Notice bibliographique
Résumé
Dear Editor: The neurophysiological mechanisms and comorbidities of anxiety and depression with chronic pain cited by the authors1 serve as evidence of correlation, not causality. When A (neurophysiological mechanism) and B (symptom of chronic pain) occur together, it cannot be concluded that A causes B, because it could just as well be that B causes A, or a third factor causes both. Regarding the comorbidity of chronic pain with anxiety or depression, it could be that these forms of psychological distress result from chronic pain due to physical impairment, that the pain is a symptomatic expression of anxiety or depression, or that underlying psychosocial issues are causing both. A mentor of mine used to say, “You can’t have a bad thought without a bad molecule, and you don’t know which comes first,” and this paper proves that adage. When a symptom or condition is diagnosed as psychosomatic, this should not be done solely by exclusion, that is, lack of objective medical evidence. There should be positive substantiation through identification of psychological factors that provide an understanding of what is going on in the life of the patient. The ability to at least ballpark such situations should be in the therapeutic armamentarium of every physician, while psychiatrists should be able to provide biopsychosocial formulations as a core skill. By doing so, we help our patients by empowering them to deal with real life problems, as opposed to placing them in a position of passivity as recipients of a medical solution. Problems occur when psychosomatic diagnoses are communicated poorly, such as “There’s nothing really wrong with you” or “It’s all in your head,” and when patients are not ready to assume psychological ownership of personal problems. Either of these can result in demonization of physicians who make such diagnoses, in the former case justifiably, not so the latter. Case in point: the diagnosis of tension headaches seems to have disappeared from the medical lexicon, because everyone has migraines. Despite their potential severity, tension headaches are not seen as medical enough, place an onus on patients to deal with whatever source of tension is causing the headaches, and places physicians who make this diagnosis at risk of demonization for allegedly blaming patients and minimizing their suffering. By contrast, the diagnosis of migraine is perceived as more validating and more supportive, leading to a proliferation of migraine diagnoses and treatments. Just as the failure to make a medical diagnosis can have serious consequences in patients with chronic pain and other medically unexplained symptoms, so, too, can the neglect of a psychosomatic diagnosis, in terms of extensive and fruitless investigations and consultations, iatrogenic complications of questionable treatments, and reinforcement of illness–disabled role issues at the expense of dealing with real problems. The mind is more than the sum of the neurochemical parts of the brain, and the failure to recognize this places us at risk of falling into a mindless brand of psychiatry.2
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,029 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,001 |
| Bibliométrie | 0,002 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,002 |
| Communication savante | 0,002 | 0,003 |
| Science ouverte | 0,003 | 0,001 |
| Intégrité de la recherche | 0,009 | 0,016 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,002 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».