Abstract:
:The term functional somatic syndrome has been applied to several related syndromes characterized more by symptoms, suffering, and disability than by consistently demonstrable tissue abnormality. These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient's belief that he or she has a serious disease. Four psychosocial factors propel this cycle of symptom amplification: the belief that one has a serious disease; the expectation that one's condition is likely to worsen; the "sick role," including the effects of litigation and compensation; and the alarming portrayal of the condition as catastrophic and disabling. The climate surrounding functional somatic syndromes includes sensationalized media coverage, profound suspicion of medical expertise and physicians, the mobilization of parties with a vested self-interest in the status of functional somatic syndromes, litigation, and a clinical approach that overemphasizes the biomedical and ignores psychosocial factors. All of these influences exacerbate and perpetuate the somatic distress of patients with functional somatic syndromes, heighten their fears and pessimistic expectations, prolong their disability, and reinforce their sick role. A six-step strategy for helping patients with functional somatic syndromes is presented here.
journal_name
Ann Intern Medjournal_title
Annals of internal medicineauthors
Barsky AJ,Borus JFdoi
10.7326/0003-4819-130-11-199906010-00016subject
Has Abstractpub_date
1999-06-01 00:00:00pages
910-21issue
11eissn
0003-4819issn
1539-3704pii
199906010-00007journal_volume
130pub_type
杂志文章,评审abstract:OBJECTIVE:To estimate relative risk of mortality and median life expectancy for patients with classic hemophilia by a life-table analysis, taking into account deaths that may have occurred in infancy or childhood before the onset of symptoms. DESIGN:Retrospective chart review of clinical series. SETTING:Referral-base...
journal_title:Annals of internal medicine
pub_type: 历史文章,杂志文章
doi:10.7326/0003-4819-114-8-641
更新日期:1991-04-15 00:00:00
abstract:BACKGROUND:Ulcerative colitis is predominantly a disease of nonsmokers. Transdermal nicotine may help control clinical manifestations of this condition. OBJECTIVE:To determine the efficacy of transdermal nicotine for controlling clinical disease activity in active ulcerative colitis. DESIGN:Randomized, double-blind, ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-126-5-199703010-00004
更新日期:1997-03-01 00:00:00
abstract::Important historical changes have occurred both in the content of the periodic health examination and in the legitimacy with which this examination has been viewed. These changes reflect fundamental shifts in the objectives of the examination and in the concerns of its advocates, the most prominent of whom have been p...
journal_title:Annals of internal medicine
pub_type: 历史文章,杂志文章
doi:10.7326/0003-4819-127-10-199711150-00010
更新日期:1997-11-15 00:00:00
abstract:Background:FLU-v is a broad-spectrum influenza vaccine that induces antibodies and cell-mediated immunity. Objective:To compare the safety, immunogenicity, and exploratory efficacy of different formulations and dosing regimens of FLU-v versus placebo. Design:Randomized, double-blind, placebo-controlled, single-center...
journal_title:Annals of internal medicine
pub_type: 杂志文章,随机对照试验
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更新日期:2020-04-07 00:00:00
abstract:Background:The safety and effectiveness of dual therapy (direct oral anticoagulant [DOAC] plus P2Y12 inhibitor) versus triple therapy (vitamin K antagonist plus aspirin and P2Y12 inhibitor) in patients with nonvalvular atrial fibrillation (AF) after percutaneous coronary intervention (PCI) is unclear. Purpose:To exami...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/M19-3763
更新日期:2020-04-07 00:00:00
abstract::Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level ...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-108-2-175
更新日期:1988-02-01 00:00:00
abstract::Many investigations consider the presence of e antigen (HBeAg) valuable in predicting which patients with acute hepatitis B are at risk of remaining infected and developing chronic liver disease. We tested this hypothesis in a retrospective study of serial samples from patients undergoing long-term hemodialysis. We fo...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-89-3-310
更新日期:1978-09-01 00:00:00
abstract:SOURCE CITATION:Cao B, Wang Y, Wen D, et al. A trial of lopinavir-ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020;382:1787-99. 32187464. ...
