Symptom anticipation and the learned visceral response: a major neglected determinant of morbidity in functional and organic disorders.
This article explores the idea that symptoms in certain functional and organic disorders may be precipitated by a patient's anxiety in anticipation of that symptom's recurrence (symptom anticipation). Furthermore, through a process of learning from earlier experience, the induction of symptoms may be a highly directed process mediated by the nervous system and driven by the patient's apprehension or anxiety. In some patients this anticipation may be a major factor in causing a seemingly deteriorating clinical situation, which is often poorly responsive or unresponsive to conventional and perhaps previously effective medication. This situation tends to evoke a response from the treating physician that may lead to a course of action potentially dangerous to the patient through the use of more invasive diagnostic procedures, second-line drugs with more hazardous side effects, or even surgery. This article attempts to demonstrate that psychosomatic processes may be of considerable importance in mediating suffering through a defined mechanism in patients with established organic disease states.
Melmed
R N
RN
Department of Medicine B, Hadassah University Hospital, Jerusalem, Israel.
Roth
D
D
Edelstein
E
E
D001007:Anxiety / Q000503:physiopathology / Q000523:psychology; D002395:Catecholamines / Q000378:metabolism; D003213:Conditioning, Psychological; D006801:Humans; D007858:Learning; D011602:Psychophysiologic Disorders / Q000503:physiopathology / Q000523:psychology*; D014781:Viscera / Q000503:physiopathology
D002395:Catecholamines