Psychosomatic liaison service in medicine - need for psychotherapeutic interventions and their realisation.
(1/42)QUESTIONS UNDER STUDY: The aim of the study was to evaluate the need for psychotherapeutic interventions and their realisation within the framework of the psychosomatic liaison service. Apart from establishing the diagnosis of psychosocial distress and mental disorders, we assessed the motivation of the patients for psychotherapy. METHODS: 62 consecutive patients admitted to the Department of Medicine (Gastroenterology and Hepatology) Freiburg University Hospital, Freiburg, Germany, underwent standardised psychodiagnostic interviews and completed psychometric self-rating tests to identify mental disorders, psychosocial distress, and motivation for psychotherapy. In addition, the patients' need for psychotherapeutic treatment was rated by the liaison therapist. RESULTS: Using ICD 10-criteria, mental disorders were diagnosed in two thirds of the patients; most frequent were adjustment disorders, affective disorders, and disorders resulting from alcohol use. One third of the patients reported signs of psychological distress; half of them were interested in psychotherapy. A need for psychotherapeutic interventions, based on motivation of the patients and on expert estimate, was found in approximately one third of the patients. 36% received actual psychotherapy. CONCLUSIONS: Our study suggests that - in the patient population studied - the patients' motivation ought to be taken into consideration more strongly when evaluating the need for psychotherapy in clinical practice and further research. (+info)
Management of "psychosomatic" problems in clinical practice.
(2/42)Skilled interviewing and investigation are essential in the diagnosis and treatment of "psychosomatic" illness, the term "psychosomatic" being used in its more colloquial sense to refer to illness characterized by somatic symptoms and related psychopathologic disorders but without organic disease.Treatment of these patients is difficult. They respond best to a psychologically oriented physician who is able and willing to take final responsibility for both physical and psychological care. The hazards of ignoring the psychosocial dimension in patient management are emphasized. Although the family physician generally is the most appropriate therapist, there may be a role for a "liaison physician", a specially trained consultant who is thoroughly familiar with both physical and psychological processes and their interaction. (+info)
Quality of life as medicine: a pilot study of patients with chronic illness and pain.
(3/42)An intensive 5-day quality-of-life (QoL) session was constructed based on a psychosomatic model. The session was comprised of teaching on philosophy of life, psychotherapy, and body therapy. The three elements were put together in such a way that they mutually supported each other. The synergy attained was considerable. The pilot study demonstrated that in the course of only 1 week, patients had time to revise essential life-denying views and to integrate important, unfinished life events involving negative feelings. Consequently, the patients became more present in the body's blocked-off areas and subjectively healthier. Nineteen persons with chronic illness and pain (fibromyalgia, chronic tiredness, whiplash, mild depression, and problems involving pain in arms and legs including osteoarthritis), and unemployed for 5-7 years attended the course. In the week before and after the 5-day course, the participants completed the validated SEQOL (Self-Evaluation of Quality of Life Questionnaire) including questions on self-evaluated health and the unvalidated "Self-Evaluation of Working-Life Quality Questionnaire" (SEQWL). This pilot study was without a control group or clinical control. As far as diagnoses were concerned, the group was inhomogeneous. Common for the group was a low QoL, poor quality of working life QWL, and numerous health problems. The study showed an 11.2% improvement in QoL (p < 0.05), a 6.3% improvement in QWL (p < 0.05), and a 12.0% improvement in self-perceived physical health (p = 0.08). There was a 17.3% improvement in self-perceived psychological health (p < 0.05) and satisfaction with health in general improved by 21.4% (p < 0.05). Symptoms like pain were almost halved and several of the participants were free of pain for the first time in years. In conclusion it seemed that the combination of training in philosophy of life, psychotherapy, and body therapy can give patients a large, fast, and efficient improvement in QoL, QWL, and health. It is not known if these changes will be permanent and if all kinds of patients with different health problems will gain from this cure. Further research should be conducted. (+info)
New vistas in psychosomatic medicine.
