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Dr.Pavan Sonar

Consultant Psychiatrist, Psychosexual Consultant & Counsellor

Psycho somatic disorders & Pain disorders

Psychosomatic disorders are manifestations of physical imbalance in which emotional components have a strong influence. The link between the mood and compromised health issues can be followed, in such cases, as the disease emerges, develops or repeats its pattern over time. "Psyche" refers to the emotional or mind related aspects and "somatic" indicates with the organic or physical symptoms and signs.

Studies have revealed that inappropriate activation of the autonomous nervous system, endocrine system (hormones and internal secretion glands), and the immune system accounts for several of the known paths that link emotional overload to a condition of organic dysfunction and, in some cases, even physical distress.

 

Some other names

Psychoneuroimmunology .

Psychoneuroimmunoendocrinology 

Psychophysiology.

Body-mind medicine, though, seems to be the most popular synonym.

 

Classification

 

Two of the main classification systems used in health care are the ICD-10 (International Classification of Diseases, tenth edition) and the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition).Psychosomatic disorders, however, do not COME into the categories of either system. In a broad sense, the concept may include "somatoform disorders" as well as "disorders with psychological factors assumed to play a major role in the etiology, triggering, and maintenance of somatic complaints".

 

Causes

Upbringing, environment, social settings, genetics and personal interpretations of events, as well as the capacity to cope with the elements that come together as the person develops and interacts seem to play an important role when confronted with a psychosomatic manifestation. The key aspect of all these disorders is that they are enduring, relatively immutable conditions that represent a baseline substrate of impaired adaptatation , of deficiencies or distortions that limit the capacity to adapt successfully to the demands of life.

 

 

Body & mind Connections

There is increasing evidence that stress has a direct biological effect on disease risk, involving the sympathetic nervous system, the Hypothalamo-Pituitary-Adrenomedullary axis, and the inflammatory response system - a major chain reaction released by the immune complex. The interaction established among these systems and a central autonomic network  which includes both prefrontal and limbic cerebral structures, are integrated to form an internal regulation system through which the brain controls visceromotor, neuroendocrine, and behavioural responses that are critical for goal-directed behavior, adaptability, and health.

When the sympathetic nervous system is activated, hormones such as catecholamines ( epinephrine and norepinephrine) are released and the hypothalamus simultaneously secretes corticotrophin-releasing factor. The release of corticotrophin-releasing factor produces adrenocorticotropic hormone from the anterior lobe of the pituitary gland. This hormone in turn stimulates the adrenal cortices to release cortisol, a stress hormone that helps the immune system to operate efficiently. The release of catecholamines and cortisol allows the body to break down sugar as a source of available energy. This represents the sympathetic adrenomedullary system, an essential component of the normal acute alarm response to threat that produces the fight-flight reaction.

When stressors are perceived in the limbic system the brain sends signals through the sympathetic and parasympathetic systems, which generally act to oppose each other. Although the system predominates in the acute stress response, it can be tonically active in some individuals, that is, highly reactive to minor perturbations. The sympathetic system, associated with energy mobilization, and the parasympathetic system, associated with vegetative and restorative functions are the two major branches of the autonomous nervous system. Normally, the activity of these branches is in dynamic balance.

The release of catecholamines creates flight responses, such as increases in blood pressure, mental agility, heart rate, breathing rate, and sweating. Activation of the sympathetic NS in the presence of a stressor results in suppression of the immune system, thereby increasing the body's susceptibility to disease when stressors are ongoing . Communication between the brain and immune system is bidirectional, meaning that stress can cause the brain to trigger the immune response, and the immune response can induce changes in the central nervous system , resulting in a constellation of behaviours described previously in this article as sickness syndrome. Chronic stress and immune response become mutually maintaining conditions, increasing the risk of inflammatory, neurodegenerative, and autoimmune diseases .

The inflammatory response, if inappropriate, excessive, or long-lasting, becomes the underpinning of many human diseases, such as coronary heart disease. Other examples of inadequate inflammatory processes also seem to be involved in certain stages of neurodegenerative diseases such as Alzheimer's and Parkinson's. Ordinarily, inflammation is an active defence mechanism against many types of insults. It acts to remove or inactivate pathogens and to inhibit and reverse their detrimental effects. Inflammation to the brain can be triggered by invading microbes such as viruses or bacteria, by injurious chemicals, or by physical insult. It can be initiated from within the organism as well, as happens with diseases affecting the nervous or immune systems. It can be triggered by the accumulation of modified proteins, by the chemical signals from injured neurons (nervous cells), or by an imbalance between pro-inflammatory and anti-inflammatory processes.

Autonomic imbalance and decreased parasympathetic tone in particular may be the final common pathway linking negative mood states and dispositions, including indirect effects due to poor lifestyle, to numerous diseases and conditions as well as increased morbidity and mortality, and it may also be implicated in psychopathological conditions.

