NGHIÊN cứu đặc điểm lâm SÀNG ĐAU ở BỆNH NHÂN rối LOẠN cơ THỂ hóa điều TRỊ nội TRÚ tại VIỆN sức KHỎE tâm THẦN

1 C Cusin et al B GIO DC V O TO B Y T TRNG I HC Y H NI CAO TH NH TUYT NGHIÊN CứU ĐặC ĐIểM LÂM SàNG ĐAU BệNH NHÂN RốI LOạN CƠ THể HóA ĐIềU TRị NộI TRú TạI VIệN SứC KHỏE TÂM THầN Chuyờn ngnh : Tõm thn Mó s : 62722245 CNG LUN VN BC S NI TR NGI HNG DN KHOA HC: TS NGUYN VN TUN H NI - 2016 MC LC 2 C Cusin et al 3 C Cusin et al DANH MC CC CH VIT TT DANH MC BNG BIU, S , HèNH V T VN Trong tỡnh hỡnh th gii hin nay, chỳng ta ó v ang chng kin s phỏt trin nh v bóo ca tt c cỏc ngnh ngh, nh ú m cht lng cuc sng ca ngi ngy cng c ci thin rừ rt Tuy nhiờn, ngi li phi chu sc ộp ln hn t cụng vic, xó hi v cỏc mi quan h xung quanh Vỡ vy, cỏc ri lon liờn quan stress gp ngy cng nhiu c trờn th gii v Vit Nam Ri lon dng c th (RLDCT) l mt s nhng ri lon thng gp ú Margot W.M De Waal (2004) nghiờn cu 1046 bnh nhõn tui t 25 n 80 ti khỏm ti cỏc phũng khỏm a khoa, nhn thy RLDCT l ri lon tõm thn (RLTT) hay gp nht, chim 16,1% [1-2] Theo nghiờn cu ca P.H Hilderink, t l gp RLDCT ngi tr tui l t 11% n 21%, la tui trung niờn l 10% n 20%, cũn tui gi dao ng t 1,5% n 13% [3] Ri lon c th hoỏ (RLCTH) l mt loi RLDCT khỏ ph bin chim 0,7% dõn s Florence [4] Biu hin lõm sng ca cỏc RLCTH ht sc a dng v phong phỳ Triu chng rt ph bin, thng gp thc t lõm ca RLCTH l au au RLCTH va mang tớnh cht thc th li va mang tớnh cht ch quan tõm lý au RLCTH l mt cỏc triu chng chớnh ca cỏc ri lon ph c th húa[5] Nhiu bnh nhõn n khỏm ti cỏc c s y t vỡ triu chng au ny, v thc t trờn lõm sng h c chn oỏn v iu tr nhm theo hng thc th H ó phi tn nhiu cụng sc, thi gian v kinh t tỡm bng c nguyờn nhõn gõy au Theo c tớnh, RLCTH tiờu tn ca nc M 256 triu ụ la hng nm, tn tht ny cao gp ụi chi tr cho ỏi thỏo ng l 132 triu ụ la[5] Vit Nam cú mt s ti nghiờn cu v RLCTH nhng cha cú ti no nghiờn cu v triu chng au ca RLCTH Vỡ vy chỳng tụi tin hnh ti Nghiờn cu c im lõm sng cm giỏc au bnh nhõn ri lon dng c th iu tr ni trỳ ti Vin Sc Khe Tõm Thn nm 2016-2017, vi mc tiờu: Mụ t c im lõm sng cm giỏc au ca bnh nhõn ri lon c th húa Chng TNG QUAN TI LIU 1.1 KHI NIM V C S CM GIC AU [6],[7],[8] 1.1.1 Khỏi nim au Theo nh ngha hip hi nghiờn cu au quc t (Internation Association for the Study of Pain IASP), au l cm nhn khụng thoi mỏi tn thng mụ c th tim tng hoc ang din hoc mụ t v mt tn thng " au l tri nghim ch quan, liờn quan n cu trỳc nhn cm cp cao khụng phi ch cỏc neuron nhn cm au Nhn cm au l quỏ trỡnh phc tp, bao gm nhiu thnh phn khỏc nhau: - Thnh phn cm th quan: thuc c ch sinh lý thn kinh ca cm giỏc thõn th, gii mó cỏc lung nhn cm bn th - Thnh phn cm xỳc - Thnh phn nhn thc gm cỏc quỏ trỡnh tõm thn khỏc chi phi cm nhn au - Thnh phn hnh vi: biu hin v ng, li núi v sinh lý( cỏc ri lon thc vt, ri lon gic ng, s n ung khụng ngon ming ) Nh vy au va cú tớnh thc th (l mt cm giỏc bỏo hiu mt tn thng thc th ti ch), li va mang tớnh ch quan tõm lý (bao gm c nhng chng au khụng cú tn thng thc th hay gp trờn lõm sng) ú cỏc nhõn t tng tỏc vi v tng tỏc vi c c nhõn t mụi trng gia ỡnh, húa xó hi 1.1.2 Cỏc c s ca cm giỏc au Nhiu cụng trỡnh nghiờn cu ó cho thy c s ca cm giỏc au bao gm: c s sinh lý v c s tõm lý 1.1.2.1 C s sinh lý s nhn cm au a Cm giỏc au v hot ng ca si thn kinh au Con ng au bao gm mt lot cỏc nron bt u l th cm au, ng ny i t ngoi vi vo ty sng v lờn nóo Hiu c quỏ trỡnh thụng