Psychosomatic patients in integrated care: Which treatment mediators do we have to focus on?

Abstract

The field of psychosomatics has gained increasing significance; it has been struggling to establish its position as either an independent discipline or a subdomain of specific areas such as internal medicine or psychiatry. However, the rise of psychosomatic syndromes and disease patterns as well as an increase of specific integrated psychosomatic wards is a clear indication for the growing importance of interdisciplinary approaches to psychosomatic disorders. The study presents data from an 8-week inpatient treatment at a psychosomatic facility and investigates whether patients improved in their subjective symptom experience. A complex treatment approach, ranging from pharmacological treatment and group and individual psychotherapy to physiotherapy and ergotherapy was integrated into this intervention. In essence, containment of intrapsychic aggression derivatives played a central role in the treatment of psychosomatic symptoms. A significant factor contributing to a successful treatment is the doctor-patient relationship. All these factors were investigated in the present study.

Interprofessional care improves health-related well-being and reduces medical costs for chronic pain patients

“…Our clinical observation was that group analysis focusing on and contain-121 ing topics of aggression was the most effective intervention (cf. Parth et al, 2016). Therefore, we are in line with Maljanen et al (2012), Fonagy et al (2015), and Zimmermann et al (2015), who have concentrated on helping patients to work through severe intrapsychic unconscious problems, leading to improvements in disease-related behavior in the long run.…”

“…A prospective intervention study over a period of three years (2007)(2008)(2009)) was conducted involving 127 consecutively admitted patients who reportedg a chief complaint of recurrent pain with no diagnosed underlying condition and who met the criteria of F45.1 listed in the WHO catalogue (2014; see also Parth, Rosar, Stastka, Storck, & Löffler-Stastka, 2016). In light of the naturalistic setting, the study used a hot-spot recruitment design.…”

“…Out of 127 patients who participated in the prior intervention study (Parth et al, 2016), 106 participants in the followsup intervention (68% female) with a main complaint of chronic pain responded and answered the survey and questionnaires. Their mean age was 54.9 years (±11.2), with no significant difference between women and men.…”

“…Patients were diagnosed and treated by a multidisciplinary team. The 8-week treatment program has been described in detail in an earlier publication (Parth et al, 2016); an overview is given in Table 1. It started with a taking a full psycho-social-medical history, a diagnostic workup according to Psy-BaDo (Heuft et al, 1998), including questions concerning motivation or subjective illness theory; and a physical examination.…”

“…Another topic for further research might be the evaluation of long-term posttreatment effects, as reported by Fonagy et al (2015) for treatment-resistant depressive patients or for depressed and anxious patients (Maljanen et al, 2012). There is also a need to take a closer look at posttreatment dose effects (Zimmermann et al, 2015) of "booster" interventions, as provided in this integrated care setting (Parth et al, 2016), or exact cost utility analyses, searching, for example, for utility weights associated with the EQ-5D and other questionnaires. Such data are a much-needed contribution to the literature and are left for further research agendas.…”