Page 115 - JCBP-3-3

Journal of Clinical and
Basic Psychosomatics Psychogenic fever and palpitations in autonomic dysfunction

key contributing factors to the patient’s PF: (i) physical questionnaire. The anxiety following VSD closure may have
(e.g., VSD closure surgery), (ii) psychological (e.g., anxiety, contributed to the pathogenesis of PF. Prolonged anxiety
depression, stress), and (iii) social (e.g., work, family). These and elevated body temperature can impede the treatment
factors align with the bio-psycho-social model of health. of primary diseases and severely affect patients’ quality of
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Moreover, the publication of the “Recommendation life. Consequently, early identification and appropriate
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from the Chinese Consensus of Standard Psycho- psychotherapy for PF are essential.
Cardiology Clinics” has promoted the adoption of this Unlike hyperthermia, PF is a true fever resulting from
model among Chinese cardiologists, thereby increasing an increased central thermoregulatory “set point.” Animal
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awareness of its application. By employing this model, studies have shown that cyclooxygenase inhibitors, such
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we systematically ruled out infectious, endocrine, and as aspirin and indomethacin, can reduce the rise in rectal
immunologic etiologies. Psychological assessment scales temperature in stressed rats, suggesting the involvement
and autonomic function evaluations were utilized to of inflammatory mediators, such as prostaglandin E and
ascertain the contribution of psychological factors to the interleukin-6 in PF. The production of these mediators
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patient’s symptoms. Accordingly, targeted interventions may be linked to the stress-induced diversion of blood
were implemented, including antidepressant medication from the mesenteric vascular bed to the heart and brain,
and instructions for specific cardiac rehabilitation potentially causing intestinal wall ischemia. However, this
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exercises. Follow-up appointments at 1 and 2 months post- mechanism alone does not fully explain the poor response
treatment revealed significant improvement in the patient’s of PF patients to non-steroidal anti-inflammatory drugs,
symptoms. However, the patient declined further visits indicating that a more complex biological mechanism is at
to the psychiatric department. This case underscores the play in human PF. Current perspectives suggest a close
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importance of physicians in general hospitals possessing association between PF and the ANS, particularly its central
a solid understanding of mental health, emphasizing and sympathetic components. Chronic stress and affective
the need for integrating psychological care into the disorders can activate stress-related neural centers, leading
management of patients with somatic complaints. In to ANS dysfunction and subsequent PF. Descending
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addition, the establishment of a multidisciplinary pathways from the dorsomedial hypothalamus to the
cooperative mechanism to effectively follow-up with such rostral medullary raphe region and rostral ventrolateral
patients, along with increasing public awareness of the medulla mediate stress-driven sympathetic excitatory
benefits of scientific psychiatric treatment, remains an transmissions, which regulate thermal and cardiovascular
urgent issue. responses. This increased sympathetic activity can
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PF is a condition that can affect individuals across elevate heart rate and blood pressure. In addition, PF
various age groups and is associated with a wide range with postural tachycardia has been associated with an
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of comorbidities. A literature review published in 2007 enhanced sympathetic response to stress. In this case, the
indicated that the onset of PF in Japan ranged from 3 assessment of the patient’s ANS function helped elucidate
to 65 years of age. PF patients have been encountered the potential etiology of PF and palpitations.
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across multiple medical specialties, including pediatrics, Given the rising prevalence of mental disorders,
psychosomatic medicine, psychiatry, internal medicine, physicians must consider psychosomatic factors when
anesthesiology, dentistry, and obstetrics and gynecology. symptoms cannot be explained by organic pathology. In
As of December 2, 2024, a PubMed search retrieved 18 response to the high incidence of mental health issues
reported cases of PF since 1953. 10,35-51 Notably, one case among cardiology patients, a protocol for the rapid
described a 61-year-old male with small cell lung cancer identification of such patients in outpatient cardiology
who experienced fluctuating temperatures between 37℃ settings has been developed and has shown promising
and 39℃, with anxiety levels confirmed by the 24-item clinical outcomes. The protocol includes :
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Hamilton Anxiety Scale. After receiving anxiolytic (i) A thorough medical history, including the evolution
treatment, the patient’s temperature normalized within of the patient’s mental state alongside the course of the
a week. Another case involved a 22-year-old female illness;
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who had recurrent low-grade fever and transient visual (ii) A physical examination and relevant laboratory tests
impairment following a head injury from a rolling to assess the severity of CVDs and exclude other
gate. Despite receiving antipyretics and antibiotics, her organic causes;
symptoms persisted until psychotherapy was initiated, (iii) A psycho-physiological examination, such as
which resulted in symptom resolution within a week. In assessments of blood pressure, heart rate, and
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our case, the patient’s mental stress was primarily related to autonomic nervous function, to elucidate the mind-
work and family, as indicated by the personal information body connection;

Volume 3 Issue 3 (2025) 109 doi: 10.36922/jcbp.4864