tin vo nóo th no l rt quan trng, cú th giỳp iu hũa tng hoc gim cm nhn au vi kớch thớch, v gúp phn lm rừ hn c ch gim au ca thuc hng thn iu tr gii lo õu v trm cm b Con ng au vo ty sng Nron tip nhn cú th cm nhn c cỏc kớch thớch cm giỏc bao gm c au, chỳng cú thõn t bo hch ty sng dc theo ct sng, chỳng nm ngoi thn kinh trung ng CNS nờn t bo ny l t bo ngoi vi Tip n quỏ trỡnh au bt u vi s thay i protein mng t bo giỳp phỏt hin nhng thay i kớch thớch v sinh s thay i in th mng t bo Cỏc kớch thớch mnh s lm gim in th ca mng v hot húa kờnh Natri nhy cm in th (VSSCs), gõy in th hot ng, v lan ta khp thõn nron ng dn truyn au t si hng tõm n h thng thn kinh trung ng cú th tng hoc gim kờnh VSSCs b chn t ngoi vi bi thuc tờ nh lidocaine - c im ỏp ng ca nron hng tõm tip nhn c xỏc nh bi cỏc receptor v cỏc kờnh bc l ngoi vi Vớ d nron th cm cú kờnh ion hot ng kộo di thng bc l receptor vanillinoid (VR1) s nhy cm vi kớch thớch c hc, hay cỏc kờnh ion c hot húa bi capsaicin v v cay, nhit s gõy cm giỏc núng Da vo nhng c im ny giỳp phõn loi nron thnh loi: A, A v si C Si C c hot húa bi tỏc ng c hc, nhit v húa hc, si A cm nhn nhng thay i chuyn ng nh, chm nh, si A cm nhn nhng tỏc ng trung gian gia nhit v c hc Tớn hiu au c dn truyn t ngoi biờn v ty sng nh hai si thn kinh A v C Si A l si cú ớt myelin, tc 6-30 m/sec, dn truyn cm giỏc au cp, A l si ỏp ng vi kớch thớch nhit v c hc Si C l si khụng cú myelin, tc 0,5-2 m/sec, dn truyn cm giỏc au mn C l si nhn cm au nhiu trng thỏi, a dng Do cú hai si dn truyn cm giỏc au nh vy nờn cú mt kớch thớch vi cng mnh s cho cm giỏc au kộp: sau mt cm giỏc au nhúi s cú mt cm giỏc au rỏt ng dn truyn cm giỏc i vo nóo chỳng c tỏch thnh ng: ng cm giỏc au nhúi v ng cm giỏc au rỏt - ng cm giỏc au nhúi: tn cựng phc hp bng- nn v liờn quan cht ch vi ni tn cựng ca cỏc si dn truyn cm giỏc xỳc giỏc Sau ú tớn hiu c truyn n cỏc vựng khỏc ca i th v vựng cm giỏc ca v nóo Tớn hiu n v nóo ch yu l khu trỳ cm giỏc au ch khụng cho bit nhn thc v au - ng cm giỏc au rỏt: nhng si cm giỏc au rỏt v au sõu tn cựng vựng cu to li ca than nóo v nhõn lỏ ca i th Cu to li ca thõn nóo v cỏc nhõn ca i th u thuc h thng hot húa chc nng ca h li Chc nng ca h thng ny l chuyn tớn hiu n cỏc b phn ch yu ca nóo Nh vy cỏc si cm giỏc au rỏt v au sõu kớch thớch vo h thng hot húa chc nng ca cu to li nờn ó tỏc dng kớch thớch vo ton h thng thn kinh nh: ỏnh giỏ i tng, to trng thỏi hng phn, to cm giỏc khn cp v phỏt ng cỏc phn ng bo v nhm lm cho i tng thoỏt nhng kớch thớch gõy cm giỏc au c Con ng cm giỏc au t ngoi vi vo nóo Tn cựng trung tõm ca nron cm nhn au ngoi biờn s synap vi nron sng sau ty sng, v truyn thụng tin lờn phớa trờn trung tõm cao hn Nron sng sau ty sng nm h thng thn kinh trung ng, l v trớ trung tõm truyn thụng tin lờn h thng thn kinh trung ng mc cao hn Cỏc cht dn truyn thn kinh sng sau ny c sn xut khụng ch nh cỏc nron th cm m cũn nh cỏc nron nm sng sau ú V mt s cỏc cht dn truyn thn kinh cú th chu tỏc ng bi cỏc thuc gim au nh opioid, SNRI, v cỏc Ligand hot ng trờn kờnh Na-Ca ( VSCCs) Trong sng sau ty sng cú mt vi loi nron: mt s nron nhn thụng tin t cỏc nron cm th ban u, mt s l cỏc t bo liờn thn kinh, v mt s l cỏc nron truyn thụng tin lờn trờn T ú cng cú cỏc ng dn truyn: ng dn truyn s khỏc bit/ cm giỏc, v ng dn truyn cm xỳc/ ng c Trong ng dn truyn s khỏc bit/ cm giỏc, thỡ nron dn i lờn theo ng i th ty sng, nron