Basic Psychosomatic Care Research Articles

Psychosomatics in ophthalmology

Apatient who presents to undertake an examination and treatment in the eye clinic or the ophthalmologist's practice, comes not only as a"sick eye", but as ahuman being with a genetic predisposition, socialization, life experiences and individual behaviors. These influence not only the disease of the eye but also the communication with the patient, the patient-doctor relationship and the implementation and success of the treatment. In our ophthalmological practices, apsychosomatic approach means accepting the patient in his/her entirety and building atrusting patient-doctor relationship through adequate communication. With aresource-oriented approach the patient can be supported in coping with the illness and can be guided towards self-responsibility and self-efficacy. The skills for psychosomatically oriented work can be acquired through the training in basic psychosomatic care.

Balint group as a mandatory training - Effects of Balint work as part of the psychosomatic basic care course

Balint group as a mandatory training - Effects of Balint work as part of the psychosomatic basic care course Objectives: Participants in the psychosomatic basic care course often lack a genuine interest in Balint work. What effects does Balint work have on these inexperienced and less motivated participants? Are there differences between male and female participants and between surgical and non-surgical specialties? What are the relationships between the group leaders and the results achieved? Methods: Between 2004 and 2019, a total of 1,667 doctors completed the feedback form for the Balint group as part of the psychosomatic basic care course. The learning objectives included cognitive and emotional items, as well as questions about the group atmosphere and leadership, about the transfer to everyday medical practice and interest in further Balint work. Results: 170 Balint groups took place during the investigation period. The overall grade was on a scale from 1 to 6 with M = 1.80 (SD = 0.72). Good to very good ratings were awarded to the motivation and competence of the group leaders and the group atmosphere, as well as gaining knowledge and positive effects on everyday medical practice. There were hardly any differences between female and male participants and between surgical and non-surgical participants. However, there were significant correlations between the assessment of the leader and the effects of group work. Discussion: The predominantly positive assessment of Balint's work is surprising, both in terms of cognitive and emotional learning goals. In addition to the group atmosphere, the motivation and competence of the group leader, perceived by the participants, are closely related to the learning effects achieved. The survey shows that Balint work can achieve positive results even with less motivated participants on a compulsory course. Balint work should therefore remain an integral part of the qualification in psychosomatic basic care. Sound training and supervision of Balint group leaders are necessary.

Evidence-based recommendations for the treatment of depressive comorbidity in somatic illness

Comorbid depression is frequent in internal medicine (e.g. in coronary heart disease, congestive heart failure or diabetes mellitus) and impairs quality of life as well as the prognosis of the somatic illness. To review evidence based recommendations for the treatment of depressive comorbidity in selected somatic disorders. Selective literature search based on national and international guidelines. In clinical routine, depressive symptoms are often overseen or misinterpreted. Therefore, aspecific diagnostic is recommended. Depressive symptoms should obligatory be screened during the clinical interview or by validated questionnaires. When screened positive, further diagnostic steps are mandatory. The treatment of depressive disorders has three main components: basic psychosomatic care, psychotherapy and antidepressant medication. These interventions are safe and effective for reducing depressive symptoms and enhancing quality of life. However, results regarding the effects on morbidity and mortality of the comorbid somatic disorder are still inconclusive. The greatest effects on depression are obtained by apreference-based, stepped-care approach and an optimal cooperation of all professionals ("collaborative care"). An effective treatment of depressive comorbidity is relevant for quality of life and possibly also for the prognosis of asomatic disease. Integrating aroutine screening for depressive symptoms is the first step toward an effective, evidence-based therapy.

Comorbid Mental Disorders in Gastroenterology and Hepatology: Prevalence and Psychosocial Needs in Tertiary Care

In the field of gastroenterology and hepatology, associations and interactions with comorbid mental disorders are often described, but there is currently a lack of methodologically high-quality studies on prevalence and the need for care. The aim of the study was to take account of this shortcoming. Prospective, monocentric, cross-sectional study of a representative sample of inpatients at a university hospital. A total of 308 participants were examined for the presence of 8 frequent psychological syndromes with a validated questionnaire (PHQ-D). In addition, 63 participants were examined for the presence of mental disorders according to ICD-10 with a diagnostic interview (SKID-I) that covers a wider range of diagnoses. The need for psychosocial care was raised from the perspective of internal medicine practitioners and psychosomatic experts. The prevalence for at least 1 mental syndrome in the questionnaire sample (PHQ-D excl. PHQ-15) was 39.6%, in 23.8% of whom more than one syndrome was present. The most frequent were depressive and anxiety syndromes. There were significant differences in the various subgroups (sex, type and severity of the somatic disease). The 4-week prevalence for any mental disorder in the interview sample (SKID-I) was 52.4%. Affective and somatoform disorders as well as adaptation disorders were dominant. The need for psychosocial care was reported in 23.1% by the practitioners and in 30.2% by the experts. Patients with gastroenterological-hepatological tertiary care have a high prevalence of treatment-related psychological syndromes or disorders. In comparison with the reference data of the Robert Koch Institute on the 12-month prevalence of mental disorders among the general population in Germany, the proportion of current mental disorders is almost twice as high (52.7 vs. 27.1%, p<0.001). To cover the need for care, the provision of psychosomatic liaison services and the strengthening of psychosomatic basic care in gastroenterology/hepatology should be established.

