Establishment of Psychosomatic Diagnostic and Therapeutic Systems in General Practice(An Overview of Paychosomatic Medicine for 21 at Century-On Treatment)

Abstract

It has been well recognized that psychosomatic disorders(PSD_s), especially persistent cases are increasing remarkably in number. Also both ends of thee age parameters of disease onset are gradually expanding, because the psycho-social environment in our daily life has been changing yearly in complicated and diverse ways. Thus these medical topics are mentioned as the social problems of today. It is suggested that such a transition of the disease structure from the past to the 21 st century will 'demand more speciality in psychosomatic medicine on the part of the doctors who wish to participate in it, and also that the general physicians are becoming aware of how important the psychosomatic approach is in general practice. Therefore, from the psychosomatic point of view, the authors are attempting to establish diagnostic and therapeutic systems in general practice which include our explanation of the present situation of PSD_s, diagnostic criteria for PSD_s and psychosomatic treatment and prevention, mainly based on our findings of psychosomatic diagnosis and treatment, and of psychosomatic primary care, which has been already reported in the Japanese Journal of Psychosomatic Medicine, etc. The main points of psychosomatic diagnosis and treatment in general practice are as follows; First, it is very important for the patients with PSD to be systematically treated with a common and basic treatment, and to be fully aware of the psychological part of such a treatment, that is, basic psychotherapy advocated by the authors. Secondly, psychosomatic diagnostic criteria, which rely on pathophysiological examinations, Diazepam test for the measurement of anxiety-tension in the cerebro-limbic system, circadian rythmus of serum cortisol levels for the marker of thalamo-hypothalamic function, and Bromocriptine test for the marker of central dopaminergic function in hypothalamo-pituitary gland, are indispensable by which to select the adequate treatment for PSD_s; and psychological and behavioral characteristics may be useful as the global clinical markers. Finally, in psychosomatic treatment and prevention, it is important for the patients with PSD to correct their inadequate habits in daily and to be made aware of how to control themselves from the point of view of psycho-somatic correlation.