& 2015 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.
Psychosomatics 2015:56:213–215
Letters to the Editor
Characteristics and Trends of Psychosomatic Medicine in Top Mainstream Medical Journals TO THE EDITOR: Sean P. Heffernan and Theodore A. Stern explain the background of their investigation as “the field of psychosomatic medicine/consultation-liaison psychiatry, now a subspecialty in psychiatry, has focused its efforts on clinical care, education, and research at the interface of psychiatry, medicine, and neurology.”1 Regardless of the main purpose of their article, which is to trace the changes in the content covered in 3 major journals of this field, it raises important questions concerning the trends in the mainstream medical journals related to the recognition of the so-called psychosomatic approach or psychosomatic paradigm. In the early years of the publications of journals such as “Psychosomatic Medicine” and “Psychosomatics,” many doctors sought to combine psychopathology and pathogenesis of somatic changes of internal organs as a form of alternative or complementary medicine. Mainstream medical journals very slowly and carefully incorporated considerations related to the significance of psychopathologic factors and disorders of the nervous system for the understanding of the pathogenesis of diseases such as atherosclerosis and coronary heart disease.2,3 At the same time, we should emphasize the fact that recognizing the significance of the interactions of behavioral, psychopathologic, and Psychosomatics 56:2, March/April 2015
neurologic factors with the environmental influences in pathogenesis of the most common diseases by the broad communities of general practitioners, internists, and primary care physicians is extremely important for the efficiency of everyday clinical practice.4 One should also notice that deepened knowledge of general practitioners (nonpsychiatrists) on the importance of integrated care and psychotherapeutic performance can make the health care more efficient in those countries where there are considerable organizational difficulties resulting, for example, in the form of the so-called long waiting lists for visits to specialists. So, it seems to me that the article by Sean P. Heffernan and Theodore A. Stern should inspire us to take similar efforts to assess the changes in the presentation of the psychosomatic approach or the theory of interactions of behavioral factors in the etiopathogenesis of common diseases and the need for an integrated method of treatment both in widely read, popular medical journals and in contemporary medical studies and postgraduate educational programs. Perhaps it is a methodologic problem of how to perform such analyses of the content of articles published in such journals as “The New England Journal of Medicine” or “The Lancet.” However, I propose here some means that should facilitate the realizations of such examinations. One of the parameters to be taken into account in such analyses could be the number of citations of articles
from journals that are (a) published by strictly psychologic communities and (b) highlight their adherence to behavioral sciences. An example of this kind of articles mentioned could be the publication by Hillbrand et al.5 It is possible to determine quickly, by means of the Web of Knowledge website, that there are 74 journals in the field of psychology with Impact Factor. Recently, these psychologic journals are available through Medline (PubMed) System. There are 49 journals in Impact Factor belonging to the category of behavioral sciences. It seems to me that the method used by Sean P. Heffernan and Theodore A. Stern, who analyzed the articles most often downloaded from the websites of 3 journals considered “psychosomatic,” is also quite effective. If we take into account that from the point of view of the psychosomatic paradigm, the psychopathologic and social factors are essential to the development, prevention, and treatment of most diseases and clinical situations, the cursory overview of the articles most downloaded from websites of the aforementioned 2 top mainstream medical journals (The New England Journal of Medicine and The Lancet) suggests that these substances do not attract much attention for authors and readers of these journals. This should prompt an accurate analysis of “characteristics and trends” of many medical journals regarding the appreciation of a psychosomatic approach. If there are grounds for concern about the quality of health care in a country (long waiting times to see specialists), a planned analysis should consider the www.psychosomaticsjournal.org
