The interaction of psychological and physical disorders and
their treatment
Francis Creed
Abstract
Patients consult doctors for symptoms that may represent well-recognised
physical disease or psychiatric disorders but many patients request help for
bodily symptoms that may result from a combination of these disorder and do
not appear to have a clear “physical” or “psychological” origin. The interaction
of physical and psychiatric disorders will be reviewed to show how recent
research can improve the care that patients receive.
The interaction of depression and physical illness will be considered in heart
disease to show how depression leads to the development of heart disease, and
vice versa. The presence of both disorders leads to a poor outcome in heart
disease patients. Guidelines concerning the treatment of depression in people
with chronic physical illness have been produced recently by UK National
Institute for Health and Clinical Excellence. A recent treatment study has raised
the prospect that depression may be prevented in newly diagnosed cancer
patients.
Although mildly bothersome bodily symptoms are very common, a small
proportion of the population report numerous such symptoms, which impair
functioning and may lead to frequent consultations with doctors. Psychiatric and
physical disorders are both associated with an increased number of bothersome
bodily symptoms but neither can fully explain such symptoms. Both genetic and
environmental risk factors have been implicated and recent research suggests
that they may respond to a variety of psychological treatments.