par Cosyns, Simone
Référence ACTA GASTRO-ENT.BELG., 38, 11-12, page (463-476)
Publication Publié, 1975
Article révisé par les pairs
Résumé : The therapeutic approach in psychosomatic medicine requires the somatician to keep psychological factors in mind and the psychiatrist to consider the somatic complaint. The therapeutic approach will vary according to whether there is a psychofunctional problem or an authentic psychosomatic disease. However, in every case, the total patient must be considered and a good doctor patient relationship established. Thanks to this relationship the doctor can better understand the emotional and intellectual aspects of his patient and therefore plan his therapy. The following should be considered: reducing anxiety by explaining to the patient the possible correlation between his complaints and emotional factors; adopting a supportive attitude; offering to the patient the possibility to explain verbally certain repressed ideas (ventilation psychotherapy); manipulating, if necessary, the milieu in which the patient lives (treatment centered on the environment); starting a deep rooted psychotherapy in certain cases. The problem of psychosomatic diseases in gastro enterology, like duodenal ulcer and hemorragic ulcerative colitis, is discussed in detail. Concerning duodenal ulcer, one can distinguish between two levels of psychotherapy: (1) psychological approach by the gastro enterologist with a proper background in the psychological approach to patients; (2) psychotherapy. Anyway, the treatment of this disease is always multidimensional, utilizing both psychological and drug treatment. Concerning hemorragic ulcerative colitis, supportive psychotherapy is crucial during the acute phase. During a remission the therapist must provide the patient with the type of relationship he desires, and be available to the patient. In some cases a deep psychotherapy should be used, even in conjunction with somatic care.

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