i th s chuyn thụng tin lờn v nóo vựng cm giỏc thõn th, v ng ny cho bit thụng chớnh xỏc v trớ au ca kớch thớch Cũn ng cm xỳc/ ng c dn truyn cỏc thụng tin ti cỏc nhõn nóo, v n h vin, ng ny cho bit cỏc thnh phn ca kớch thớch au Ch no ng ny cựng hot ng song hnh vi mi cú th to c cm giỏc au au bnh lý thn kinh ch tỡnh trng cú tn thng hay cú ri lon chc nng thn kinh gi l neuropathic pain, cũn au thụng thng gi l nociceptive pain ch nguyờn nhõn l hot húa si nron cm giỏc au S bin i v dn truyn ca cỏc nron hng tõm cú th b ỏnh cp trỡ cm giỏc au trng hp vng mt kớch thớch au Nron cú th b tn thng lm thay i hot ng ca cỏc nron, cho phộp s dn truyn chộo gia cỏc nron, cú th phỏt quỏ trỡnh viờm gõy cm nhn ngoi vi C ch trung ng ca au bnh lý thn kinh 10 Cm nhn trung ng theo on thay i xy sng sau ty sng trng hp nh au chi ma sau ct ct chi Kt qu ca vic kớch thớch liờn tc s gõy tỡnh trng tng cm giỏc au, hoc gõy ỏp ng kộo di hn bỡnh thng vi bt kỡ kớch thớch au no Khi cỏc receptors mng c phosphorination thỡ hot ng ca synap gia cỏc nron cú hiu qu hn, t ú s khuch i cm giỏc au v to cm giỏc au c khụng cú kớch thớch Cm nhn trung ng theo on cú liờn h vi thay i nóo vựng i th v v nóo trng hp cú kớch thớch au v c trng hp khụng cú kớch thớch au V nóo cú th hc t nhng tri nghim au t ú s trỡ v lm cm giỏc au Cú th lm giỏn on quỏ trỡnh dn truyn au trung ng bng cỏch lm nóo quờn tri nghim au, ú cng l mc tiờu ca cỏc thuc hng thn iu tr tõm thn phõn lit, lo õu v nghin cht Hi chng cm nhn trung ng trờn on cú th gõy cm nhn au c khụng cú kớch thớch au ngoi vi gm: au c, au mn tớnh, au ri lon trm cm, lo õu v c bit PTSD Ngoi cũn cú iu tit t nóo xung synapse ty sng (descending spinal synapse): Cỏc neuron t nóo i xung ty sng iu tit s nhn cm au (tng hoc gim ngng cm giỏc au) xut phỏt t ba vựng: - Cht xỏm quanh cng (periaqueduetal gray PAG): tit enkephaline, endorphine, thụng qua cỏc th th c bit l th th c ch DTTK t cỏc nron nhn cm u tiờn - Nhõn lc ( Locus Coeruleus L-C ) v phn di nhõn uụi (caudal ) ca thõn nóo c ch i xung bng Norepinephrine - Nhõn Raphe v nhõn uụi ( pallidus, obscuris ) tit serotonin vi vai trũ iu tit i xung: + c ch : qua th th HT1b/D c ch dn truyn thn kinh + Hot húa: qua th th HT3 hot húa dn truyn thn kinh 50 [1] Waal M.W.M., Ingrid A., Just A>H (2004), Somatoform disordes in general practice: Prevalence, functional impairment and comorbidity with anxiety and depressive disorders, The Bristish Journal of Psychiatry 184: 470-476 [3] Rief W, Hessel A, Braehler E Somatization symptoms and hypochondriacal features in the general population Psychosomatic Medicine 2001;63(4):595602 [4] Interian A et al (2004), The value of pseudoneurological symptoms for assessing psychopathology in primary care, Psychosomatic Medicine 66:141-146 [5] Mai F (2004), Somatization disorder A practical review, Can J of Psychiatry 49 (10): 652-661 [6] Mechanic D (1972), The concept of illness behavior, Journal of Chronic Disease 15: 189-194 [7] Hales R., Cloninger C et al (1994), Somatoform disoders, Diagnostic and Statistical Manual of Mental Disorder, DSM-IV: 455-470 [8] Kaplan H., Sadock B (1995), Somatoform disorders, Comprehensive Textbook of Psychiatry-VI, vol 1, sixth edition, chapter 18: 1251-1270 [9] Martin R., Yutzy S (1999), Somatoform disorder, Am Psy Press11: 413-437 [10] Trn Hu Bỡnh (1995), Nhn xột c im lõm sang cỏc ri lon dng