journal_title:Annals of internal medicine
pub_type: 评论,杂志文章
doi:10.7326/ACPJ202006160-063
更新日期:2020-06-16 00:00:00
abstract::We evaluated 10 patients with hidradenitis suppurative or acne conglobata who developed arthritis. In contrast to patients with acne fulminans and arthritis, all our subjects were adults over 22 years of age; nine were black; and four were women. Nine patients had episodic inflammatory oligoarthritis affecting mainly ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-97-4-520
更新日期:1982-10-01 00:00:00
abstract:Background:Iron chelation therapy (ICT) in patients with lower-risk myelodysplastic syndromes (MDS) has not been evaluated in randomized studies. Objective:To evaluate event-free survival (EFS) and safety of ICT in iron-overloaded patients with low- or intermediate-1-risk MDS. Design:Multicenter, randomized, double-b...
journal_title:Annals of internal medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.7326/M19-0916
更新日期:2020-04-21 00:00:00
abstract:BACKGROUND:Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors. OBJECTIVE:To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-144-4-200602210-00006
更新日期:2006-02-21 00:00:00
abstract:OBJECTIVE:To determine the toxicity and efficacy of low-dose interferon-alpha therapy in inducing remissions and prolonging survival in patients with chronic myeloid leukemia. DESIGN:Phase II evaluation and comparison with historical control patients and other series in which the investigators used higher interferon-a...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章
doi:10.7326/0003-4819-121-10-199411150-00002
更新日期:1994-11-15 00:00:00
abstract::Ambulatory education has become an essential part of all internal medicine residencies. To develop excellent ambulatory education programs, we must thoroughly understand the opportunities available in such a setting, and the leaders in internal medicine must be willing to experiment with nontraditional locations and r...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-116-12-1076
更新日期:1992-06-15 00:00:00
abstract:STUDY OBJECTIVE:To determine the sensitivity of herpes simplex virus isolates to acyclovir and the importance of resistant isolates in hospitalized patients. DESIGN:Retrospective incidence cohort study. SETTING:All herpes simplex virus isolates cultured over 1 year from patients followed at a tertiary care center. P...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-76-3-112-6-416
更新日期:1990-03-15 00:00:00
abstract::Levels of circulating platelet aggregates and plasma beta-thromboglobulin reflect the degree of platelet activation in vascular injury and repair. Both values were evaluated in 38 patients with scleroderma and 18 control subjects matched for age, sex, and race. Circulating platelet aggregates (expressed as percentage ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-96-5-610
更新日期:1982-05-01 00:00:00
abstract::Fifteen patients with chronic type B hepatitis were treated with corticosteroids in a randomized, double-blind, placebo-controlled trial lasting 28 days. Ten patients received prednisolone, 60 mg/d for 2 weeks, then 30 mg/d for another 2 weeks; 5 patients received placebo. Serum aminotransferase levels decreased signi...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.7326/0003-4819-104-1-12
更新日期:1986-01-01 00:00:00
abstract::In September 1978, cases of hepatitis B in two patients treated by the same dentist led to investigation of a dental practice in Baltimore, Maryland. The dentist had had acute hepatitis B in June 1978 and had remained positive for hepatitis B surface antigen and hepatitis B e antigen over the ensuing 6 months. He had ...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-95-2-133
更新日期:1981-08-01 00:00:00
abstract::In studies of the cause of gastrointestinal symptoms in homosexual men, Campylobacter jejuni was recovered from 10 of 158 men with, and 2 of 75 men without, intestinal symptoms. In addition, a heterogeneous group of Campylobacter-like organisms was identified in 26 symptomatic and 6 asymptomatic homosexual men, but in...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-101-2-187
更新日期:1984-08-01 00:00:00
abstract:BACKGROUND:The paucity of public health messages that directly address communities of color might contribute to racial and ethnic disparities in knowledge and behavior related to coronavirus disease 2019 (COVID-19). OBJECTIVE:To determine whether physician-delivered prevention messages affect knowledge and information...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M20-6141
更新日期:2020-12-21 00:00:00
abstract:BACKGROUND:Visits to physicians for genital herpes simplex virus (HSV) infection continue to increase. Most patients with symptomatic infections have recurrences, but no studies of the long-term clinical course of genital herpes are available. OBJECTIVE:To determine whether the frequency of HSV recurrences decreases o...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-131-1-199907060-00004
更新日期:1999-07-06 00:00:00
abstract:BACKGROUND:Introduction of a universal varicella vaccine program for U.S. children in 1996 sparked concern that less-frequent exposure to varicella would decrease external boosting of immunity to varicella zoster virus and thereby increase incidence of herpes zoster (HZ). OBJECTIVE:To determine whether the varicella v...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-159-11-201312030-00006
更新日期:2013-12-03 00:00:00
abstract:STUDY OBJECTIVE:To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes. DESIGN:MEDLINE search of English-language articles from 1966 to 1987 using the following medical subjects headings respiratory function tests, lung, lung diseases, ...
