Medically Unexplained Symptoms: A Brain-Centered Approach

ISBN-13: 9783030591809 / Angielski / Miękka / 2020 / 204 str.

Robert W. Baloh

Spis treści

Introduction

 

Chapter 1. Overview of Medically Unexplained Symptoms

                Pain

                Brain flaws

                Fear

                Anxiety

                Dizziness

                Stress

                Fatigue

                Diagnostic uncertainty

 

Chapter 2. Early ideas on hysteria

                Hysteria and female sexuality

                Bizarre behaviors

                Hysteria and the occult

                Nerves

                Hysteria, a nervous disorder

                Early treatments of hysteria

                Spinal irritation and the spinal reflex theory

                The attack on the female genitalia

                Hysteria and fasting girls

 

Chapter 3. The Golden age of Hysteria

                Briquet’s syndrome

                Charcot and his hysterical circus

                Hysteria and hypnosis

                Borderlands of hypnosis

                Nature or nurture

                Ideas about hysteria evolve

                Neurasthenia and neurosis

                Americanitis

                S Weir Mitchell and the Civil War

                The Rest Cure

                S Weir Mitchell, the enigma

                Nerve doctors

                Evolution and the brain

 

Chapter 4. Psychosomatic illness in the 20th Century

                Freud, the early years

                Breuer’s famous patient, Bertha Pappenheim

                Freud and Breuer’s book on hysteria

                Suppressed memories and childhood sexuality

                Freud’s model of the mind

                Overall impact of psychoanalysis

                Physicians, patients and psychosomatic symptoms

                Common sense psychotherapy

                Alternate medical treatments and suggestibility

                War and Psychogenic Illness

                PTSD the prototypical delayed stress disorder

                Relationship between PTSD and mild traumatic brain injury (mTBI)

                Psychosomatic medicine

 

Chapter 5. Biological mechanisms of Psychosomatic Symptoms

                The biological link between stress and illness

                                The hypothalamic-sympathetic-adrenal axis

                                The brain’s emotional center, the limbic system

                                The hypothalamic-pituitary-adrenal axis

                Pavlov and neural plasticity

                Hebb’s Synapse

                Molecular mechanisms of brain plasticity

                Stress and the limbic system

                                Nerve growth factors and stress

                                The amygdala-prefrontal cortex connection

                Central sensitization, a model of neuroplasticity

                                The descending pain modulatory system (DPMS)

                Brain neurotransmitters

                                Gamma aminobutyric acid (GABA)

                                Noradrenalin

                                Serotonin

                                Dopamine

                                Cannibinoids

                Stress and human behavior

                                Operant conditioning and behavioral therapy

 

Chapter 6. Psychosocial mechanisms of psychosomatic Symptoms

                How can beliefs and expectations change brain function?

                Doctor patient relationship and psychosomatic symptoms

                The power of the placebo

                Placebo’s evil twin, nocebo

                                Statins and muscle pain and weakness

                                Glutens and Celiac disease

                                Expectations and beliefs

                                Hyperventilation syndrome

                Idiopathic environmental intolerance and the nocebo effect

                                The Belgium Coca-Cola fiasco

                                Electromagnetic hypersensitivity

                                Infrasound sensitivity

                                Sick building syndrome

                Summary of Idiopathic environmental intolerance mechanisms      

 

Chapter 7. Low back pain, abdominal pain and headache

                Overview of common pain syndromes

                Low back pain

                                Historical perspective

                                Current approach to chronic low back pain

                                Physical activity and expectation 

                                Depression and fear avoidance

                Abdominal pain

                                Autonomic nervous system and the gut

                                Irritable bowel syndrome (IBS)

                                Peptic ulcer disease 

                Primary headache disorders

                Migraine as a model for psychophysiological illnesses         

                                Historical perspective

                                Migraine Auras 

                                Early ideas on the cause of migraine

                                Mechanism of the migraine aura 

                                Genetic susceptibility to migraine

 

Chapter 8. Fibromyalgia/Chronic Fatigue Syndrome

                Pain but much more

                Fibromyalgia

                                Tender points

                                Central sensitization to pain

                Repetitive strain injury (RSI)

                Chronic fatigue

                Epidemic and sporadic neuromyasthenia

                Epstein-Barr virus (EBV)

                Chronic fatigue immune dysfunction syndrome (CFIDS)

                Myalgic encephalomyelitis (ME)

                Overlap with depression and other psychogenic illnesses

                Genetics of fibromyalgia and chronic fatigue syndrome

 

Chapter 9. Chronic dizziness

                Anxiety and Dizziness

                Near faint dizziness and fainting

                                Postural orthostatic tachycardia syndrome (POTS)

                                Dizziness and mass psychogenic illness

                Persistent Postural Perceptual Dizziness (PPPD)

                Migrainous dizziness

                Post Concussion Dizziness

                Sea legs and mal de Debarquement syndrome

                Height vertigo and acrophobia

 

Chapter 10. Treatment of psychosomatic symptoms

                Lifestyle changes

                                Exercise and the brain

                                Sleep and eating habits

                Mindfulness

                Cognitive Behavioral Therapy

                Internet Directed Therapy

                Drug treatments

                Drugs that increase brain monoamines (antidepressants)

                Drugs that decrease excitatory (glutamate) transmission

                                Antiepileptic drugs

                                Anxiolytic drugs

                Drugs that enhance neuroplasticity and neurogenesis

                                Ketamine, the new “wonder drug”

                Drugs that effect endocannibinoid neurotransmission

                Extracranial Brain stimulation

                                Electroconvulsive therapy (ECT)

                                Transcranial direct current stimulation (tDCS)

                                Transcranial magnetic stimulation (TMS)

                Deep brain stimulation

                                DBS for PTSD

                Future Directions

O autorze

Robert W. Baloh MD

Distinguished Professor of Neurology

David Geffen School of Medicine at UCLA

Los Angeles, CA

Blurb

Despite the rapid advances in medical science, the majority of people who visit a doctor have medically unexplained symptoms (MUS), symptoms that remain a mystery despite extensive diagnostic studies. The most common MUS are back pain, abdominal pain, headache, fatigue, and dizziness.  This book addresses the obstacles of managing people with MUS in our modern day society from both a historical and contemporary perspective.

Most MUS are psychosomatic in origin, caused by a complex interaction between nature and nurture, between biological and psychosocial factors.  Psychosomatic symptoms are as real and as severe as the symptoms associated with structural damage to the brain.  Unique and concise, the book explores the biological and psychosocial mechanisms, the clinical features, and current and future treatments of common MUS. 

Exploring the unsolved in an accessible manner, Medically Unexplained Symptoms invokes the methodologies of medical science, history, and sociology to investigate how brain flaws can lead to debilitating symptoms.