c th qua 15 bnh nhõn iu tr ti Vin sc khe tõm thn, Lun tt nghip bỏc s chuyờn khoa cp II, i hc Y H Ni [11] Trn Vit Ngh (2003), Stress v cỏc ri lon liờn quan stress lõm sang tõn thn hc, Cỏc ri lon liờn quan vi stress v iu tr tõm 51 thn, Bi ging dnh cho hc viờn SH, B mụn tõm thn hc, i hc Y H Ni, Tr 3-10 [12] Trn Hu Bỡnh (2003), Cỏc ri lon dng c th, Cỏc ri lon liờn quan vi stress v iu tr tõm thn, Bi ging dnh cho hc viờn SH, B mụn tõm thn hc, i hc Y H Ni, Tr 50-60 [13] T chc Y t th gii (1992), Ri lon phõn ly (chuyn di) , ICD-10, WHO, Geneve, Tr 129-14 [14] T chc Y t th gii (1992), Ri lon dng c th, ICD-10, WHO, Geneve, Tr 140-150 [15] Hales R., Cloninger C et al (1994), Dissociative disorders, Diagnostic and Statistical Manual of Mental Disorder, DSM-IV:477-492 [16] B mụn sinh lý hc (2000) Sinh lý au Chuyờn sinh lý hc, Trng i hc Y H Ni, trang: 138-152 [17] B mụn sinh lý hc (2002) Sinh lý thn kinh Sinh lý hc c s, Trng i hc Y H Ni, trang: 229-232 [18] Grenn J.H (2001) Cỏc dõy thn kinh ng v cm giỏc Sinh lý hc lõm sng c s Nh xut bn Y hc, trang 325-356 [19] Stein, C, (1995) Morphine A local analgesic Pain: Clinical Updates [20] Clark MR, Chodynicki MP, (2005) Pain management Textbook of psychosomatic medicine Arlington: American Psychiatric Publishing, Inc.; p 82767 [21] Mallouh SK, Abbey SE, Gillies LA The role of loss in treatment outcomes of persistent somatization General Hospital Psychiatry 1995;17(3)18791 [PubMed] [22] Mattila AK, Kronholm E, Jula A, Salminen JK, Koivisto AM, Mielonen RL, Joukamaa M Alexithymia and somatization population Psychosomatic Medicine 2008;70(6):71622 in general 52 [23] Grabe HJ, Spitzer C, Freyberger HJ Alexithymia and personality in relation to dimensions of psychopathology The American Journal of Psychiatry 2004:1299301 [24] Lemche E, Klann-Delius G, Koch R, Joraschky P Mentalizing language development in a longitudinal attachment sample: implications for alexithymia Psychotherapy & Psychosomatics.2004;73(6):36674 [25] Maunder RG, Hunter JJ Attachment and psychosomatic medicine: developmental contributions to stress and disease.Psychosomatic Medicine 2001;63(4):55667 [26] Ciechanowski PS, Walker EA, Katon WJ, Russo JE Attachment theory: a model for health care utilization and somatization Psychosomatic Medicine 2002;64(4):6607 [27] Taylor R, Mann A, White N, Goldberg D Attachment style in patients with unexplained physical complaints Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences 2000;30(4):93141 [28] Landa A Beyond the unexplainable pain: Relational dynamics and alexithymia in somatization Dissertation Abstracts International: Section B: The Sciences and Engineering.2009;70(6-B):2009 [29] Blaustein JP, Tuber SB Knowing the unspeakable: somatization as an expression of disruptions in affective-relational functioning Bulletin of the Menninger Clinic 1998;62(3):35165 [30] Eisenberger NI, Lieberman MD Why rejection hurts: A common neural alarm system for physical and social pain Trends in Cognitive Sciences 2004;8(7):294300 [31] Eisenberger NI Identifying the Neural Correlates Underlying Social Pain: Implications for Developmental Processes Human Development 2006;49(5):27393 53 [32] Kuhn CM, Schanberg SM Responses to maternal separation: mechanisms and mediators International Journal of Developmental Neuroscience 1998;16(3-4):26170 [33] Hofer MA In: Developmental neuroscience Berntson Gary G., editor Vol 2009 pp 1231 [34] Dickinson AL, Leach MC, Flecknell PA Influence of early neonatal experience on nociceptive responses and analgesic effects in rats Laboratory Animals 2009;43(1):116 [35] Coutinho SV, Plotsky PM, Sablad M, Miller JC, Zhou H, Bayati AI, McRoberts JA, Mayer EA Neonatal maternal separation alters stress-induced responses to viscerosomatic nociceptive stimuli in rat American Journal of Physiology - Gastrointestinal & Liver Physiology 2002;282(2):G30716 [36] Bernardi M, Genedani S, Tagliavini S, Bertolini A Effects on long-term sensitivity to pain and morphine of stress induced in the newborn rat by pain or manipulation Physiology & Behavior.1986;37(5):82731 [37] Kalinichev M, Easterling KW, Holtzman SG Repeated neonatal maternal separation alters morphine-induced antinociception in male rats Brain Research Bulletin.2001;54(6):64954 [38] Barreau F, de Lahitte JD, Ferrier L, Frexinos J, Bueno L, Fioramonti J Neonatal maternal deprivation promotes Nippostrongylus brasiliensis infection in adult rats Brain, Behavior, & Immunity 2006;20(3):25460 [39] Caldji C, Francis D, Sharma S, Plotsky PM, Meaney MJ The effects of early rearing environment on the development of GABAA and central benzodiazepine receptor levels and novelty-induced fearfulness in the rat Neuropsychopharmacology.2000;22(3):21929 54 [40] Hagekull B, Bohlin G Predictors of Middle Childhood Psychosomatic Problems: An Emotion Regulation Approach.Infant and Child Development 2004;13(5):389405 [41] Karibe H, Arakawa R, Tateno A, Mizumura S, Okada T, Ishii T, Oshima K, Ohtsu M, Hasegawa I, Okubo Y Regional cerebral blood flow in patients with orally localized somatoform pain disorder: a single photon emission computed tomography study.Psychiatry & Clinical Neurosciences 2010;64(5):47682 [42] Moles A, Kieffer BL, D'Amato FR Deficit in attachment behavior in mice lacking the mu-opioid receptor gene Science.2004;304(5679):19836 [43] Barr CS, Schwandt ML, Lindell SG, Higley JD, Maestripieri D, Goldman D, Suomi SJ, Heilig M Variation at the mu-opioid receptor gene (OPRM1) influences attachment behavior in infant primates Proceedings of the National Academy of Sciences of the United States of America; 2008; pp 527781 [44] Limer KL, Nicholl BI, Thomson W, McBeth J Exploring the genetic susceptibility of chronic widespread pain: the tender points in genetic association studies Rheumatology 2008;47(5):5727 [45] Buskila D Genetics of chronic pain states Best Practice & Research in Clinical Rheumatology 2007;21(3):53547 [46] Mann NH, Brown MD, Hertz DB, Enger I, Tompkins J Initialimpression diagnosis using Low-back pain patient pain drawing Spine 1993;18:4153 [47] Chan CW, Goldman S, Ilstrup DM, Kunselman AR, ONeill PI The pain drawing and Waddels nonorganic physical signs in chronic Low-back pain Spine 1993;13:17171722 55 [48] Toomingas A Characteristics of pain drawings in the neck-shoulder region among the working population Int Arch Occup Env Health 1999;72:98106 [49] Bertilson B, Grunnesjử M, Johansson SE, Strender LE Pain drawing in the assessment of neurogenic pain and dysfunction in the neck/shoulder region: inter-examiner reliability and concordance with clinical examination Pain Med 2007;8(2):134146 [50] Broadbent E, Niederhoffer