213
Letters to the Editor medical journals that are the most popular and are read in national languages. Andrzej Brodziak, M.D., Ph.D. Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
References 1. Heffernan SP, Stern TA: Characteristics and trends in peer-reviewed publications in the field of psychosomatic medicine. Psychosomatics 2014; 55 (5):450–457 2. Gutstein WH: The central nervous system and atherogenesis: endothelial injury. Atherosclerosis 1988; 70(1-2): 145–154 3. Serrano CV, Setani KT, Sakamoto E, Andrei AM, Fraguas R: Association between depression and development of coronary artery disease: pathophysiologic and diagnostic implications. Vasc Health Risk Manag 2011; 7:159–164 4. Sivik T: Education of general practitioners in psychosomatic medicine. Effects of a training program on the daily work at Swedish primary health care centers. Gen Hosp Psychiatry 1992; 14(6):375–379 5. Hillbrand M, Waite BM, Rosenstein M, Harackiewicz D, Lingswiler VM, Stehney M: Serum cholesterol concentrations and non-physical aggression in healthy adults. J Behav Med 2005; 28:295–299
Factitious Mastectomy and Hysterectomy: The Importance of Staying Abreast of the Medical Record TO THE EDITOR: We read with great interest the article by Hamre et al.1 in the recent issue of Psychosomatics, which describes a case of a woman who presented with a factitious history of breast and cervical cancer. In her particular case, she 214
www.psychosomaticsjournal.org
had the physical manifestations of prior surgeries that supported her history, a finding that shows the lengths at which some patients go to bolster their story. In reviewing the literature for similar cases, the salient point brought up by the authors is the importance of a thorough medical history, which in some cases may require review of the medical records. In the authors' case, a history of psychiatric illness and vague and inconsistent details prompted this further step. It is interesting to note that in the authors' review of the literature, most cases of factitious disorder were discovered after the fact, which underlies the difficulty and importance of obtaining a timely diagnosis. The authors' vigilance in examining the medical records is to be commended. However, one facet of the discussion that has not been given adequate attention is the importance of recognizing the clinical profile of these patients.2,3 SHAFT disorder, which stands for sad, hostile, anxious, frustrating, and tenacious, describes a constellation of personality traits that tend to cluster in patients who manipulate physicians into performing unnecessary surgeries for the purpose of assuming the sick role.4 In the largest series to date, we have presented a series of 28 patients who displayed features of SHAFT syndrome.5 We have also identified objective findings that correlate with this diagnosis—patients with this disorder tend to be women, describe physical findings out of proportion to objective findings, cry with pain, and have a psychiatric history. We believe that this expanded profile can be a very useful tool in helping a physician determine when extra caution and
review of the medical records may be necessary. Joshua Choo, M.D. Morton Kasdan, M.D., F.A.C.S. Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, KY Dean Louis, M.D. Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, MI *Send correspondence and reprint requests to Joshua Choo, M.D., Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, ACB Building, 2nd Floor, Louisville, KY 40202.
References 1. Hamre MC, Nguyen PH, Shepard SE, Caplan JP: Factitious mastectomy and hysterectomy: the importance of staying abreast of the medical record. Psychosomatics 2014; 55(2):186–190 2. Kasdan ML, Stutts JT: Factitious injuries of the upper extremity. J Hand Surg 1995; 20(3 Pt 2):S57–S60 3. Louis DS, Jebson PJ: Factitious disorders. Tech Hand Up Extrem Surg 1998; 2(2):88–93 4. Wallace PF, Fitzmorris CS: The S-HA-F-T syndrome in the upper extremity. J Hand Surg 1978; 3(5):492–494 5. Kasdan ML, Soergel TM, Johnson AL, Lewis K, White WL: Expanded profile of the SHAFT syndrome. J Hand Surg 1998; 23(1):26–31
Comment on “Metabolic Syndrome and Elevated C-Reactive Protein Levels in Elderly Patients With Newly Diagnosed Depression” TO THE EDITOR: We read with great interest the article by Park et al.1 who elegantly highlighted the relationship between depression and metabolic syndrome in elderly Korean patients. Psychosomatics 56:2, March/April 2015
Psychosomatics 2015:56:213–215
Letters to the Editor