journal_title:Annals of internal medicine
pub_type: 杂志文章,meta分析
doi:10.7326/0003-4819-112-10-763
更新日期:1990-05-15 00:00:00
abstract::The coexistence of chronic idiopathic thrombocytopenic purpura and myasthenia gravis has been infrequently reported. We report another case and show the coexistence of autoantibodies to the platelet glycoprotein IIb and IIIa complex and the acetylcholine receptor. Autoantibody levels were followed during 8 weeks of tr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-100-6-829
更新日期:1984-06-01 00:00:00
abstract:BACKGROUND:Markers are needed for assessing response to antiretroviral therapy over time. The CD4+ lymphocyte count is one such surrogate, but it is relatively weak. OBJECTIVE:To assess the association of changes in plasma human immunodeficiency virus (HIV) RNA level and CD4+ lymphocyte count with progression to the a...
journal_title:Annals of internal medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.7326/0003-4819-126-12-199706150-00002
更新日期:1997-06-15 00:00:00
abstract:BACKGROUND:Although weight loss improves risk factors for cardiovascular and metabolic disease, it is unclear whether intentional weight loss reduces mortality rates. OBJECTIVE:To examine the relationships among intention to lose weight, weight loss, and all-cause mortality. DESIGN:Prospective cohort study using a pr...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-138-5-200303040-00007
更新日期:2003-03-04 00:00:00
abstract:Background:Frailty assessment may inform surgical risk and prognosis not captured by conventional surgical risk scores. Purpose:To evaluate the evidence for various frailty instruments used to predict mortality, functional status, or major adverse cardiovascular and cerebrovascular events (MACCEs) in older adults unde...
journal_title:Annals of internal medicine
pub_type: 杂志文章,评审
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更新日期:2016-11-01 00:00:00
abstract::A 45-year-old woman from Mendoza, Argentina, was severely bitten by a dog that died 4 days later. Before death, the dog was nervous, aggressive, and had occasional seizures. Ten days after the woman had been bitten, rabies vaccine treatment was begun: 14 daily doses of suckling mouse brain vaccine followed by 2 booste...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-85-1-44
更新日期:1976-07-01 00:00:00
abstract::Adult T-cell leukemia associated with human T-cell leukemia virus type I (HTLV-I) is characterized by a clonal expansion of a CD4-positive subset of T lymphocytes that constitutively express high numbers of interleukin-2 receptors and that frequently infiltrate the skin; osteolytic bone lesions, and hypercalcemia. Usi...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-109-4-274
更新日期:1988-08-15 00:00:00
abstract:STUDY OBJECTIVE:To define the clinical and hematologic effects of recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF) on patients with chronic severe neutropenia. DESIGN:Open-label, phase II study of rhGM-CSF. SETTING:Inpatient hematology and surgery clinic at a university medical center. P...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/0003-4819-111-11-887
更新日期:1989-12-01 00:00:00
abstract:Background:Medicare uses the Centers for Medicare & Medicaid Services Hierarchical Condition Category (CMS-HCC) model to predict patients' annualized Medicare costs in value-based payment programs. The CMS-HCC model does not include measures of frailty, and prior research shows that it systematically underpredicts cost...
journal_title:Annals of internal medicine
pub_type: 杂志文章
doi:10.7326/M19-3261
更新日期:2020-04-21 00:00:00