K, Hague T, Corter A, Reynolds L Headache sufferersdrawings reflect distress, disability and illness J Psychosom Res 2009;66:465470 [51] Escobar J., Camino G (1989), Unexplained physical complaints: Psychopathology and Epidemiological Correlates British Journal Psychiatry 154 (4): 24-27 [52] Swart M., Blazer D., Geoge L., Lamderman R (1996), Somatixation disorderin a community population, The American Journal of Psychiatry 143: 1403-1408 [52] Soc Psychiatry Psychiatr Epidemiol 1997 Jan;32(1):24-9 Epidemiology of somatoform disorders: a community survey in Florence Faravelli C1, Salvatori S, Galassi F, Aiazzi L, Drei C, Cabras P Waal M.W.M v Ingrid A (2004) Somatoform disordes in general practice: Prevalence, functional impairment and comorbidity with anxiety and depressive disorders The Bristish Journal of Psychiatry, 184, 470-476 56 T T H An Nghiờn cu c im lõm sang ri lon c th húa, Rief W, Hessel A v B E (2001) Somatization symptoms and hypochondriacal features in the general population Psychosomatic Medicine, 63, 595602 S S Faravelli C1, Galassi F, Aiazzi L, Drei C, Cabras P (1997 ) Epidemiology of somatoform disorders: a community survey in Florence Soc Psychiatry Psychiatr Epidemiology, 32(1), 24-29 Hilderink PH, Collard R, Rosmalen JG v cng s (2013 ) Prevalence of somatoform disorders and medically unexplained symptoms in old age populations in comparison with younger age groups: a systematic review 12, 151156 B m s l hc (2000) Chuyờn sinh lý hc, , Trng i hc Y H Ni, B m s l hc (2002) Sinh lý hc c s, 1, G J.H (2002) Sinh lý hc lõm sng c s, Sinh lý thn kinh, 229232 I A e al (2004) The value of pseudoneurological symptoms for assessing psychopathology in primary care Psychosomatic Medicine, 66, 141-146 10 M F (2004) Somatization disorder A practical review 49 652-661 57 11 M D (1972) The concept of illness behavior Journal of Chronic Disease, 15, 189-194 12 Hales R v C C e al (1994) Diagnostic and Statistical Manual of Mental Disorder, DSM-IV, 13 S B Kaplan H (1995) Textbook of Psychiatry, 14 15 T H Bỡnh (2003) Cỏc ri lon liờn quan vi stress v iu tr tõm thn, Bi ging dnh cho hc viờn SH, i hc Y H Ni, 16 T c Y t t gii (1992) Ri lon phõn ly (chuyn di), ICD-10, 17 T c Y t t gii (1992) ICD-10, 18 C C e a Hales R (1994) Diagnostic and Statistical Manual of Mental Disorder, DSM-IV, 19 B D Swart M., Geoge L., Lamderman R (1996) Somatixation disorderin a community population The American Journal of Psychiatry, 143, 14031408 20 C Marquis, N Vabres, E Caldagues v cng s (2016) [Clinic of somatoform disorders in abused adolescents] Presse Med, 45 (4 Pt 1), e5158 58 21 E Fischer-Homberger (1972) Hypochondriasis of the eighteenth century neurosis of the present century Bull Hist Med, 46 (4), 391-401 22 D V Sheehan, J Ballenger v G Jacobsen (1980) Treatment of endogenous anxiety with phobic, hysterical, and hypochondriacal symptoms Arch Gen Psychiatry, 37 (1), 51-59 23 L S Walker, J Garber v J W Greene (1991) Somatization symptoms in pediatric abdominal pain patients: relation to chronicity of abdominal pain and parent somatization J Abnorm Child Psychol, 19 (4), 379-394 24 D R Offord, M H Boyle, P Szatmari v cng s (1987) Ontario Child Health Study II Six-month prevalence of disorder and rates of service utilization Arch Gen Psychiatry, 44 (9), 832-836 25 F Petrak, J Hardt, B Kappis