Characteristics and Trends of Psychosomatic Medicine in Top Mainstream Medical Journals TO THE EDITOR: Sean P. Heffernan and Theodore A. Stern explain the background of their investigation as “the field of psychosomatic medicine/consultation-liaison psychiatry, now a subspecialty in psychiatry, has focused its efforts on clinical care, education, and research at the interface of psychiatry, medicine, and neurology.”1 Regardless of the main purpose of their article, which is to trace the changes in the content covered in 3 major journals of this field, it raises important questions concerning the trends in the mainstream medical journals related to the recognition of the so-called psychosomatic approach or psychosomatic paradigm. In the early years of the publications of journals such as “Psychosomatic Medicine” and “Psychosomatics,” many doctors sought to combine psychopathology and pathogenesis of somatic changes of internal organs as a form of alternative or complementary medicine. Mainstream medical journals very slowly and carefully incorporated considerations related to the significance of psychopathologic factors and disorders of the nervous system for the understanding of the pathogenesis of diseases such as atherosclerosis and coronary heart disease.2,3 At the same time, we should emphasize the fact that recognizing the significance of the interactions of behavioral, psychopathologic, and Psychosomatics 56:2, March/April 2015
neurologic factors with the environmental influences in pathogenesis of the most common diseases by the broad communities of general practitioners, internists, and primary care physicians is extremely important for the efficiency of everyday clinical practice.4 One should also notice that deepened knowledge of general practitioners (nonpsychiatrists) on the importance of integrated care and psychotherapeutic performance can make the health care more efficient in those countries where there are considerable organizational difficulties resulting, for example, in the form of the so-called long waiting lists for visits to specialists. So, it seems to me that the article by Sean P. Heffernan and Theodore A. Stern should inspire us to take similar efforts to assess the changes in the presentation of the psychosomatic approach or the theory of interactions of behavioral factors in the etiopathogenesis of common diseases and the need for an integrated method of treatment both in widely read, popular medical journals and in contemporary medical studies and postgraduate educational programs. Perhaps it is a methodologic problem of how to perform such analyses of the content of articles published in such journals as “The New England Journal of Medicine” or “The Lancet.” However, I propose here some means that should facilitate the realizations of such examinations. One of the parameters to be taken into account in such analyses could be the number of citations of articles
from journals that are (a) published by strictly psychologic communities and (b) highlight their adherence to behavioral sciences. An example of this kind of articles mentioned could be the publication by Hillbrand et al.5 It is possible to determine quickly, by means of the Web of Knowledge website, that there are 74 journals in the field of psychology with Impact Factor. Recently, these psychologic journals are available through Medline (PubMed) System. There are 49 journals in Impact Factor belonging to the category of behavioral sciences. It seems to me that the method used by Sean P. Heffernan and Theodore A. Stern, who analyzed the articles most often downloaded from the websites of 3 journals considered “psychosomatic,” is also quite effective. If we take into account that from the point of view of the psychosomatic paradigm, the psychopathologic and social factors are essential to the development, prevention, and treatment of most diseases and clinical situations, the cursory overview of the articles most downloaded from websites of the aforementioned 2 top mainstream medical journals (The New England Journal of Medicine and The Lancet) suggests that these substances do not attract much attention for authors and readers of these journals. This should prompt an accurate analysis of “characteristics and trends” of many medical journals regarding the appreciation of a psychosomatic approach. If there are grounds for concern about the quality of health care in a country (long waiting times to see specialists), a planned analysis should consider the www.psychosomaticsjournal.org
213
