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Journal of Clinical and
Basic Psychosomatics Allostatic overload in the medically ill

The evidence that medically ill patients with or structured psychotherapies such as cognitive behavior
without DCPR-R AO differ in terms of specific clinical therapy aimed at reshaping dysfunctional automatic
features (i.e., co-occurring DCPR-R illness behavior, thoughts related to stressful events such as medical
demoralization, DSM-5 major depressive episode or diseases, and well-being therapy. We have now ushered
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major depressive disorder) suggest that considering in an era where it is necessary to transcend the boundaries
medical disease only from the biological point of view is of organ disease and break the unseen hurdles imposed
reductionistic. 36,41 Medically ill patients are in need of a by the myopic medical practices that fixate only at the
comprehensive assessment which include, among others, dimension of single apparatus or organ system.
the appraisal of stressful events as well as their relation
to the disease, and of coping strategies used to deal with Acknowledgments
it. 36,41 This approach allows to clinically distinguish among None.
subjects with otherwise deceptively similar medical disease
due to the same medical diagnosis made. 3 Funding

The present study has some limitations. First, female None.
subjects were overrepresented in this study, but such sex
unbalance mirrors the clinical realm which is characterized Conflict of interest
by higher prevalence and incidence of systemic sclerosis The authors declare they have no competing interests.
and migraine among females than males. 42,43 Second, it
was not possible to establish a causal relationship among Author contributions
mental disorders, psychosomatic syndromes, and DCPR-R Conceptualization: Giovanni Mansueto, Fiammetta Cosci
AO since this study adopted a cross-sectional design; Formal analysis: Giovanni Mansueto
therefore, longitudinal studies unraveling this relationship Investigation: Sara Romanazzo, Caterina Romaniello
are warranted. In this study, we measured the DCPR-R Methodology: Giovanni Mansueto, Sara Romanazzo,
AO prevalence across different populations with medical Caterina Romaniello
diseases, an achievement that had not been attained by a Writing – original draft: Giovanni Mansueto, Fiammetta Cosci
previous research.
Writing – review & editing: Giovanni Mansueto, Serena
5. Conclusion Guiducci, Sara Galimberti, Fiammetta Cosci
DCPR-R AO is a clinically useful transdiagnostic Ethics approval and consent to participate
feature potentially associated with other psychosomatic Data collection on patients recruited at S. Chiara Hospital
syndromes and mental disorders that contribute to the (Pisa, Italy) was approved by the Ethical Committee of
disease burden and to poor health conditions in medically the Tuscany Region (Area Vasta Nord Ovest – CEAVNO,
ill patients. DCPR-R, which allows to diagnose AO and protocol number: 20097); data collection on patients
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relevant psychosomatic syndromes, should become part of recruited at the University Hospital Careggi (Florence, Italy)
the armamentarium of clinicians together with tools that was approved by the Ethical Committee of the Tuscan region
allow to formulate DSM diagnoses as well as clinimetric
instruments for assessing psychosocial aspects of medical (Area Vasta Centro – CEAV, protocol numbers: 11633_spe;
diseases. A detailed and comprehensive anamnesis 16425_spe). All procedures contributing to this work
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should also be conducted for understanding and managing comply with the ethical standards of the relevant national
health-damaging behaviors, such as unhealthy lifestyle, and institutional committees on human experimentation
high level of disability, and/or compromised quality and with the Helsinki Declaration of 1975, as revised in
of life in relation to what is expected in disease status, 2013. All patients gave written informed consent.
illness behavior, and lack of treatment adherence. This Consent for publication
44
means applying a novel global clinimetric assessment
which outlines biopsychosocial variables and integrates Both written and verbal permissions were obtained from
the interplay among the variables under study. It each of the subjects to publish their data, and effort has
44
would contribute to characterizing unique individual been made by the authors to conceal any identifying
profiles for patients. Such approach is a stepping stone information of the participants that appear in the paper.
to attaining comprehensive care path, which should also Availability of data
include education about healthy lifestyle, psychological
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interventions aimed at empowering quality of life and Data collected can be obtained from the corresponding
increasing individual functioning, and, when appropriate, author following formal request.

Volume 2 Issue 2 (2024) 7 https://doi.org/10.36922/jcbp.2758