From the New England Journal of Medicine, December 23, 2004
This book summarizes many recent studies of illnesses characterized by symptoms that, as yet, have no clear pathophysiology: chronic fatigue syndrome, fibromyalgia, Gulf War illness, irritable bowel syndrome, and premenstrual dysphoria. Although the clinical manifestations of these illnesses are not identical, they have in common increased sensitivity to pain, sleep disturbance, difficulty with concentration, and labile mood. Indeed, many patients meet criteria for several of the illnesses. The book cites hundreds of recent publications and will serve as a road map for anyone interested in these common and perplexing illnesses. For each illness, Manu presents a synthesis of the literature regarding clinical manifestations, the prevalence of psychiatric diagnoses, personality profiles, "abnormal" behavior associated with the illness, cognitive testing, and neurobiologic (e.g., neuroimaging, neurotransmitter, and neuroendocrine) studies. Because it involves many different disciplines, pulling together this large and complex body of literature was no small task. Manu's review is thorough. Although he has previously argued that these syndromes are probably manifestations of a primary affective disorder, in this book he concludes otherwise. In particular, he notes that a substantial portion of patients with these disorders do not have a mood disorder. Manu cites many studies indicating that patients often believe that they are suffering from an "organic" illness, even though no well-recognized organic illness has been diagnosed, and he suggests that this constitutes "abnormal illness behavior." He also states that the literature supports a connection between the "functional somatic syndromes" and somatization disorder. However, the literature he cites indicates that most patients with these syndromes do not meet the criteria for somatization disorder. Indeed, if symptoms have an organic basis, then they cannot be said to stem from a somatization disorder, and a patient's belief that his or her suffering is due to an organic illness cannot be called "abnormal behavior." Hence, the central question: Do these functional disorders have an organic basis? What is the evidence? Manu summarizes many neurobiologic studies that have found objective, biologic abnormalities in patients with these syndromes (e.g., abnormal patterns on magnetic resonance imaging and on single-photon-emission computed tomography; abnormal responses on the testing of several hypothalamic-pituitary axes), in contrast to matched, healthy subjects and patients with psychiatric disorders, particularly major depression. Perhaps the most interesting question raised by this book is this: What are "functional somatic syndromes"? The question is never explicitly addressed or answered. For many physicians, the word "functional" implies an illness that probably has no biologic cause, with symptoms that reflect a weakness of character or outright malingering. The literature summarized in this book argues that such inferences are unfounded. Indeed, in my view, the continued use of the term "functional" by mental health professionals perpetuates an archaic notion of mind-body dualism. The symptoms of these "functional" illnesses probably have biologic underpinnings, even though the articulation of a patient's suffering clearly is influenced by personal experiences and cultural values. Although we are a long way from identifying the precise pathophysiology of these illnesses, there is considerable evidence that they have an underlying biologic basis. Anthony L. Komaroff, M.D.Copyright © 2004 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.


From Book News, Inc.
Because they lack demonstrable biochemical and structural abnormalities, chronic fatigue syndrome, fibromyalgia, irritable bowel syndrome, premenstrual syndrome, and Gulf War syndrome, are viewed by most physicians as mental illnesses. Manu (clinical medicine and psychiatry, Albert Einstein College of Medicine) and his colleagues investigate these conditions over the course of 15 chapters, exploring links between psychopathology and the physical manifestations of illness; reviewing recent work in the neurological appraisal of the functional syndromes; and examining the correlation of measurable dimensions of personality, coping, and illness behavior with the severity and prognosis of medically unexplainable illness.Copyright © 2004 Book News, Inc., Portland, OR

FROM THE PUBLISHER

"This book examines the link between mental illness and physical syndromes that lack organic disease explanations, including chronic fatigue syndrome, fibromyalgia, premenstrual dysphoria, irritable bowel, and Gulf War illness." "The author has evaluated the best research work of the past twenty years to determine the association between psychopathology and functional illness, the biological gradient between somatic and psychological symptoms, and the manifestations of dysfunctional coping." The Psychopathology of Functional Somatic Syndromes challenges recent conceptualizations of functional somatic syndromes as brain disorders connected to affective spectrum disorder, serotonin deficiency, cerebral hypoperfusion, or abnormal hypothalamic-pituitary-adrenal functional and highlights the importance of abnormal illness behavior, sexual victimization, and maladaptive coping for the production and maintenance of these disorders.

SYNOPSIS

Learn how a patient?s behavior can factor into the prognosis of medicallyunexplainable illness!

The Psychopathology of Functional Somatic Syndromes examines the linkbetween mental illness and physical syndromes that lack organic diseaseexplanations, including chronic fatigue syndrome, fibromyalgia,premenstrual dysphoria, irritable bowel, and Gulf War illness.

The author has evaluated the best research work of the past 20 years todetermine the association between psychopathology and functional illness,the biological gradient between somatic and psychological symptoms, and themanifestations of dysfunctional coping.

The Psychopathology of Functional Somatic Syndromes challenges recentconceptualizations of functional somatic syndromes as brain disordersconnected to affective spectrum disorder, serotonin deficiency, cerebralhypoperfusion or abnormal hypothalamic-pituitary-adrenal function andhighlights the importance of abnormal illness behavior, sexualvictimization, and maladaptive coping for the production and maintenance ofthese disorders.

The Psychopathology of Functional Somatic Syndromes explores observationson the neurobiology and the personality abnormalities of patients made fromstructured data collected over a period of several years. It describesmodern perceptions of functional somatic syndromes and how they haveevolved into a tightly knit family of self-standing syndromes with a commoncore. The book examines the correlation between the burden ofpsychopathology and the physical features of these illnesses; reviewsadvances made in the appraisal of the neuroanatomy, neuropsychology, andneurochemistry of functional syndromes; and focuses on the connectionbetween measurable dimensions of personality, coping, and illness behaviorand the prognosis of medically unexplainable illnesses.

The Psychopathology of Functional Somatic Syndromes examines:

psychiatric morbiditybrain perfusionpost-traumatic stress in Gulf War illnessthe spectrum of mood disordersthe hypothalamatic-pituitary-adrenal axisthe sexual victimization of patientsand much more!

The Psychopathology of Functional Somatic Syndromes is an essentialresource for psychiatrists and psychologists working in outpatientpractice.

FROM THE CRITICS

- MD, Editor, International Journal of Psychiatry in Medicine; Author of Chronic Pain: Biomedical and Spiritual Approaches; Associate Professor of Psychiatry and Medicine, Duke University Medical Center

Perhaps THE MOST COMPREHENSIVE TEXT EVER WRITTEN on the functional somatic syndromes. Easy reading and immensely informative, this book is A MUST FOR ALL PRIMARY CARE PHYSICIANS AND MENTAL HEALTH PROFESSIONALS. I can think of no better or more enjoyable way to learn about these fascinating, complex, and extremely common disorders.

John DeLuca - PhD, Director of Neuroscience Research, Kessler Medical Rehabilitation Research and Education Corporation; Professor, UMDNJ-New Jersey Medical School