Letters to the Editor medical journals that are the most popular and are read in national languages. Andrzej Brodziak, M.D., Ph.D. Institute of Occupational Medicine and Environmental Health, Sosnowiec, Poland
References 1. Heffernan SP, Stern TA: Characteristics and trends in peer-reviewed publications in the field of psychosomatic medicine. Psychosomatics 2014; 55 (5):450–457 2. Gutstein WH: The central nervous system and atherogenesis: endothelial injury. Atherosclerosis 1988; 70(1-2): 145–154 3. Serrano CV, Setani KT, Sakamoto E, Andrei AM, Fraguas R: Association between depression and development of coronary artery disease: pathophysiologic and diagnostic implications. Vasc Health Risk Manag 2011; 7:159–164 4. Sivik T: Education of general practitioners in psychosomatic medicine. Effects of a training program on the daily work at Swedish primary health care centers. Gen Hosp Psychiatry 1992; 14(6):375–379 5. Hillbrand M, Waite BM, Rosenstein M, Harackiewicz D, Lingswiler VM, Stehney M: Serum cholesterol concentrations and non-physical aggression in healthy adults. J Behav Med 2005; 28:295–299
Factitious Mastectomy and Hysterectomy: The Importance of Staying Abreast of the Medical Record TO THE EDITOR: We read with great interest the article by Hamre et al.1 in the recent issue of Psychosomatics, which describes a case of a woman who presented with a factitious history of breast and cervical cancer. In her particular case, she 214
www.psychosomaticsjournal.org
had the physical manifestations of prior surgeries that supported her history, a finding that shows the lengths at which some patients go to bolster their story. In reviewing the literature for similar cases, the salient point brought up by the authors is the importance of a thorough medical history, which in some cases may require review of the medical records. In the authors' case, a history of psychiatric illness and vague and inconsistent details prompted this further step. It is interesting to note that in the authors' review of the literature, most cases of factitious disorder were discovered after the fact, which underlies the difficulty and importance of obtaining a timely diagnosis. The authors' vigilance in examining the medical records is to be commended. However, one facet of the discussion that has not been given adequate attention is the importance of recognizing the clinical profile of these patients.2,3 SHAFT disorder, which stands for sad, hostile, anxious, frustrating, and tenacious, describes a constellation of personality traits that tend to cluster in patients who manipulate physicians into performing unnecessary surgeries for the purpose of assuming the sick role.4 In the largest series to date, we have presented a series of 28 patients who displayed features of SHAFT syndrome.5 We have also identified objective findings that correlate with this diagnosis—patients with this disorder tend to be women, describe physical findings out of proportion to objective findings, cry with pain, and have a psychiatric history. We believe that this expanded profile can be a very useful tool in helping a physician determine when extra caution and
review of the medical records may be necessary. Joshua Choo, M.D. Morton Kasdan, M.D., F.A.C.S. Division of Plastic and Reconstructive Surgery, University of Louisville School of Medicine, Louisville, KY Dean Louis, M.D. Department of Orthopaedic Surgery, University of Michigan Medical Center, Ann Arbor, MI *Send correspondence and reprint requests to Joshua Choo, M.D., Department of Surgery, University of Louisville School of Medicine, 550 South Jackson Street, ACB Building, 2nd Floor, Louisville, KY 40202.
References 1. Hamre MC, Nguyen PH, Shepard SE, Caplan JP: Factitious mastectomy and hysterectomy: the importance of staying abreast of the medical record. Psychosomatics 2014; 55(2):186–190 2. Kasdan ML, Stutts JT: Factitious injuries of the upper extremity. J Hand Surg 1995; 20(3 Pt 2):S57–S60 3. Louis DS, Jebson PJ: Factitious disorders. Tech Hand Up Extrem Surg 1998; 2(2):88–93 4. Wallace PF, Fitzmorris CS: The S-HA-F-T syndrome in the upper extremity. J Hand Surg 1978; 3(5):492–494 5. Kasdan ML, Soergel TM, Johnson AL, Lewis K, White WL: Expanded profile of the SHAFT syndrome. J Hand Surg 1998; 23(1):26–31
Comment on “Metabolic Syndrome and Elevated C-Reactive Protein Levels in Elderly Patients With Newly Diagnosed Depression” TO THE EDITOR: We read with great interest the article by Park et al.1 who elegantly highlighted the relationship between depression and metabolic syndrome in elderly Korean patients. Psychosomatics 56:2, March/April 2015
