Page 26 - JCBP-2-1

Journal of Clinical and
Basic Psychosomatics The endocannabinoid system

disrupts this paradigm, plunging clinicians into the depths we aspire to pave the way for more targeted and effective
of diagnostic ambiguity [3-8] . interventions.
Historically, PSD carried the weight of societal In the pages that follow, we will traverse the historical
misunderstanding and stigma. These conditions were nuances that have shaped our perception of PSD, dissect
once relegated to a distinct category where stress and the contemporary insights that have transformed our
psychological distress were erroneously perceived as the understanding, and underscore the imperative of a
primary causative agents. Individuals grappling with PSD multidisciplinary approach in deciphering and managing
found themselves unfairly labeled as attention-seekers or these conditions. Embarking on this journey, we invite
hypochondriacs. The manifestation of psychosomatization, readers from diverse backgrounds to join us in unraveling
characterized (defined) by multiple, recurrent, and often- the mysteries of PSD, where the convergence of psychology
changing physical symptoms persisting for at least 2 years and physiology paints a canvas of unparalleled complexity
before seeking medical attention, perpetuated these and intrigue.
misconceptions [9-11] .
The Diagnostic and Statistical Manual of Mental 2. Neurobiological mechanisms of PSD
Disorders, Fifth Edition, has since ushered in a paradigm 2.1. The hypothalamic-pituitary-adrenal (HPA) axis
shift, consolidating various presentations of PSD under The HPA axis, serving as the central coordinator of
the umbrella of somatic symptom disorder. This inclusive neuroendocrine responses to stress, assumes paramount
classification encompasses somatization disorder, significance in individuals afflicted with PSD [13-19] . The
hypochondriasis, pain disorder, and undifferentiated HPA axis, comprised the hypothalamus, pituitary gland
somatoform disorder, reflecting a more nuanced and (hypophysis), and adrenal glands, is a vital neuroendocrine
comprehensive understanding . system tasked with responding to stressors and maintaining
[12]
Contemporary perspectives have ushered in a new homeostasis. Dysregulation of this axis can have far-
era of enlightenment, expanding our comprehension of reaching effects on diverse physiological and psychological
the intricate mechanisms underpinning psychosomatic processes, influencing the presentation of psychosomatic
phenomena. It is now acknowledged that stress, symptoms [13,19] .
depression, and a dearth of social support, in tandem On encountering a stressor, whether it is of a physical,
with biological factors, play pivotal roles in both the psychological, or emotional nature, a complex cascade of
etiology and outcome of diseases associated with PSD. physiological events is initiated. The hypothalamus, acting
Stressors, irrespective of their nature – whether physical, as the HPA axis’s “control center,” releases corticotropin-
psychological, or emotional – set in motion a complex releasing hormone (CRH) [20-25] . This hormone, in
cascade of physiological responses, orchestrating the turn, stimulates the anterior pituitary gland to release
[3]
body’s preparation for an adaptive reaction . adrenocorticotropic hormone (ACTH), which serves
The narrative unfolds beyond the confines of as a signal for the adrenal glands to produce and release
traditional categorizations, inviting a holistic exploration glucocorticoids, notably cortisol (Figure 1A) [20,25] .
of the factors at play in the genesis and progression of This process initiates with the release of norepinephrine
PSD. As we navigate through this scientific review, we (NE) and acetylcholine (Ach), which act on receptors on
will delve into the diverse manifestations of PSD, each a the surface of neurons of the paraventricular nucleus
unique thread in the complex tapestry of PSD. From the (PVN) of the hypothalamus. This initiation triggers a
neurological intricacies to the visceral manifestations, we cascade of intracellular signaling events, including the
aim to demystify the enigma surrounding these conditions, activation of adenylate cyclase and subsequent elevation of
providing a comprehensive understanding accessible to cyclic adenosine monophosphate (cAMP) levels. Elevated
readers across diverse disciplines. cAMP activates protein kinase A (PKA), leading to the
The significance of unraveling the complexities of phosphorylation of transcription factors such as cAMP
PSD extends beyond the realms of academic curiosity. It response element-binding protein (CREB). Phosphorylated
permeates the clinical landscape, where misdiagnoses and CREB then binds to cAMP response elements in the
inadequate treatment plans pose formidable challenges. As promoter region of the CRH gene, thereby instigating the
we articulate the intricacies of PSD, our aim is not only to transcription and synthesis of CRH. Once synthesized,
broaden theoretical frameworks but to enhance the efficacy CRH is transported to the median eminence of the
of clinical practice. By fostering a deeper comprehension hypothalamus, where it is released into the hypophyseal
of the intricate dance between the mind and body in PSD, portal system, ultimately reaching the anterior pituitary

Volume 2 Issue 1 (2024) 2 https://doi.org/10.36922/jcbp.2288