%0 Journal Article
%T A neurological approach to biopsychosocial medicine: Lessons from irritable bowel syndrome
%A Shin Fukudo
%J BioPsychoSocial Medicine
%D 2011
%I BioMed Central
%R 10.1186/1751-0759-5-1
%X Functional gastrointestinal disorders are useful for illustrating how the rationale of "nervism" of my notion is manifest. In particular, irritable bowel syndrome (IBS) is a prototype of functional gastrointestinal disorders [1], and the biopsychosocial model is well fit to IBS [1]. Although genes, inflammation, gut microbiota, psychosocial stress, and early learning may play an important role in the pathogenesis of IBS [2,3], brain-gut interactions cannot be excluded from the pathophysiology of IBS [4]. Brain imaging studies have clarified the roles of the anterior cingulate cortex, amygdala, insula and the brain stem in response to visceral stimulation [2,5,6]. These structures produce both visceral pain and negative emotion that are typical symptoms of IBS patients. Some researchers interpret the anxiety and depression of IBS patients as "noise" or "confounding factors" that require control. However, IBS patients naturally have negative emotion. Some IBS patients may not have anxiety or depression at the clinically diagnostic level, but a high percentage of IBS patients show increased levels of anxiety and depression. Therefore, the concept that "pure IBS" pathophysiology is completely separated from anxiety and depression is influenced by the Descartes' mind-body dualism and may hinder our ability to see the true nature of the mind-body relationship.The clinical usefulness of psychological treatments for IBS patients is evidence of the rationale of the biopsychosocial model. The theoretical background of psychotherapies for IBS is as follows. First, IBS patients have deranged life styles characterized by more perceived stress, more irregular sleep and more irregular meals [7]. Reduction of these risk factors is the first step to minimize the exacerbating factors of IBS. Second, the doctor-patient relationship is important for effective treatment. A positive physician-patient interaction is associated with a good prognosis of IBS [8]. Third, the close relationshi
%U http://www.bpsmedicine.com/content/5/1/1