Psychosomatic Medicine

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Psychosomatic Medicine

Psychosomatic Medicine

Psychosomatic medicine remains a challenging field. Subspecialty areas in psychosomatic medicine make it more complicated to diagnose, treat, and refer patients with complex medical comorbidities. Providers need to provide best practice comprehensive psychiatric consultation evaluations with thorough consideration of psychiatric, medical, and social factors. The UPMC Psychosomatic Medicine Conference is a one-day meeting that will highlight local and regional talent in consultation-liaison (CL) psychiatry. Through dynamic speakers and experts in the field, it will provide an update on clinical care and research at the interface of psychiatry and other medical specialties. These will include topics in palliative care, transplantation psychiatry, law and ethics, perinatal psychiatry, and integrated care. The conference will give an up-to-date overview of community resources in addition to research studies in the area of psychosomatic medicine to enable participants to incorporate them into individual practice and discern their applicability to clinical care.
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History, aims and present structure of psychosomatic medicine in Germany

History, aims and present structure of psychosomatic medicine in Germany

At the beginning of the last century, German physicians observed an increase in neurotic diseases. War neuroses and functional disorders without organic findings were in- creasingly seen during World War I (1914–1916). The lack of therapeutic options in the entire field of internal and psychiatric medicine was a reason for developing psycho- analytic oriented psychotherapy and the origins of psycho- somatic medicine: Between the two world wars, approaches were made by leading internists V.v. Weizsäcker, G.v. Berg- mann, K. Hansen, and coworkers. Moreover, the experience of the national socialist regime and World War II enabled internists like A. Jores to become more familiar with psy- chosomatic aspects, which they had experienced by them- selves or observed in others during that dreadful time. Especially at the internal medicine conference in Wies- baden in 1949 and by influential internists (T.v. Uexküll, A. Jores et al.), the further institutional development of psy- chosomatic medicine at universities and in the German health care system was supported. But psychosomatic medicine and its integration in the German academic world and in the area of health care had, compared to other coun- tries, a specific historical, sociological, health policymaking, and medical dimension, which allowed this development and influences it until this day [2]:
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Current state and future prospects for psychosomatic medicine in Japan

Current state and future prospects for psychosomatic medicine in Japan

In this article, we describe the history and current state of psychosomatic medicine (PSM) in Japan and propose measures that could be considered based on our view of the future prospects of PSM in Japan. The Japanese Society of PSM (JSPM) was established in 1959, and the first Department of Psychosomatic Internal Medicine in Japan was established at Kyushu University In 1963. PSM in Japan has shown a prominent, unique development, with 3,300 members (as of March 2016), comprised of 71.6% of medical doctors including psychosomatic internal medicine (PIM) specialists, general internists, psychiatrists, pediatricians, obstetricians and gynecologists, dentists, dermatologists, and others. Most of the non-physician members include psychology and nursing staff specialists. The Japanese Society of Psychosomatic Internal Medicine (JSPIM), founded in 1996, is another major society with more than 1,200 physicians that is mainly composed of internists. The first joint congress of the five major PSM societies from each field was held in 2009. They included the Japanese Society of Psychosomatic Medicine, Psychosomatic Obstetrics and Gynecology, Psychosomatic Pediatric Medicine, Psychosomatic Dental Medicine, and Psychosomatic Internal Medicine. Several subdivided societies in related medical fields have also been established for cardiovascular, digestive, dermatological, and oriental medicine and for eating disorders, pain, fibromyalgia, stress science, behavioral medicine, and psycho-oncology. JSPM and JSPIM participate in international activities including publishing BioPsychoSocial Medicine (BPSM) and the establishment of a sister society relationship with the Germany College of PSM. PSM in Japan has adopted a variety of professional psychotherapies, including transactional analysis, autogenic therapy, and cognitive behavioral therapy. Mutual interrelationship has been promoted by the Japanese Union of Associations for Psycho-medical Therapy (UPM).
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Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic

Clinical features of outpatients with somatization symptoms treated at a Japanese psychosomatic medicine clinic

Background: Somatization is produced due to the summation of psychological factors, irrespective of the presence or absence of physical factors. A group of diseases with severe pain and other disorders exhibit so-called Medically Unexplained Symptoms (MUS), and the characteristics of patients with MUS are largely unexplained. In this paper, the characteristics of a series of new patients with somatization treated in a Japanese university hospital are discussed. Method: The subjects were 871 patients who newly visited the Department of Psychosomatic Medicine, Toho University Omori Medical Center between January and December of 2015. Under the assumption that the definition of somatization is same as that of MUS, the correlation between somatization and the age, sex, academic background, chief complaints, reasons for visiting the medical center, diagnosis, symptoms, presence or absence of a referral form, continued treatment after the first visit, and marital status of these patients at the time of their respective examinations were evaluated.
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The History, present state, and future prospects of the Asian College of Psychosomatic Medicine (ACPM)

The History, present state, and future prospects of the Asian College of Psychosomatic Medicine (ACPM)

center of Beijing and that was renovated for the Beijing Olympics, was the site of the conference. More than 400 topics were presented. The conference was especially well organized. The participants had the opportunity to see traditional Chinese Opera at the welcome party, visit the Great Wall, a World Heritage site, where one could enjoy the distant view of Inner Mongolia, and visit the Ming Dynasty Tombs. President ZHAO ’ s son, Dr. ZHAO Peng, who is studying abroad at the Department of Psychosomatic Medicine of Kyushu University, ably assisted President KUBO in preparing for the conference [16].
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Development and challenges of palliative care in Indonesia: role of psychosomatic medicine

Development and challenges of palliative care in Indonesia: role of psychosomatic medicine

Palliative care is not a new issue in Indonesia, which has been improving palliative care since 1992 and developed a palliative care policy in 2007 that was launched by the Indonesian Ministry of Health. However, progress has been slow and varied across the country. Future work is needed to build capacity, advocate to stakeholders, and to create care models that provide services in the community and increase the palliative care workforce. Psychosomatic medicine is based on a bio-psychosocial- spiritual model of care and is related to physical and psychosocial factors and to good communication. There are many similarities between psychosomatic and pallia- tive patients. Psychosomatic medical doctors have the advantage of contributing to palliative care without stress overload or burnout because of their special train- ing in communication skills to deal with patients from the standpoints of both mind and body.
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Attitudes of Iranian Psychiatrists to Psychosomatic Medicine: A Qualitative Content Analysis

Attitudes of Iranian Psychiatrists to Psychosomatic Medicine: A Qualitative Content Analysis

Participants' responses were analyzed in 7 areas (Table 1). In the assessment and diagnosis domain, differential diagnosis of physical illness, differential diagnosis of mental disorder, and comprehensive assessment of psychosocial status was shown and named with respect to the condensed analysis units. In etiology, 2 codes were extracted from psychiatrists' responses, which were biogenetic causes and diathese stress model. According to the participants' responses to questions that were related to treatment plan, psychotherapy and medication were identified. We classified relapse factors into 3 codes: (1) adherence, (2) biological relapse and social problems, and (3) interpersonal conflicts. Psychiatrists' experiences of therapeutic alliance indicated that they confirmed potential components that must be present in the doctor-patient relationship to achieve therapeutic purposes. Conformance and trust were influential components which were entered the communication by patients. Authority and sympathy were also physician resources that were thought to be existed. In addition to personal resources, psychiatrists also pointed to other economic and social factors in patient resources domain. Thus, 6 codes were derived from analysis units: (1) former coping strategies, (2) positive attitude, (3) insight, (4) social support, (4) economic resources, and (6) appropriate interpersonal relationship. Finally, participants were asked to provide a definition of psychosomatic medicine and establish the position of this field in practice. Psychosomatic medicine and psychosomatic disorders were classified as related codes. The connection between psychological factors and physical discomfort was noted in psychosomatic medicine. Also, participants acknowledged the role of
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The European Network on Psychosomatic Medicine (ENPM) – history and future directions

The European Network on Psychosomatic Medicine (ENPM) – history and future directions

each conference. Interestingly, 60 years later we recognize distinguished psychosomatic scientists who were among these successive organizers of the ECPR’s meetings o.g. Johannes J. Groen, Archibald Denis Leigh, Lennart Levi. A formal society did not seem necessary in those days, when communication was a very individ- ualized process. The main goal of these meetings was to modernize the psychosomatic medicine focus from literature and philosophy into comprehensive research oriented toward acquiring better and sounder know- ledge in psychosomatics. It seemed necessary by then to come forward with evidence-based findings obtained through experimental research and studies on the psychosomatic underpinnings of different diseases. Of relevance to this matter were the London group, D. Leigh, psychiatrists from Madrid, J. J. López Ibor and Italy, Ferrucio Antonelli, as well as internists from Amsterdam and Hamburg, J. Groen, Henk Pelser, Arthur Jores. From the 1950′s, the group was able to present, discuss and promote their own studies in the scientific journals “Psychotherapy and Psychosomatics” (1953) and “Journal of Psychosomatic Research” (1957). At the time ENPM was founded five other societies were already involved in the “Psychosomatic field”:
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Avoiding diagnostic errors in psychosomatic medicine: a case series study

Avoiding diagnostic errors in psychosomatic medicine: a case series study

Case presentation: The study period was from January 2001 to August 2017. The data of patients who had visited the Department of Psychosomatic Medicine, Kindai University Hospital and its branches, Sakai Hospital and Nihonbashi Clinic, were collected. All patients were aged 16 years or over. Multiple factors, such as age, sex, presenting symptoms, initial diagnosis, final diagnosis, sources of re-diagnosis and types of diagnostic errors were retrospectively analyzed from the medical charts of 20 patients. Among them, four typical cases can be described as follows. Case 1; a 79-year-old woman, initially diagnosed with psychogenic vomiting due to depression that was changed to gastric torsion as the final diagnosis. Case 2; a 24-year-old man, diagnosed with an eating disorder that was later changed to esophageal achalasia. Case 10; a 60-year-old woman ’ s diagnosis changed from conversion disorder to localized muscle atrophy. Case 19; a 68-year-old man, appetite loss from depression due to cancer changed to secondary adrenal insufficiency, isolated ACTH deficiency (IAD).
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Clinical application of somatosensory amplification in psychosomatic medicine

Clinical application of somatosensory amplification in psychosomatic medicine

The symptoms related to psychosocial stress are often temporary and disappear with the relief of such stress. However, a specific illness may be caused when the expe- rienced stressors are too intense and persistent. When people are vulnerable to stress because of their character and ability to adapt, a psychosomatic illness is likely to occur even if the stressors are mild or moderate[2]. The Japanese Society of Psychosomatic Medicine defines psy- chosomatic illness as any physical condition with organic or functional damage affected by psychosocial factors in its onset or development[3]. This definition largely corre- sponds to that of "psychosocial factors affecting general medical conditions (code 316.00)" of the Diagnostic and Statistical Manual of Mental Disorders fourth edition, text revision (DSM-IV-TR) [4], published by the American Psy- chiatric Association.
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Prospects of Psychosomatic Medicine

Prospects of Psychosomatic Medicine

Trials of combinations of techniques to determine brain activity have begun to emerge [1]: These do not solely measure a specific brain function but at the same time measure various physiological indexes of the autonomic nervous system, such as pulse/skin conductance/electro- myogram, to detect dynamic associations of the bodily states with neural states. EEG has been used simultane- ously with other neruoimaging techniques like fMRI, to utilize the advantages of the high spatial resolution of MRI and temporal resolution of EEG. The transcranial magnetic stimulation method (TMS) is also used with fMRI as a non-invasive method to temporarily suppress the neuronal activity in a local region by electric stimula- tion by a coil outside the head. The current trend in neu- roscience to focus on brain function as one component of a unified physical system, including the connection between the bodily states and brain activity, seems extremely well matched to the direction of psychosomatic medicine. Furthermore, neuroimaging studies have been done that compare psychosomatic patients and healthy controls and that focus on the association of neuronal states with individual differences in personality tenden- cies (e.g., alexithymia associated with psychosomatic dis- orders) [2-5].
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No departure to "Pandora"? Using critical phenomenology to differentiate "naive" from "reflective" experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010)

No departure to "Pandora"? Using critical phenomenology to differentiate "naive" from "reflective" experience in psychiatry and psychosomatic medicine (A comment on Schwartz and Wiggins, 2010)