 

Treatment and the Psychosomatic Approach

 

The treatment for psychosomatic disorders brings together therapeutic measures from the medical and psychosocial fields, many of which are formal guidelines and high standard procedures, mostly attained through the use of research data and evidence based results. Different diseases require adapted approaches and follow parameters used basically in main stream medicine, aiming at the most reliable options in each specialty. An aspect that is particularly relevant for the psychosomatic approach is the identification of biological, psychological and social (bio-psycho-social) patterns inherent to the development of the disorder and the influence of individual response to a variety of stressors.

Psychosomatic conditions and disorders give clear signals that attention has to be paid to the conflicts in the organism, which are causing painful symptoms . Therefore it is reasonable to expect that fear, anxiety and a state of vulnerability may surface. Some patients are, of course, manipulating to jump the queue, but for others, merely knowing the physician is available and responsive may exert a concrete effect on the anxiety that underlies their symptoms.

In the psychosomatic illnesses it is almost always a 'bodily disturbance' for which the patient seeks help. Though characteristic organic illness might not be identified when a psychosomatic condition is the case, there is an ailment that diminishes life quality and distorts the perception of good health. Included in this picture is the range of interpersonal, social, environmental, educational, occupational, economic, and legal problems.When symptoms or signs are present but the investigation fails to identify patterns that link the organic dysfunction or complaint to a major bio-psycho-social influence, chances are that an inadequate understanding of that type of disorder will carry the risk of an incomplete or delayed therapeutic plan.

Psychosomatic Diseases can be seen as movement disorders that result from psychological or psychiatric rather than neurological disturbance. The primary psychiatric diagnosis varies; most cases are considered to be   conversion disorders in which the problem is caused by an unconscious mechanism, but infrequently some are factitious disorders or malingering, in which the abnormal movements are purposefully feigned . Motor conversion is estimated to occur at the rate of approximately 5 per 100,000 and thus manifests itself in a large proportion of all conversion cases. Recent research has begun to unravel the pathophysiology of motor conversion disorders and has emphasized the need for approaching somatoform disorders as neurophysiologic disturbances with functional and behavioral manifestations . A delay in diagnosing psychosomatic disorders should be avoided at all costs. Failure to do so often results in multiple referrals, repeated unnecessary diagnostic tests, unjustified and potentially harmful treatments including medication trials and even surgeries, and the perpetuation of the belief of underlying organic illness. This also delays the initiation of appropriate treatment (though treatment is often very different), which reduces efficacy, particularly if treatment is started 6–12 months after onset of the movement disorder.

 

Important Tips

The effectiveness of medical and psychiatric interventions may be improved by treatment methods that address interpersonal processes in the patient's world that may have contributed to the dysfunctional state and help to maintain it .

The effectiveness of the writing or verbalization task is believed to be based on its ability to help people work through the traumatic event .

The importance of language in shaping experience has important implications for the understanding of many psychosomatic reactions in women and men.

Although evidence is preliminary, both cognitive therapy and interpersonal psychotherapy likely have an anti-inflammatory effect. Interpersonal psychotherapy focuses on improving social support, which buffers stress and down-regulates the inflammatory response. Cognitive therapy lowers inflammation by changing the negative beliefs that up-regulate the stress and inflammatory response.

Motivation for treatment is important since cognitive-behavioral therapy requires an active attitude on the part of the patient and includes homework and exercises. 

Social support may help in preventing illnesses, whereas social isolation has the potential for negative health outcomes. An important implication for behavioural correlates of immune function is that some may be altered to promote healthy lifestyles. Not only does the provision of social support influence one's emotional state, but a person's emotional state also influences the likelihood that social support is provided. We would expect that people would be more likely to provide on-going assistance to others who maintain a more positive outlook on life.

Stress management and relaxation interventions may hold promise for reducing some of the adverse immunological effects of stress . Hypnosis is indicated as an effective adjunct in the treatment of psychosomatic disorders.  Modern hypnotherapy appears to be comparatively superior to classical hypnotherapy . Meditation and the relaxation helps a lot.

Smoking cessation, reduced alcohol consumption, and increased physical activity rest in part on their ability to restore autonomic balance and increase parasympathetic tone. Exercise, particularly, can contribute to an increase in stress resiliency. The body initially experiences exercise as a stressor. However, as exercise becomes more regular and level of fitness improves, exercise reduces stress. Exercise not only lowers stress but specifically lowers the inflammatory response to stress . Nutritional benefits are also among the main traditional options, in this case, the aim is to specifically lower inflammation levels. Diet supplements with eicosapentaenoic acid EPA and docosahexaenoic acid DHA (omega-3s) are showing a lot of promise in treating both physical and mental health problems, and they do not appear to have negative side-effects that non-steroid anti-inflammatory drugs.                                                

Pain Disorders and Headaches

Headaches 

 

Migraine

 

Tension headache

 

Neck pain

 

Body Pain

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Psychiatrist in Andheri / Juhu / Kandivali / Borivali

Dr.Pavan A. Sonar is consultant psychiatrist , psychotherapist , sexologist & counselor, providing  services to the patients & clients in the area of Mumbai suburbs. He has been serving areas including Andheri, Lokhandwala, Juhu, Goregaon ,Malad, Kandivali, Borivali & Dahisar.

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