Results matching “Functional Somatic Syndrome” from Research in Psychosomatic Medicine

 Somatic symptoms of medically unknown origin are highly prevalent in the community and clinical settings.  Functional somatic syndrome (FSS) refers to several related syndromes that are characterized more by symptoms, suffering, and disability than by demonstrable abnormalities.  Two aspects should be considered in the underlying pathophysiology of FSS: dysregulation of the stress response in autonomic nervous systems and psychological factors that modulate the expression of symptoms.

 Psychophysiological Stress Profiling (PSP) is a method of estimating the response to a stress by measuring multiple physiological parameters and psychological indices.
Physiological indices were hypo-reactive to mental work stress and psychological tension was high in the FSS compared with controls.  These findings suggest FSS patients have hypo-functional stress responses, and couldn't cope with the stress properly.

  Somatic symptoms of medically unknown origin are highly prevalent in the community and clinical settings; not only the primary care setting but also the secondary care setting(1-3), and are clinically important(4).  Functional somatic syndrome (FSS) refers to several related syndromes that are characterized more by symptoms, suffering, and disability than by disease-specific, demonstrable abnormalities of structure or function(6). 

   FSSs include various diseases in many medical specialties such as irritable bowel syndrome, functional dyspepsia, fibromyalgia syndrome, and chronic fatigue syndrome.

  FSSs are expected to share a common underlying pathophysiology (6).  Among the regulating systems in human body, we have been focusing on autonomic nervous system (ANS) and its relationship to stress.  The following two aspects should be considered in the pathophysiology of FSS: a) dysregulation of the stress response in ANS and b) psychological factors that modulate the expression of symptoms.  These two aspects of pathophysiology interact with one another.

  The origin of functional somatic symptoms cannot be detected by regular medical examination, because the abnormalities don't accompany visual changes typically.  Moreover, functional somatic symptoms are involved in stress.  Considering these things and pathophysiology, we evaluated the response of ANS-related physiological parameters to stress.

 

  Psychophysiological stress profiling (PSP) is a method of estimating the response to a stress by simultaneously measuring multiple physiological parameters based on the concept of autonomic response specificity (7,8).  PSP also include psychological measurements as we consider both pathophysiology a) and b) above.

  Overall, physiological indices relevant to ANS were hypo-reactive to mental work stress and psychological tension indices were high in the FSS patients compared with healthy controls.  These findings suggest that FSS patients have hypo-functional stress responses, and could not cope with the stress properly, so felt higher subjective tension feelings.

  While these findings were results by averaging, the cluster analysis divided the FSS patients into two clusters by autonomic response to the stress: high-lability and low-lability group (the number of low-lability group was larger).  The mood scores were higher in the high-lability group than in the low-lability group.

  Moreover, heart rate variability, well known as an index of autonomic function, was reduced at the pre-stress resting period in FSS patients.  This finding suggests that both reduced autonomic lability in pre-stress period and attenuated autonomic response to stress exist, and both dysfunctions would interactively yield the maladaptive process.

  These tendencies were not depend upon diagnosis, suggesting the existence of common pathophysiology in FSS patients.

・While many problems are exist in FSS, which embarrasses medical stuff and come out economic loss, the pathology, assessment and managements isn't yet established.  Therefore the impact of our study would be large for widespread medical field universally.

・Population of functional somatic symptoms or peripheral symptoms, especially involved in psychosocial problems, are increasing more and more.  Traditional medical approaches have limitations for such diseases.  Management of FSS would be widely applied for such syndromes more in the future.

・Psychophysiological Stress Profiling have potential demand in not only FSS but also in various difficult-to-assess disorders such as psychosomatic disease, stress-related disorder, so-called autonomic nervous disorder, social anxiety disorder (excessive mental or physical tension), panic disorder, somatization disorder, etc.

・The relationship or dissociation between objective findings and subjective feelings are a essential theme, which has widely application possibility.

1. Kellner R.: Functional somatic symptoms and hypochondriasis. A survey of empirical studies. Arch Gen Psychiatry, 42, 821-33, 1985
2. Peveler R, Kilkenny L, Kinmonth AL.: Medically unexplained physical symptoms in primary care: a comparison of self-report screening questionnaires and clinical opinion. J Psychosom Res, 42, 245-52, 1997
3. Reid S, Wessely S, Crayford T, Hotopf M.: Frequent attenders with medically unexplained symptoms: service use and costs in secondary care. Br J Psychiatry, 180, 248 -53, 200
4. Wessely S, Nimnuan C, Sharpe M.: Functional somatic syndromes: one or many? Lancet, 354, 936 -9, 1999
5. Henningsen, P., Zipfel, S., Herzog, W.: Management of functional somatic syndromes. Lancet, 369, 946-55, 2007.
6. Barsky AJ, Borus JF.: Functional somatic syndromes. Ann Intern Med, 130, 910 -21, 1999
7. Lacey JI, Bateman DE, VanLehn R.: Autonomic response specificity. An experimental study. Psychosom Med, 15, 8 -21, 1953
8. Wenger MA, Clemens TL, Coleman MA, Cullen TD, Engel BT.: Autonomic response specificity. Psyshosom Med, 23, 185-93, 1961
9. Fink P, Toft T, Hansen MS, Ornbol E, Olesen F.: Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med, 69(1), 30-9, 2007
10. Henningsen, P., Zimmermann, T., Sattel, H.: Medically unexplained physical symptoms, anxiety, and depression: a meta-analytic review. Psychosom Med, 65, 528-33, 2003
11. Kanbara, K., Fukunaga, M., Mutsuura, H. et al.: An exploratory study of subgrouping of patients with functional somatic syndrome based on the psychophysiological stress response: its relationship with moods and subjective variables. Psychosom Med, 69, 158-65, 2007
12. Kanbara, K., Mitani, Y., Fukunaga, M. et al.: Paradoxical results of psychophysiological stress profile in functional somatic syndrome: correlation between subjective tension score and objective stress response. Appl Psychophysiol Biofeedback, 29(4), 255-268, 2004
13. Nimnuan, C., Rabe-Hesketh, S., Wessely, S., Hotopf, M.: How many functional somatic syndromes?.J Psychosom Res, 51, 549-57, 2001
14. Robbins, J.M., Kirmayer, L.J., Hemami, S.: Latent variable models of functional somatic distress. J Nerv Ment Dis, Oct;185(10), 606-15, 1997
15. Kanbara, K., Mitani, Y., Fukunaga, M. et al.: Characteristics of psychophysiological stress responses in patients with psychosomatic disorders. Japanese Journal of Psychosomatic Medicine, 45, 685-695, 2005
16. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation, 93, 1043-65,1996.