(4/42)Further understanding in the field of psychosomatic medicine has come to light recently as the result of new approaches and methods of research. Such diseases as hypertension, ulcerative colitis, rheumatoid arthritis, peptic ulcer, diabetes and cardiovascular dysfunction may represent the body's method of adapting to chronic stress, according to Selye's concept of the general adaptation syndrome, with the phases of alarm, resistance and exhaustion. It has been postulated that unconscious dynamics of which patients are unaware are crucial in the understanding and interpretation of physiological research and therapy of patients with psychosomatic disorders. The concept of partial regression was applicable to patients with psychosomatic illness who were highly successful in social, economic and professional spheres. The illness was viewed as a protection against psychological regression by limited somatic regression. Pilot studies suggested that patients seriously ill with such disorders as ulcerative colitis and asthma responded favorably to enforced psychological regression and exploitation of dependency by excessive coddling, babying and mothering by an "all-giving" physician in a hospital setting. Good physician-patient relationship remains the keystone in therapy and is the common denominator to many so-called successful modes of treatment. (+info)
TREATMENT OF PSYCHOSOMATIC DISORDERS.
(5/42)Goals, potentialities and limitations of treatment of psychosomatic disorders are reviewed. Removal of a disturbing psychosomatic symptom may be all that can be accomplished. The bulk of patients suffering from psychosomatic disorders should be treated by physicians other than psychiatrists. Difficulties arise, owing to differences in approach, when treatment is carried out by a general physician as well as a psychiatrist. In appraising the prospects of treatment, the age on examination, intelligence, duration of illness, degree of insight, nature of illness, environmental stress and personality structure of the patients should be considered. Psychiatric measures which have been employed include: electroconvulsive therapy, psychotropic drugs, hypnosis, drug abreaction, group therapy, supportive psychotherapy and psychoanalysis. Psychoanalysis provides the best understanding of the psychodynamics of psychosomatic illness but is, for a variety of reasons, applicable only to a small number of patients. Alternations and removal of disturbing symptoms can be accomplished by the other therapeutic means. (+info)
PSYCHOLOGICAL MANAGEMENT OF CHILDHOOD ASTHMA.
(6/42)Over-emphasis on physical factors in asthma probably has come about because psychological factors have seemed elusive, difficult to define and often misleading. Several concepts of classic causes of emotional disturbances that abet asthmatic attacks in children may be helpful in management of the patient and his environs. The first concept has to do with feelings of inadequacy in the mother which lead her to place the burden of decision-making upon the child. She is thus able to give the child very little support and communicates to him her anxiety. Often encouragement to the mother, through the physician's pointing out her very real capacities and achievements can be helpful to the child. The second concept has to do with the asthmatic child's character structure and his assumption of a pseudo-mature position. Among the things the physician can do is to advise the parents as to what is age-appropriate behavior for the child and instruct them in ways to make the child recognize his position of dependence. The third concept concerns threat of separation as a precipitant to the asthma attack. To deal with such a situation the physician may make a number of recommendations of methods for alleviating such a threat. In some families, the degree of disturbance is so great that the parents cannot respond to the physician's advice and may need psychiatric referral. Clues for recognizing such a situation are given along with recommendations on how to make a successful referral. (+info)
COMMUNICATION IN ILLNESS: THE RELATIONSHIP OF NATIONAL ORIGIN TO SYMPTOMS AND DIAGNOSIS.
(7/42)This study compares the subjective symptoms recorded by questionnaire, and the diagnoses applied, in 289 adult medical outpatients of six national origins, namely, Canada (Ontario), England, Germany, Hungary, Italy, and Scotland. No significant differences were observed in the number or type of symptoms presented among the national groups. In each group, women and patients with psychological diagnoses reported more symptoms. There were considerable differences in the incidence of somatic (organic) and psychological diagnoses between the groups, which did not reflect equivalent variations in the incidence of definite clinical entities. It is suggested that the symptom habits of the groups studied appeared similar, with the method of investigation used, but that difficulties in patient-physician communication may lead to significantly different diagnostic habits for the national groups involved. (+info)
PSYCHOLOGICAL ASPECTS OF HEADACHE.
(8/42)Headache is considered as a non-specific syndrome illustrating the concept of pain as an emotion. Viewed in this way, its meaning looms larger than its site.Pain indicates dis-ease of the patient, sometimes with his body, but more often with his life. No pain is "imaginary", nor can some pain be assigned to physiological and some to psychological pathways. Such a decision is often merely a judgmental one.Just as the "brain" cannot easily be separated from the "mind", so to believe that some pain is "physical" and some "emotional" is a distortion. All painful syndromes are mixed and the problem is to decipher the meaning of the pain. Only rarely will headache respond to physical measures alone. (+info)