背景:病理性健康焦虑(PHA)(例如,疑病和疾病焦虑症)在医疗环境中很常见,并且与医疗费用的增加有关。然而,导致PHA发育和维持的心理和神经生物学机制尚未完全了解。
方法:我们进行了系统综述,以表征对PHA的机械理解。PubMed,PsycINFO,搜索Embase数据库,以查找1990年1月1日至2022年12月31日之间发表的文章,这些文章采用了软骨病患者的行为任务和/或生理措施,疾病焦虑症,和PHA更广泛。
结果:在确定的9141条记录中,57人符合纳入标准。文章质量因研究而异,总体上是不够的。Cognitive,行为,与PHA相关的情感发现包括与健康相关的注意力和记忆回忆偏差,狭隘的健康概念,威胁确认思维模式,使用寻求安全的行为,以及对健康相关主题的有偏见的显性和隐性情感处理。有初步证据支持在PHA患者中高估感受刺激。神经内分泌,电生理学,PHA的脑成像研究尤其处于早期阶段。
结论:包括对PHA进行了分类评估的文章,这表明亚阈值和维度健康焦虑的考虑因素没有被情境化。
结论:在综合的认知-行为-情感和预测加工配方中,我们从理论上讲,次优的疾病和健康概念,改变了感知力模型,有偏见的基于疾病的预测和关注,和异常预测误差学习是与需要更多研究的PHA相关的潜在机制。全面调查PHA的病理生理学提供了识别辅助诊断生物标志物和催化新的生物学知情治疗的潜力。
BACKGROUND: Pathological health anxiety (PHA) (e.g.,
hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood.
METHODS: We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with
hypochondriasis, illness anxiety disorder, and PHA more broadly.
RESULTS: Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages.
CONCLUSIONS: Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized.
CONCLUSIONS: Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.