Psychiatric Consultation in Somatization Disorder

Abstract

The per capita expenditure for health care of patients with multiple physical symptoms but no apparent physical disease (somatization disorder) is up to nine times the average per capita amount. We conducted a randomized controlled trial to determine whether psychiatric consultation would reduce the medical costs of these patients, without effecting a substantial change in patient outcome. Thirty-eight patients were randomly assigned to treatment or control groups and studied prospectively for 18 months. Treatment consisted of a psychiatric consultation and suggestions on management given to primary physicians. After nine months, the control group was crossed over to receive treatment with the same intervention. After the psychiatric consultation, the quarterly health care charges in the treatment group declined by 53 percent (P less than 0.05). In contrast, the charges in the control group showed wide variations but no overall change. The quarterly charges in the control group were significantly higher than those in the treatment group (P less than 0.05). After the control group was crossed over to receive treatment, their quarterly charges declined by 49 percent (P less than 0.05). The reductions in expenditures in both groups were due largely to decreases in hospitalization. We conclude that psychiatric consultation in the care of patients with somatization disorder reduced subsequent health care expenditures without inducing changes in health status or patients' satisfaction with their health care.

Cognitive Behavioral Therapy for Somatoform Disorders

“…Smith and colleagues sent a psychiatric consultation letter to patients' primary care physicians, describing somatization disorder and providing recommendations to guide primary care (Smith, Monson, & Ray, 1986b). The recommendations to physicians were straightforward: (a) to schedule somatizers' appointments every 4 to 6 weeks instead of "as needed", (b) to conduct a physical examination in the organ system or body part relevant to the presenting complaint, (c) to avoid diagnostic procedures and surgeries unless clearly indicated by underlying somatic pathology, and (d) to avoid making disparaging statements, such as "your symptoms are all in your head."…”

Managing Somatization Disorder

“…Short, frequent appointments or telephone calls have been shown to decrease outpatient medical costs while maintaining patient satisfaction [13]. These clinical encounters should include a brief but focused history and physical exam followed by open-ended questions like, "How are things at home?"…”

Tratamiento psicológico en el trastorno de somatización : eficacia y propuestas de intervención

“…Se han desarrollado dos estudios controlados randomizados evaluando la utilidad de enviar una carta de interconsulta a para informar/entrenar al medico de familia que solicita consulta sobre el tratamiento más adecuado para este tipo de pacientes (Rost et al, 1994;Smith et al 1986). En el primero de ellos (Smith et al, 1986) se randomizan 41 pacientes con diagnóstico DSM-III de trastorno de somatización diagnosticados mediante entrevista psiquiátrica estructurada, que fueron distribuidos en dos grupos: lista de espera o un grupo en el que los generalistas recibieron una carta de consulta donde un especialista recomendaba una serie de intervenciones a realizar con estos pacientes.…”

“…En el primero de ellos (Smith et al, 1986) se randomizan 41 pacientes con diagnóstico DSM-III de trastorno de somatización diagnosticados mediante entrevista psiquiátrica estructurada, que fueron distribuidos en dos grupos: lista de espera o un grupo en el que los generalistas recibieron una carta de consulta donde un especialista recomendaba una serie de intervenciones a realizar con estos pacientes. Los pacientes fueron seguidos durante 3 meses por un investigador ciego que desconocía a qué grupo pertenecía el paciente.…”