There is the additional problem, which we call here, a “ soft ” problem (to distinguish it from the “ hard pro- blem ” , or mind-body-duality, and the related “ explana- tory gap ” between phenomenal-mental experience (qualia) and neural process we have been discussing up till now): even if we perform “ reduction ” in a Husserlian sense, we are never totally free in our reflection from historical consciousness, and from language which makes such methodic reflective “reduction possible.” H.-G. Gadamer [39] called this inevitable historical con- sciousness the pre-reflective precondition of understand- ing (präreflexive Vorstruktur des Verstehens). Moreover, we are not able (contra Schwartz & Wiggins) to “start from both sides - from the side of what empirical science can tell us about inorganic and organic reality and from the side of our own direct experience of life in ourselves and in others ” [1]. These perspectives are not only not the same, they methodically exclude one another in what Viktor von Weizsäcker [15] calls a Gestalt-circle (Gestaltkreis). Their difference depends on the respective way, or applied method which brings “things” into focus. With respect to the phenomenon of “life”, it is not at all clear whether these different, mutually exclusive approaches focus on the same phe- nomenon. Obviously there is a difference between observing living cells through a microscope and under- standing Homer’s concept of life. At any rate, we acknowledge that certain characteristics may be “phy- siognomically ” given when experiencing something which is alive, or saying something about the structure of our experience as a living being. Viktor von Weizsäcker, who, as we already noted, is regarded as the “ founder ” of psychosomatic medicine in Germany, had argued that we must introduce the concept of subjectiv- ity into the study of life or biology. However, as reflect- ing subjectivity, we do not have access to the “hidden unity” between mind and body in what von Weizsäcker calls the fundamental relationship (Grundverhältnis) to our own being. Mind and body are, as can be said with reference to Aristotle, rather experienced as “two sides of the same coin” [40,41]). That is, mind and body are in “hidden” unity or Gestaltkreis, which is not given directly to consciousness whether in pre-reflective naïve experiencing, or the reflection on this experiencing. In our view, it is only through acknowledging this human finitude (rather than claiming that “ mind-body dualism ” has been overcome) that a psychosomatic medicine or a
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Psychosomatic medicine and the philosophy of life

Psychosomatic medicine and the philosophy of life

Basing ourselves on the writings of Hans Jonas, we offer to psychosomatic medicine a philosophy of life that sur- mounts the mind-body dualism which has plagued Western thought since the origins of modern science in seven- teenth century Europe. Any present-day account of reality must draw upon everything we know about the living and the non-living. Since we are living beings ourselves, we know what it means to be alive from our own first- hand experience. Therefore, our philosophy of life, in addition to starting with what empirical science tells us about inorganic and organic reality, must also begin from our own direct experience of life in ourselves and in others; it can then show how the two meet in the living being. Since life is ultimately one reality, our theory must reinte- grate psyche with soma such that no component of the whole is short-changed, neither the objective nor the subjective. In this essay, we lay out the foundational components of such a theory by clarifying the defining fea- tures of living beings as polarities. We describe three such polarities:
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Work-related stress and psychosomatic medicine

Work-related stress and psychosomatic medicine

In the occupational health field, medical professionals have many roles, including regular health examinations of employees, health consultation with symptomatic employ- ees, and regular monitoring of the work environment to protect all workers. In addition, metabolic syndrome health examinations and special examinations for employ- ees with excessive work schedules are current concerns in the Japanese workplace. Because physicians specializing in psychosomatic medicine can assess both physical and psy- chological illness, they are often asked to perform such assessments in the workplace. Medicine should not be limited to disease treatment in a hospital; it is also impor- tant to prevent disease. To practice psychosomatic medi- cine in the hospital requires a trusting relationship between the patient and doctor, and both must be aware of the power of the mind-body connection. Communica- tion is the key factor for developing this relationship. This is also true for the relationship between the employee and occupational health physician and between the occupa- tional health physician and the physician in charge at the hospital, who see the same patient in different settings. For example, good communication helps employees with psychosomatic distress to recover and return to work. For this reason, it is critical for psychosomatic practitioners and researchers to understand the basic ideas of work- related stress from the viewpoint of occupational health.
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The role of traditional Japanese medicine (Kampo) in the practice of psychosomatic medicine: the usefulness of Kampo in the treatment of the stress-related symptoms of women, especially those with peri-menopausal disorder

The role of traditional Japanese medicine (Kampo) in the practice of psychosomatic medicine: the usefulness of Kampo in the treatment of the stress-related symptoms of women, especially those with peri-menopausal disorder

