Contribuições da interocepção e do processamento preditivo para a compreensão dos sintomas pelo médico de família e comunidade

Abstract

The family physician is often faced with vague and nonspecific symptoms, which can be self-limited or prolonged, and which require tools for a rational approach to their management. A conceptual framework based on interoception and predictive processing, two recent constructs widely developed in the field of experimental psychology and in research employing functional neuroimaging studies, offers potential applications to family medicine. In order to integrate these constructs into the family medicine practice, an integrative literature review was carried out, based on the description by Ian McWhinney of the presentation of symptoms. To this model, knowledge about interoception, predictive processing and emotional experience were integrated. In the construction of an integrative theoretical framework, theories, paradigms and other relevant constructs such as phenomenology, narratives and clinical tools, were explored. The result is a comprehensive model that views “feeling sick” as a homeostatic emotion which induces the person to take or seek care, and the symptom as the conscious dimension of the regulatory mechanisms of homeostasis. The model recognizes the role of family and culture in the process of developing the strategies which people use to regulate their symptoms. Finally, possibilities of therapeutic interventions were presented in light of this model. The applicability of this model was illustrated through a fictitious case study