v cng s (2003) Determinants of healthrelated quality of life in patients with persistent somatoform pain disorder Eur J Pain, (5), 463-471 26 E Shorter, S E Abbey, L A Gillies v cng s (1992) Inpatient treatment of persistent somatization Psychosomatics, 33 (3), 295-301 27 G Alfven (1997) Psychosomatic pain in children: a psychomuscular tension reaction? Eur J Pain, (1), 5-14; discussion 14-15 28 G L Engel (1959) Psychogenic pain and pain-prone patient Am J Med, 26 (6), 899-918 59 29 E M Rocha, K M Prkachin, S L Beaumont v cng s (2003) Pain reactivity and somatization in kindergarten-age children J Pediatr Psychol, 28 (1), 47-57 30 V Busch, J Haas, T Cronlein v cng s (2012) Sleep deprivation in chronic somatoform pain-effects on mood and pain regulation Psychiatry Res, 195 (3), 134-143 31 Mann NH, Brown MD, Hertz DB v cng s (1993) Initial-impression diagnosis using Low-back pain patient pain drawing 18, 4153 32 Chan CW, Goldman S, Ilstrup DM v cng s (1993) The pain drawing and Waddels nonorganic physical signs in chronic Low-back pain Spine 13, 17171722 33 T A (1999) Characteristics of pain drawings in the neck-shoulder region among the working population International Archives of Occupational and Environmental Health, 72, 98106 34 ] Bertilson B, Grunnesjử M, Johansson SE v cng s (2007) Pain drawing in the assessment of neurogenic pain and dysfunction in the neck/shoulder region: inter-examiner reliability and concordance with clinical examination Pain Medicine, 8(2), 134146 35 Broadbent E, Niederhoffer K, Hague T v cng s (2009) 66, 465470 60 36 A S Mallouh SK, Gillies LA (1995) The role of loss in treatment outcomes of persistent somatization General Hospital Psychiatry, 17(3), 187191 37 K E Mattila AK, Jula A, Salminen J (2008) Alexithymia and somatization in general population Psychosomatic Medicine 70(6), 716722 38 S C Grabe HJ, Freyberger HJ (2004) Alexithymia and personality in relation to dimensions of psychopathology The American Journal of Psychiatry, 12991301 39 Lemche E, Klann-Delius G, Koch R v cng s (2004) Mentalizing language development in a longitudinal attachment sample Psychotherapy & Psychosomatics, 73(6), 366374 40 H J Maunder RG (2001) Attachment and psychosomatic medicine: developmental contributions to stress and disease Psychosomatic Medicine, 63(4), 556567 41 Ciechanowski PS, Walker EA, Katon WJ v cng s (2002) Attachment theory: a model for health care utilization and somatization Psychosomatic Medicine, 64(4), 660667 42 Taylor R, Mann A, White N v cng s (2000) Attachment style in patients with unexplained physical complaints Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 30(4), 931941 61 43 L A (2009) Beyond the unexplainable pain: Relational dynamics and alexithymia in somatization Dissertation Abstracts International The Sciences and Engineering, 70(6-B), 44 Blaustein JP v T SB (1998) Knowing the unspeakable: somatization as an expression of disruptions in affective-relational functioning Bulletin of the Menninger Clinic, 62(3), 351365 45 L M Eisenberger NI (2004) Why rejection hurts: A common neural alarm system for physical and social pain Trends in Cognitive Sciences, 8(7), 294300 46 L M Eisenberger NI (2006) Identifying the Neural Correlates Underlying Social Pain: Implications for Developmental Processes Human Development, 49(5), 