This April 2005 issue of Psychiatric Annals, guest edited by Dr. Stanley Caroff, addresses common medical–psychiatric comorbidities. The two-way relationship between psychiatric and medical conditions is demonstrated aptly in patients manifesting medically unexplained physical symptoms, including pseudo-seizures, irritable bowel syndrome, chronic fatigue syndrome, chronic subjective dizziness, and fibromyalgia. These and related somatic complaints, as well as treatment methods, are covered well by the articles in this issue.
Considering these common conditions reminds us that despite the advantages of super-specialization in medicine, without a holistic approach, we can end up facing many of our patients much like the three blind men trying to apprehend an elephant. Despite our modern laboratories, sophisticated imaging capabilities, and other technological marvels in medicine, there are a lot of clinical presentations we can't explain and are left to treat empirically, with a limited amount of efficacy data to guide us. We still have much to learn about the relationships between the mind–brain functions and the autonomic nervous system, immunologic, and pain mechanisms that operate within the human body.
Meanwhile, psychiatrists continue to work “on the edges” of these common sources of human suffering, treating symptoms where we can, while hoping for a better understanding of the pathophysiology of these conditions that will lead to more specific and effective treatment. It's good to review the state of our knowledge and ignorance about these conditions from time to time, lest we get complacent and start to think we know a lot.