Management of Functional Somatic Syndromes and Bodily Distress
Management of Functional Somatic Syndromes and Bodily Distress
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DOI：
10.1159/000484413
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发表时间：
2018-01-01
影响因子：
22.8
通讯作者：
Creed, Francis
中科院分区：
文献类型：
--
作者：
Henningsen, Peter;Zipfel, Stephan;Creed, Francis
功能性躯体综合征（FSS），如肠易激综合征或纤维肌痛和其他反映身体痛苦的症状，在世界范围内几乎所有医学领域都很常见。从生物医学到精神病学，这些症状和综合征的诊断和治疗方法在医学专业之间和内部存在很大差异。患者可能因缺乏有效治疗而感到沮丧，医生可能认为这些疾病难以治疗，这类健康问题构成了全球疾病负担的一个重要组成部分。本文旨在建立一个统一的视角来理解和管理FSS和身体痛苦。首先，我们提出了临床问题，并回顾了目前的分类概念。其次，我们提出了一个综合的病因学模型，该模型包含了广泛的生物心理社会脆弱性和触发因素，并考虑了连续加重和维持因素。第三，我们根据2007年至2017年的系统综述系统地审查了当前的证据基础，并提出了针对各级护理的治疗建议，重点关注过去10年的发展。我们的结论是，激活、患者参与和集中作用的治疗似乎比主要作用于外周生理的被动治疗更有效，我们推荐阶梯式护理方法，将真正的生物心理社会方法转化为患者的实际管理。(c) 2018年S. Karger AG，巴塞尔
Functional somatic syndromes (FSS), like irritable bowel syndrome or fibromyalgia and other symptoms reflecting bodily distress, are common in practically all areas of medicine worldwide. Diagnostic and therapeutic approaches to these symptoms and syndromes vary substantially across and within medical specialties from biomedicine to psychiatry. Patients may become frustrated with the lack of effective treatment, doctors may experience these disorders as difficult to treat, and this type of health problem forms an important component of the global burden of disease. This review intends to develop a unifying perspective on the understanding and management of FSS and bodily distress. Firstly, we present the clinical problem and review current concepts for classification. Secondly, we propose an integrated etiological model which encompasses a wide range of biopsychosocial vulnerability and triggering factors and considers consecutive aggravating and maintaining factors. Thirdly, we systematically scrutinize the current evidence base in terms of an umbrella review of systematic reviews from 2007 to 2017 and give recommendations for treatment for all levels of care, concentrating on developments over the last 10 years. We conclude that activating, patient-involving, and centrally acting therapies appear to be more effective than passive ones that primarily act on peripheral physiology, and we recommend stepped care approaches that translate a truly biopsychosocial approach into actual management of the patient. (c) 2018 S. Karger AG, Basel