Friday, December 18, 2009

Psychosomatic aspects of Cushing’s syndrome

Psychosomatic aspects of Cushing’s syndrome

Reviews in Endocrine & Metabolic Disorders

Springer Netherlands

1389-9155 (Print) 1573-2606 (Online)


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SpringerLink Date
Thursday, December 03, 2009

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Psychosomatic aspects of Cushing’s syndrome

Nicoletta Sonino1, 2, 3 Contact Information, Francesco Fallo4 and Giovanni A. Fava3, 5

Department of Statistical Sciences, University of Padova, Via Battisti 241, 35121 Padova, Italy

Department of Mental Health, Padova, Italy

Department of Psychiatry, State University of New York at Buffalo, Buffalo, NY, USA

Department of Medical and Surgical Science, University of Padova, Padova, Italy

Department of Psychology, University of Bologna, Bologna, Italy

Published online: 4 December 2009

Abstract  There has been growing interest in the psychosocial aspects of Cushing’s syndrome, such as the role of life stress as a pathogenetic factor, the association with affective disorders, and the presence of residual symptoms after treatment.

Interestingly, a temporal relationship between stressful life events and disease onset is relevant only to pituitary-dependent Cushing’s disease, and not to the pituitary-independent forms. A number of psychiatric and psychological disturbances may be associated with the active hypercortisolemic state, regardless of its etiology.

Within the high frequency of mood disorders (about 60%), major depression is the most common complication. Other psychopathological aspects include mania, anxiety disorders, psychological symptoms (demoralization, irritable mood, somatization) and cognitive impairment. Cognitive symptoms are associated with brain abnormalities (mainly loss of brain volume).

Quality of life may be seriously compromised during both active and post-treatment phases. Long-standing hypercortisolism may imply a degree of irreversibility of the pathological process. Recovery, thus, may be delayed and be influenced by highly individualized affective responses.

Outcomes of Cushing’s syndrome treatment are not fully satisfactory. Within its great complexity, a conceptual shift from a merely biomedical care to a psychosomatic consideration of the person and his/her quality of life appears to be necessary to improve effectiveness. It is time to translate the research evidence that has accumulated into clinical practice initiatives.

To patients who show persistence or even worsening of psychological distress upon adequate endocrine treatment psychiatric/psychological interventions should be readily available. Applying interdisciplinary expertise and addressing the needs for rehabilitation would markedly improve final outcome.

Keywords  Cushing’s syndrome - Psychosomatic medicine - Quality of life - Life events - Depression - Cognitive impairment

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Nicoletta Sonino

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