The pathogenesis of Functional Dyspepsia （FD） remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association betwe...The pathogenesis of Functional Dyspepsia （FD） remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intdnsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to vadation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited.展开更多
Dyspepsia itself is not a diagnosis but stands for a constellation of symptoms referable to the upper gastrointestinal tract. It consists of a variable combination of symptoms including abdominal pain or discomfort, p...Dyspepsia itself is not a diagnosis but stands for a constellation of symptoms referable to the upper gastrointestinal tract. It consists of a variable combination of symptoms including abdominal pain or discomfort, postprandial fullness, abdominal bloating, early satiety, nausea, vomiting, heartburn and acid regurgitation. Patients with heartburn and acid regurgitation invariably have gastroesophageal reflux disease and should be distinguished from those with dyspepsia. There is a substantial group of patients who do not have a definite structural or biochemical cause for their symptoms and are considered to be suffering from functional dyspepsia （FD）. Gastrointestinal motor abnormalities, altered visceral sensation, dysfunctional central nervous system-enteral nervous system （CNS- ENS） integration and psychosocial factors have all being identified as important pathophysiological correlates. It can be considered as a biopsychosocial disorder with dysregulation of the brain-gut axis being central in origin of disease. FD can be categorizeo into different subgroups based on the predominant single symptom identified by the patient. This subgroup classification can assist us in deciding the appropriate symptomatic treatment for the patient.展开更多
"Psychosocial stress" is an increasingly common concept in the challenging and highly-demanding modern society of today. Organic response to stress implicates two major components of the stress system, namel..."Psychosocial stress" is an increasingly common concept in the challenging and highly-demanding modern society of today. Organic response to stress implicates two major components of the stress system, namely the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Stress is anamnestically reported by patients during the course of disease, usually accompanied by a decline in their overall health status. As the mechanisms involving glucocorticoids and catecholamines have been deciphered, and their actions on immune cell function deeper understood, it has become clear that stress has an impact on hepatic inflam-matory response. An increasing number of articles have approached the link between psychosocial stress and the negative evolution of hepatic diseases. This article reviews a number of studies on both human populations and animal models performed in recent years, all linking stress, mainly of psychosocial nature, and the evolution of three important liver-related pathological entities: viral hepatitis, cirrhosis and hepatocellular carcinoma.展开更多
The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since s...The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since selective serotonin reuptake inhibitors were introduced to Japan＇s pharmaceutical market in 1999, demand for anti-depressant medications has rapidly expanded. It seems likely then that the efforts of pharmaceutical companies, as part of their marketing strategies, to increase people＇s awareness of mental illness have led people who are not actually depressed to have medical consultations and drug treatments for it. This phenomenon is known as ＂disease mongering＂ and has been reported on. Problems exist from the medical perspective also and include the following： expansion of the diagnostic criteria for depression as formulated in the American Psychiatric Association＇s Diagnostic and Statistical Manual of Mental Disorders; treatments that rely heavily on drugs; and biomedicalization. Another reason for the increase in medical consultations is the declining function of communal bodies. This has resulted in individuals struggling psychologically, for example, with anxiety, worry, and depression. In summary, this sociological research analyzed the problems of depression in ｜apan and revealed how the pharmaceuticalization of mental health accelerates the individualization of social problem.展开更多
文摘The pathogenesis of Functional Dyspepsia （FD） remains unclear, appears diverse and is thus inadequately understood. Akin to other functional gastrointestinal disorders, research has demonstrated an association between this common diagnosis and psychosocial factors and psychiatric morbidity. Conceptualising the relevance of these factors within the syndrome of FD requires application of the biopsychosocial model of disease. Using this paradigm, dysregulation of the reciprocal communication between the brain and the gut is central to symptom generation, interpretation and exacerbation. Appreciation and understanding of the neurobiological correlates of various psychological states is also relevant. The view that psychosocial factors exert their influence in FD predominantly through motivation of health care seeking also persists. This appears too one-dimensional an assertion in light of the evidence available supporting a more intdnsic aetiological link. Evolving understanding of pathogenic mechanisms and the heterogeneous nature of the syndrome will facilitate effective management. Co-morbid psychiatric illness warrants treatment with conventional therapies. Acknowledging the relevance of psychosocial variables in FD, the degree of which is subject to vadation, has implications for assessment and management. Available evidence suggests psychological therapies may benefit FD patients particularly those with chronic symptoms. The rationale for use of psychotropic medications in FD is apparent but the evidence base to support the use of antidepressant pharmacotherapy is to date limited.
文摘Dyspepsia itself is not a diagnosis but stands for a constellation of symptoms referable to the upper gastrointestinal tract. It consists of a variable combination of symptoms including abdominal pain or discomfort, postprandial fullness, abdominal bloating, early satiety, nausea, vomiting, heartburn and acid regurgitation. Patients with heartburn and acid regurgitation invariably have gastroesophageal reflux disease and should be distinguished from those with dyspepsia. There is a substantial group of patients who do not have a definite structural or biochemical cause for their symptoms and are considered to be suffering from functional dyspepsia （FD）. Gastrointestinal motor abnormalities, altered visceral sensation, dysfunctional central nervous system-enteral nervous system （CNS- ENS） integration and psychosocial factors have all being identified as important pathophysiological correlates. It can be considered as a biopsychosocial disorder with dysregulation of the brain-gut axis being central in origin of disease. FD can be categorizeo into different subgroups based on the predominant single symptom identified by the patient. This subgroup classification can assist us in deciding the appropriate symptomatic treatment for the patient.
文摘"Psychosocial stress" is an increasingly common concept in the challenging and highly-demanding modern society of today. Organic response to stress implicates two major components of the stress system, namely the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Stress is anamnestically reported by patients during the course of disease, usually accompanied by a decline in their overall health status. As the mechanisms involving glucocorticoids and catecholamines have been deciphered, and their actions on immune cell function deeper understood, it has become clear that stress has an impact on hepatic inflam-matory response. An increasing number of articles have approached the link between psychosocial stress and the negative evolution of hepatic diseases. This article reviews a number of studies on both human populations and animal models performed in recent years, all linking stress, mainly of psychosocial nature, and the evolution of three important liver-related pathological entities: viral hepatitis, cirrhosis and hepatocellular carcinoma.
文摘The growing number of people suffering from depression has become a social problem in Japan. The problems associated with depression in Japan have been influenced by the pharmaceuticalization of mental health. Since selective serotonin reuptake inhibitors were introduced to Japan＇s pharmaceutical market in 1999, demand for anti-depressant medications has rapidly expanded. It seems likely then that the efforts of pharmaceutical companies, as part of their marketing strategies, to increase people＇s awareness of mental illness have led people who are not actually depressed to have medical consultations and drug treatments for it. This phenomenon is known as ＂disease mongering＂ and has been reported on. Problems exist from the medical perspective also and include the following： expansion of the diagnostic criteria for depression as formulated in the American Psychiatric Association＇s Diagnostic and Statistical Manual of Mental Disorders; treatments that rely heavily on drugs; and biomedicalization. Another reason for the increase in medical consultations is the declining function of communal bodies. This has resulted in individuals struggling psychologically, for example, with anxiety, worry, and depression. In summary, this sociological research analyzed the problems of depression in ｜apan and revealed how the pharmaceuticalization of mental health accelerates the individualization of social problem.
