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Manejo de los síndromes somáticos funcionales
Peter Henningsen1, Stephan Zipfel, Wolfgang Herzog
1Department of Psychosomatic Medicine and Psychotherapy, University Hospital, Technical University of Munich, Langerstrasse 3, 81675 Munich, Germany. p.henningsen@tum.de
Lancet (London, England)
|March 21, 2007
Resumen
El manejo efectivo de los síndromes somáticos funcionales (SSF) requiere un enfoque de cuidado gradual. La participación activa del paciente en tratamientos como el ejercicio y la psicoterapia es más beneficiosa que las intervenciones pasivas para estas complejas condiciones psicosomáticas.
Área de la Ciencia:
- La medicina psicosomática es una medicina psicosomática.
- Psicología Clínica Psicología clínica.
- Práctica general Práctica general
Sus antecedentes:
- Los síndromes somáticos funcionales (SSF) exhiben una superposición significativa, pero carecen de criterios de diagnóstico unificados, lo que dificulta la investigación y el tratamiento entre especialidades.
- La investigación actual sobre el tratamiento se centra predominantemente en síndromes individuales, descuidando el espectro más amplio de FSS.
Objetivo del estudio:
- Revisar las estrategias de gestión para todo el espectro de FSS basado en revisiones sistemáticas y meta-análisis desde 2001.
- Proponer un modelo de cuidado escalonado diferenciando entre FSS sin complicaciones y FSS complicadas.
- Proporcionar recomendaciones basadas en la evidencia para la gestión del FSS.
Principales métodos:
- Revisión sistemática y metanálisis de la investigación de tratamiento para FSS publicado desde 2001.
- Análisis de la eficacia del tratamiento no farmacológico y farmacológico.
- Evaluación de los diferentes enfoques terapéuticos (biomédicos, orientados a los órganos, cognitivo e interpersonal).
Principales resultados:
- Los tratamientos no farmacológicos que requieren la participación activa del paciente (por ejemplo, ejercicio, psicoterapia) son más efectivos que las medidas físicas pasivas.
- Los agentes farmacológicos que actúan sobre el sistema nervioso central (SNC) demuestran una eficacia más consistente que aquellos dirigidos a la disfunción periférica.
- Un enfoque equilibrado que integre estrategias biomédicas, orientadas a los órganos y cognitivas e interpersonales es óptimo para FSS.
Conclusiones:
- Se recomienda un enfoque de cuidado escalonado para el manejo de los síndromes somáticos funcionales, distinguiendo entre casos no complicados y complicados.
- Las intervenciones no farmacológicas activas y centradas en el paciente y los medicamentos que actúan sobre el SNC son componentes terapéuticos clave.
- Abordar el componente iatrogénico y centrarse en la relación médico-paciente son cruciales para una gestión exitosa de la FSS.
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