Page 36 - JCBP-2-3

Journal of Clinical and
Basic Psychosomatics Organ donation after euthanasia

involve multiple brain regions. Chronic pain has been tinnitus and chronic pain syndrome were categorized
associated with altered activity and connectivity in limbic as suffering from somatic disorders. Only those patients
and cortical structures. These neural changes can lead formally diagnosed with a psychiatric disorder such
to the amplification and persistence of pain perception, as depression, in addition to tinnitus and chronic pain
as well as the development of comorbid psychological syndrome, were categorized as suffering from a psychiatric
symptoms such as anxiety and depression. 15-17 disorder. This distinction enabled us to detect incidence
The experience of chronic pain can lead to psychological patterns between patient groups in our studies. We
distress, feeling helpless, anxious, and depressed, and have not attempted to divide or distinguish the severity
such conditions can, in turn, worsen the perception and of their suffering. Consequently, the prior distinction
impression of pain. Comparable to tinnitus, chronic pain between patients suffering from somatic and psychiatric
is thus highly linked to the occurrence of anxiety and disorders was relinquished in the Dutch guideline for
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depression. Consequently, chronic pain management ODE in January 2023. To enable data comparison with
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often requires a multidisciplinary approach involving other studies on ODE across different patient subgroups,
health-care professionals from both physical and mental future research should clearly acknowledge the rationale
health disciplines. behind any categorization method used. A suggestion for
In summary, physical health and mental health are categorization in future studies is to add an additional
intrinsically interconnected. Physical illnesses can elevate group alongside the psychiatric and somatic disorders,
the risk of developing mental disorders, and conversely, a group that highlights the overlap between these two
mental disorders can increase the susceptibility to categories of disorders.
physical illness. To gain a deeper understanding of 4. Conclusion
these relationships, it is essential to integrate diverse
perspectives on the same matter. Therefore, irrespective Since 2012, over 130 ODE cases have been performed
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of whether a somatic or psychiatric perspective is in the Netherlands. The classification of various medical
applied to conditions such as tinnitus and chronic pain conditions into distinct categories of somatic diseases
disorder, recognizing and addressing the associated and psychiatric disorders continues to pose significant
somatic or psychiatric comorbidities and the resultant challenges. Extensive evidence underscores the frequent
burden of disease for the patient is more pertinent than co-occurrence of psychiatric symptoms alongside somatic
the mere categorization of the disease as either somatic illnesses. Given the scientific evidence and the updated
or psychiatric in origin. Dutch guideline for ODE, the rigid categorization of
3. Misclassification potential these conditions has become less critical. As of January
2023, the updated ODE guideline applied universally to
The recent DSM classification system has been critiqued all patients, regardless of the nature of their underlying
for its criteria regarding SSDs. The DSM-5 may contribute suffering, potentially enhancing patient care and research
to misdiagnosis, misclassification, and unnecessary outcomes.
stigma when applied to patients with tinnitus and chronic
pain. Several authors have consequently proposed Future studies in this prospect should acknowledge
modified diagnostic criteria to reduce the likelihood the recent ODE guideline update, emphasizing that after
of misclassification of a purely physical disorder for a confirming the patient’s mental competence in their
psychiatric disorder. At present, an increasing subset of decision to undergo euthanasia, the focus should be on
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the primary care population with medically unexplained the patient’s suffering rather than its categorization and
symptoms is at risk of receiving the diagnosis of SSD, classification as either somatic or psychiatric. Scientifically
potentially associated with the misconceived bias that unraveling the psychological factors contributing to
“physical disorders are considered genuine,” while patients the patient’s decision regarding ODE, considering their
with SSD are “inappropriately accused of manufacturing perspective and regardless of their underlying condition, is
their symptoms.” 19 a promising direction for future research.

Potentially, tinnitus and chronic pain may be incorrectly Acknowledgments
labeled as psychopathological. We made a deliberate effort
to avoid misclassification in our previous study. In our first None.
article on ODE, where we compared patients suffering Funding
1
from an underlying somatic disorder with those suffering
from an underlying psychiatric disorder, patients with None.

Volume 2 Issue 3 (2024) 3 doi: 10.36922/jcbp.3182