Friday, January 16, 2009

Functional Symptoms have Organic Basis

Inflammatory and oxidative and nitrosative stress pathways
underpinning chronic fatigue, somatization and psychosomatic symptoms.

Journal: Curr Opin Psychiatry. 2009 Jan;22(1):75-83.

Author: Maes M.

Affiliation: Clinical Research Centre of Mental Health (CRC-MH),
Antwerp, Belgium.

NLM Citation: PMID: 19127706

PURPOSE OF REVIEW: The aim of this paper is to review recent findings
on inflammatory and oxidative and nitrosative stress (IO&NS) pathways
in chronic fatigue and somatization disorder.

RECENT FINDINGS: Activation of IO&NS pathways is the key phenomenon
underpinning chronic fatigue syndrome (CFS): intracellular
inflammation, with an increased production of nuclear factor kappa
beta (NFkappabeta), cyclo-oxygenase-2 (COX-2) and inducible NO
synthase (iNOS); and damage caused by O&NS to membrane fatty acids
and functional proteins. These IO&NS pathways are induced by a number
of trigger factors, for example psychological stress, strenuous
exercise, viral infections and an increased translocation of LPS from
gram-bacteria (leaky gut). The 'psychosomatic' symptoms experienced
by CFS patients are caused by intracellular inflammation (aches and
pain, muscular tension, fatigue, irritability, sadness, and the
subjective feeling of infection); damage caused by O&NS (aches and
pain, muscular tension and fatigue); and gut-derived inflammation
(complaints of irritable bowel). Inflammatory pathways (monocytic
activation) are also detected in somatizing disorder.

SUMMARY: 'Functional' symptoms, as occurring in CFS and somatization, have a genuine organic cause, that is activation of peripheral and central IO&NS pathways and gut-derived inflammation. The development of new drugs, aimed at treating those disorders, should target these IO&NS pathways.

No comments: