Clinical Challenges in the Biopsychosocial Interface

Clinical Challenges in the Biopsychosocial Interface

Advances in Psychosomatic Medicine Vol. 34 Series Editor T.N. Wise Falls Church, Va. Editors R. Balon Detroit, Mich. G.A. Fava Bologna I. Fukunishi Tokyo M.B. Rosenthal Cleveland, Ohio

Clinical Challenges in the Biopsychosocial Interface Update on Psychosomatics for the 21st Century Volume Editors R. Balon Detroit, Mich. T.N. Wise Falls Church, Va. 9 Figures, 16 tables, 2015 Basel Freiburg Paris London New York Chennai New Delhi Bangkok Beijing Shanghai Tokyo Kuala Lumpur Singapore Sydney

Advances in Psychosomatic Medicine Founded 1960 by F. Deutsch (Cambridge, Mass.) A. Jores (Hamburg) B. Stockvis (Leiden) Continued 1972 1982 by F. Reichsman (Brooklyn, N.Y.) Library of Congress Cataloging-in-Publication Data Clinical challenges in the biopsychosocial interface : update on psychosomatics for the 21st century / volume editors, R. Balon, T.N. Wise. p. ; cm. -- (Advances in psychosomatic medicine, ISSN 0065-3268 ; vol. 34) Includes bibliographical references and indexes. ISBN 978-3-318-02966-6 (hard cover : alk. paper) -- ISBN 978-3-318-02967-3 (electronic version) I. Balon, Richard, editor. II. Wise, Thomas N., editor. III. Series: Advances in psychosomatic medicine ; v. 34. 0065-3268 [DNLM: 1. Psychosomatic Medicine--methods. W1 AD81 v.34 2015 / WM 90] RC49 616.08--dc23 2015002067 Bibliographic Indices. This publication is listed in bibliographic services, including Current Contents and Index Medicus. Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements. Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 2015 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) www.karger.com Printed in Germany on acid-free and non-aging paper (ISO 9706) by Kraft Druck, Ettlingen ISSN 0065 3268 e-issn 1622 2855 ISBN 978 3 318 02966 6 e-isbn 978 3 318 02967 3

Contents VII Preface Balon, R. (Detroit, Mich.); Wise, T.N. (Falls Church, Va.) 1 Psychosomatic Medicine in the 21st Century: Understanding Mechanisms and Barriers to Utilization Wise, T.N. (Falls Church, Va.); Balon, R. (Detroit, Mich.) 10 Communication with Patients Suffering from Serious Physical Illness Grassi, L.; Caruso, R. (Ferrara); Costantini, A. (Rome) 24 Dimensional Psychopharmacology in Somatising Patients Biondi, M.; Pasquini, M. (Rome) 36 Forensic Issues in Medical Evaluation: Competency and End-of-Life Issues Soliman, S. (Northfield, Ohio); Hall, R.C.W. (Orlando, Fla.) 49 Then and Now HIV Consultation Psychiatry Update Goforth, H.W. (Cleveland, Ohio); Bader, M. (Chapel Hill, N.C.); Fernandez, F. (Harlington, Tex.) 61 Fibromyalgia and Chronic Fatigue: The Underlying Biology and Related Theoretical Issues Romano, G.F. (London); Tomassi, S. (Verona); Russell, A.; Mondelli, V.; Pariante, C.M. (London) 78 Fibromyalgia and Chronic Fatigue Syndrome: Management Issues Bourke, J. (London) 92 Telomeres, Early-Life Stress and Mental Illness Ridout, S.J.; Ridout, K.K.; Kao, H.-T.; Carpenter, L.L.; Philip, N.S.; Tyrka, A.R.; Price, L.H. (Providence, R.I.) 109 Coping with Losses, Grief, and Mourning in Prostate Cancer Wittmann, D. (Ann Arbor, Mich.) 123 Psychodermatology Brown, G.E. (Tucson, Ariz./San Francisco, Calif.); Malakouti, M. (San Francisco, Calif./North Chicago, Ill.); Sorenson, E. (San Francisco, Calif./Los Angeles, Calif.); Gupta, R. (Berywn, Ill.); Koo, J.Y.M. (San Francisco, Calif.) 135 Huntington s Disease: Looking Beyond the Movement Disorder Morreale, M.K. (Detroit, Mich.) V

143 Joint Hypermobility, Anxiety and Psychosomatics: Two and a Half Decades of Progress Toward a New Phenotype Bulbena, A.; Pailhez, G. (Barcelona); Bulbena-Cabré, A. (Barcelona/New York, N.Y.); Mallorquí-Bagué, N. (Barcelona); Baeza-Velasco, C. (Paris) 158 Author Index 159 Subject Index VI Contents

Preface Medicine has always been a changing field in terms of explanations of disease states, the appearance of new disorders, and therapeutic interventions. Psychiatry and psychosomatic medicine are in a dramatic state of change if one takes a decades-long perspective. Only a century ago, therapeutic options were almost nonexistent for the major psychoses. Within two decades, convulsive therapies offered an option for psychotic depressions. A few decades later, the advent of neuroleptics offered hope to those with schizophrenia who previously languished in isolated hospital wards. More recently, newer antidepressants have minimized side effects and allowed primary care physicians to effectively treat uncomplicated mood and anxiety disorders. However, as time moves forward, problems both persist in the limited access of patients with psychiatric disorders to care and arise with new challenges, such as the reduced length of stay demanded by third-party payors and the ever-increasing prices of both new and old treatments. Another challenge is the high comorbidity of chronic mental illnesses and various chronic physical illnesses, such as diabetes mellitus, obesity, and cardiovascular disease, which significantly contributes to the shortened lifespan of people with chronic mental illness. Finally, the stigmas of mental illness, substance abuse, and some physical illnesses present yet another challenge, as they constitute yet another barrier in access to health care, especially in patients with multiple stigmatizing conditions. The rise of population medicine, with special attention to preventive measures and to the importance of treating psychiatric disorders, substance abuse, and comorbid illnesses, may offer better treatments and increased access to care. Psychosomatic medicine is considered to be one of the leading approaches to treating comorbid disorders and conditions, such as distress in the patient with cancer, demoralization and depression in the dermatological patient, or anxiety in the patient awaiting surgery. This volume addresses new, psychosomatic views on such conditions and approaches. It crisscrosses psychosomatic medicine, from basic sciences to clinical medicine, and discusses areas previously covered rarely, if at all, such as telomeres and mental illness, communication with seriously ill patients, fibromyalgia, psychiatric symptomatology in Huntington s disease, grieving in prostate cancer patients, and dimensional psychopharmacology. We hope that this volume offers new ideas and increased recognition of the advances of contemporary psychosomatic medicine. Richard Balon, MD Thomas N. Wise, MD VII