Giugno 2004 - Volume XXIII - numero 6
Focus
Professore Emerito, Dipartimento di Scienze della Riproduzione e dello Sviluppo, Università di Trieste
Key words: Psychosomatics, Psychotherapy, Child
The relationship between physiological responses to stressful stimuli and the onset of psychosomatic illnesses has been an area of intense interest for many years. Subtle disregulations of the hypothalamic-pituitary-adrenal (HPA) axis have been proposed as an underlying pathophysiological mechanism for some psychosomatic disorders. Links between the gut and the brain, involving neuroendocrine associations of the enteric nervous system and its connections with the spinal, autonomic and central nervous systems, are well documented. The characterising feature of psychosomatic disorders is the possibility to treat them with psychotherapy. The following diseases are included among those having a psychosomatic component: fibromyalgia, migraine, recurrent abdominal pain, chronic fatigue and, maybe, irritable bowel syndrome. It has been shown that also tumoral, infective and autoimmune diseases have a psychosomatic component, which, in some cases, may influence their prognosis.
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Unità Operativa di Neuropsichiatria Infantile, IRCCS “Burlo Garofolo”, Trieste
Key words: Somatoform disorders, Adolescent, Assessment, Rehabilitative approach
Our current understanding of somatoform disorders and their consequences is limited. The article defines the concept of paediatric and adolescent somatoform disorder and presents a model for case management based on the collaboration between mental health professionals and primary health care professionals. The need for careful assessment, precise criteria for diagnosis and cognitive-behavioral rehabilitative approach are emphasised. Better understanding of these disorders can promote early diagnosis and timely treatment, improve the quality of life and prevent unfavourable outcomes.
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*Clinica Pediatrica, IRCCS “Burlo Garofolo”, Università di Trieste
**Unità Operativa di Neuropsichiatria Infantile, IRCCS “Burlo Garofolo”, Trieste
Key words: Somatoform disorders, Factitious illness, Children, Adolescents
Somatoform disorders are common among children and adolescents. The authors describes the clinical history of 4 out of 8 cases with somatoform or factitious disorders referred to the Hospital during a period of one year (total number of admission: 130). Abnormal psychosocial situations were found to be associated with onset and course of the disorders in all cases. The level of school absenteism in adolescents with somatoform disorder is remarkably higher than that reported in other chronic diseases. In some cases, physicians and the health care system play a significant role in reinforcing somatisation by patients. It is recommended that paediatricians include illness falsification by the child and adolescent patients in the differential diagnosis of persistent and unexplained medical condition, along with somatisation and malingering by proxy.
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