Psychogenesis and somatogenesis of common symptoms

There are situations in clinical practice in which the physican should keep in mind the influence of emotional factors in the elaboration of symptoms and yet should not conclude hastily that "all is in the patient's mind". Symptoms are often the result of complex etiologic factors including life-threatening illnesses presenting psychologic symptoms as an early manifestation. Psychologic disorders and physical illnesses with similar symptoms may coexist in the same patient. There are also cases in which the symptoms are the result of the constant interaction of psychologic and physical factors. Some suggestions to help to clarify the diagnosis are given and a classification of the different clinical situations involved is presented. Becuase physicians should be constantly aware of the complexity of the factors involved in the elaboration of obscure symptoms, some recommendations are given in regard to undergraduate and graduate medical education.