A serious problem currently plaguing the medical field is the widening gap between academic medicine, which studies the features and causes of illness, and the medical care that patients desire. An example of this gap can be observed in the practice of psychotherapy, which is effective only for certain patients. Kampo medicine that combines the advantages of Western medicine with those of traditional Japanese medicine is currently undergoing a revival in the healthcare sector. The therapeutic policies underlying Kampo medicine are based on the physical constitution and current symptoms of each patient. For this reason, Kampo medicine is referred to as “ tailor-made medicine ” and has properties similar to “ mind and body ” or psychosomatic medicine. Some women exhibit multiple undefined stress-related symptoms during the peri-menopausal period. In order to accurately diagnose and provide patient-specific treatment, physicians should not only investigate the various stress factors in patients ’ lives but should also provide a Sho, or a Kampo diagnosis. The therapeutic approach in Kampo medicine is aimed at harmonizing the mind, body, and spirit; this practice involves the use of narrative and holistic medication that treats the entire being of the patient, resulting in an increased number of specialized treatment plans.
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The International College of Psychosomatic Medicine – a personal history

The International College of Psychosomatic Medicine – a personal history

The 23rd World Congress, held in Glasgow, Scotland, in 2015, was particularly satisfying for me, and a turning point, with several firsts for ICPM. Many cities, conven- tion centers and other venues compete for conferences and group meetings and I had begun to meet with many representatives from various venues several years before. Glasgow had indicated that there was a healthcare pro- fessional that might be interested in hosting our Con- gress there in 2015. Indeed, a bid was submitted and we had competitive bidding for the first time in my mem- ory. Previously, the host organizer was found by word of mouth, usually being an officer of ICPM, and while most congresses were successful, there were mixed results. The submitted bid was more professional than any we had previously seen, and we were very impressed by the support promised by the Glasgow and Scotland visitor industry. The host organizer, Mike Gow, is a dentist, an- other first for ICPM and an advance for the mission of psychosomatic medicine. The Congress turned out to be very successful scientifically, financially and socially. At- tendance by dentists was significant. There were excel- lent scientific presentations that included dental-related topics such as temporomandibular disorder and dental hypnosis.
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Psychosomatic Medicine in the U.K. A Personal View. Structure of presentation. Ms F. Ms F. The National Health Service-(NHS) Mr A.

Psychosomatic Medicine in the U.K. A Personal View. Structure of presentation. Ms F. Ms F. The National Health Service-(NHS) Mr A.

• For private patients, in order for medical insurance to pay, generally you have to designate an ICD or DSM diagnosis-depression, anxiety etc. Sometimes the insurance excludes mental conditions. I would not propose the diagnosis “psychosomatic” to an insurer !

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Childhood physical abuse in outpatients with psychosomatic symptoms

Childhood physical abuse in outpatients with psychosomatic symptoms

Background: In Japan and Asia, few studies have been done of physical and sexual abuse. This study was aimed to determine whether a history of childhood physical abuse is associated with anxiety, depression and self-injurious behavior in outpatients with psychosomatic symptoms. Methods: We divided 564 consecutive new outpatients at the Department of Psychosomatic Medicine of Kyushu University Hospital into two groups: a physically abused group and a non- abused group. Psychological test scores and the prevalence of self-injurious behavior were compared between the two groups.
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Psychosomatic problems and countermeasures in Japanese children and adolescents

Psychosomatic problems and countermeasures in Japanese children and adolescents

psychosomatic problems in Japanese children The Japanese Society of Psychosomatic Pediatrics, a sub- committee of the Japan Pediatric Society, was founded in 1983 and will soon celebrate 30 years of establish- ment. The purpose of the establishment of the society is to promote clinical practices of psychosomatic medicine and to improve family and school circumstances in cor- poration with general pediatricians, psychologists, nurses, school teachers and other related personnel, and finally, to bring favorable mental/psychological develop- ment in children. The major activity of the society in the former period for thirty-years history included post- graduate trainings with serial special lectures for general pediatricians and publication of various researches. Nevertheless, in spite of our efforts, the number of chil- dren with psychosomatic diseases (OD, eating disorder, chronic headache, irritable bowel syndrome, recurrent abdominal pain in young children, recurrent vomiting, hyperventilation syndrome, bronchial asthma and incon- tinence) has continued rising.
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Psychosomatic problems in dentistry

Psychosomatic problems in dentistry

Dentists have been struggling because of the increasing prevalence of MUOS and have been asked to adopt a new treatment approach and to leave behind “brainless dentis- try” or “mindless dentistry”. In collaboration with specialists in psychosomatic medicine, the pathophysiology of MUOS should be investigated, with a focus on brain-mouth inter- actions. The education of dentists who are able to treat not only teeth, but also the patient’ s psychosomatic oral dis- comfort is an important priority.

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