston, MA 02115(Peter Manu. 299 pp., illu)