273293 47 S S Kuhn CM (1998) Responses to maternal separation: mechanisms and mediators International Journal of Developmental Neuroscience, 16(34), 261270 48 H MA (2009) Developmental neuroscience 1, 1231 49 L M Dickinson AL, Flecknell PA (2009) Influence of early neonatal experience on nociceptive responses and analgesic effects in rats Laboratory Animals, 43(1), 1116 50 Coutinho SV, Plotsky PM, Sablad M v cng s (2002) Neonatal maternal separation alters stress-induced responses to viscerosomatic 62 nociceptive stimuli in rat American Journal of Physiology - Gastrointestinal & Liver Physiology, 282(2):G, 307316 51 Bernardi M, Genedani S, Tagliavini S v cng s (1986) Effects on longterm sensitivity to pain and morphine of stress induced in the newborn rat by pain or manipulation Physiology & Behavior, 37(5), 827831 52 Kalinichev M, Easterling KW v H SG (2001) Repeated neonatal maternal separation alters morphine-induced antinociception in male rats Brain Research Bulletin, 54(6), 649654 53 Barreau F, de Lahitte JD, Ferrier L v cng s (2006) Neonatal maternal deprivation promotes Nippostrongylus brasiliensis infection in adult rats Brain, Behavior, & Immunity, 20(3), 254260 54 Caldji C, Francis D, Sharma S v cng s (2000) The effects of early rearing environment on the development of GABAA and central benzodiazepine receptor levels and novelty-induced fearfulness in the rat Neuropsychopharmacology, 22(3), 219229 55 Karibe H, Arakawa R, Tateno A v cng s (2010) 64(5), 476482 56 K B Moles A, D'Amato FR (2004) Deficit in attachment behavior in mice lacking the mu-opioid receptor gene.Science 304(5679), 19831986 57 Limer KL, Nicholl BI, Thomson W v cng s (2008) 47(5), 572577 63 58 B D (2007) Genetics of chronic pain states Best Practice & Research in Clinical Rheumatology, 21(3), 535547 59 T H Bỡnh (2003) Bi ging dnh cho hc viờn SH, 60 Y L Luo, M Y Zhang, W Y Wu v cng s (2009) A randomized double-blind clinical trial on analgesic efficacy of fluoxetine for persistent somatoform pain disorder Prog Neuropsychopharmacol Biol Psychiatry, 33 (8), 1522-1525 61 P Onghena v B Van Houdenhove (1992) Antidepressant-induced analgesia in chronic non-malignant pain: a meta-analysis of 39 placebocontrolled studies Pain, 49 (2), 205-219 62 M Aragona, L Bancheri, D Perinelli v cng s (2005) Randomized double-blind comparison of serotonergic (Citalopram) versus noradrenergic (Reboxetine) reuptake inhibitors in outpatients with somatoform, DSM-IVTR pain disorder Eur J Pain, (1), 33-38 63 G M Van Kempen, F G Zitman, A C Linssen v cng s (1992) Biochemical measures in patients with a somatoform pain disorder, before, during, and after treatment with amitriptyline with or without flupentixol Biol Psychiatry, 31 (7), 670-680 64 C M Clark MR (2005) Textbook of psychosomatic medicine American Psychiatric Publishing, 64 65 Keson B C Tan v Y H Chan (2004) Relationships Between Depression/Somatization and Self-reports of Pain and Disability Journal of orofacial pain, 66 R J A C Niklaus Egloff, Roland von K anel, Nicole Klin- ă v E M gler, Marie-Louise Gander Ferrari Hypersensitivity and Hyperalgesia in Somatoform Pain Disorders General Hospital Psychiatry, 67 Escobar J v C G (1989) Unexplained physical complaints: Psychopathology and Epidemiological Correlates British Journal Psychiatry, 154 (4), 24-27