Akupunktur und Gespräch: Eine psychosomatische Allianz und vertiefte Arzt-Patienten-Beziehung

Novices in acupuncture justifiably start acquiring new points and their indication according to modern medical diagnoses. Only gradually will the theory of Chinese Medicine be grasped and transferred into practical action. Nevertheless, even beginners in acupuncture will frequently encounter surprising successes. Nowadays, basic scientific research and clinical studies will explain discernable effects to a large extent. The needle is essential, however, that's not all. The doctor-patient-relationship is evidenced to be of paramount scientific significance.Considering the comprehensive effect of the needle on soma and psyche, it seems reasonable to integrate acupuncture into the curriculum ”psychosomatic basic care”.The therapeutic dialogue, being preceded or followed by needling, has the potential to fill a gap in psychosomatic basic care. In first place this concerns patients who are not (yet) willing to have psychotherapy or whose GP is not capable of meeting their need for dialogue.

Chronic pelvic pain in women

Chronic pelvic pain in women represents a difficult diagnostic and therapeutic problem in the gynecological practice which is always a challenge when dealing with affected women. Possible gynecological causes are endometriosis, adhesions and/or pelvic inflammatory disease (PID), pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome, interstitial cystitis and fibromyalgia. Psychosocial causes contributing to chronic pelvic pain are a high comorbidity with psychological factors, such as anxiety disorders and substance abuse or depression but the influence of social factors is less certain. The association with physical and sexual abuse also remains unclear. Important diagnostic steps are recording the patient history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are considered to be very promising. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage.

Multiple Psychovegetative Symptoms

The article (1) is obviously a very thorough explanation of physical symptoms, or syndromes, of vertigo, which is based on a wealth of experience. Unfortunately, such vertigo by no means occurs in all affected patients, even in our specialized outpatient clinic, and hardly any attention is paid to the fact that isolated vertigo is very rare, since it is almost always embedded in a multitude of psychovegetative symptoms—a perspective from which vertigo is the lead symptom only for certain specialties: otolaryngology and neurology. The number of “vertigo patients” in non-specialized practices is high, as investigations have shown, so that the number of symptoms that cannot be captured with organic causes is correspondingly higher in such practices than in specialized outpatient clinics (2). But even in the mentioned publication, the rate of disorders that cannot be explained with organic causes is 35%, and if patients with Meniere’s disease are included, which is a non-controversial approach for doctors with a psychosomatic approach, then this rate rises to 45%. What happens to such patients, who in a specialized outpatient clinic ultimately do not receive adequate help? Except for the administration of citalopram in “phobic vestibular vertigo,” the authors do not share any therapeutic recommendations. Adequate psychological diagnostic evaluation is apparently also not undertaken. This should no longer be the case in these times with training opportunities for “basic psychosomatic care” and in view of the existence of specialists for psychosomatic medicine.

Awareness Should Be Raised Among Doctors

In times of compulsive control, demand, and perfectionism in the realm of limitless possibilities, almost every pregnancy turns into a crisis with long latency periods until exhaustion and ambivalence are integrated or resolved. This pathway includes symptoms such as hyperemesis, premature labor, hypertension, dystocia of labor, breastfeeding and bonding problems, and sometimes depression. The latter does not have to be used as the umbrella term even if ambivalence always entails an element of depression. Independently of these factors I share the following considerations regarding possible strategies: awareness needs to be improved in gynecologists and midwives in order for them to address ambivalences, identify these, and initiate the correct treatment. Networks to support parents with psychosocial burdens (for example, www.mutterkindgesundheit.de) are also suitable instruments. The high prevalence is acknowledged by the fact that gynecologists have to acquire a qualification in basic psychosomatic care. This should actually be included in the further training curriculum for every medical specialty. The German Society of Psychosomatic Obstetrics and Gynecology (DGPFG, Deutsche Gesellschaft fur Psychosomatische Geburtshilfe und Gynakologie) does not only provide curricula for psychosomatic basic care on a nationwide basis, but it also arranges specialty-specific psychotherapy and psychosomatic further professional education for midwives and psychologists.

Psychotrichology: psychosomatic aspects of hair diseases

Hair growth and hair disorders with changes in hair density or quality not only influence an individual's appearance but also often lead to an enormous emotional burden with low self-confidence, impaired quality of life, and even psychological disorders. Psychosomatic hair diseases cover a wide spectrum of specific psycho-dermatological disease patterns. This review provides an overview and classification of psychosomatic hair diseases based on primary and secondary disorders. Somatoform disorders are among the primary psychiatric diseases, especially body dysmorphic disorder in which patients have an exaggerated and excessive preoccupation of normal and physiological hair loss. Self-inflicted skin diseases as trichotillomania, often with an impairment of impulse control, also belong to this group. Secondary/reactive psychosocial disorders may occur in congenital and acquired hair disorders. These may be accompanied by feelings of disfigurement, depressive and anxiety disorders including social avoidance. Furthermore, psychosomatic comorbidity could complicate coping with hair loss. Psychosomatic therapy and coping are based on an early and accurate differential diagnostic approach to psychosomatic disorders. Psychotrichological disorders need to be treated promptly with psychosomatic basic care, improvement of coping strategies, behavior therapy, depth psychology, and/or appropriate psychopharmacotherapy with antidepressants or anxiolytics.

Psychosomatische Grundversorgung im Krankenhaus - Eine empirische Untersuchung zu biopsychosozialen Belastungen, Behandlungsmaßnahmen und Behandlungsergebnissen aus Sicht der Ärzte

The present study investigates the psycho-social stress, the treatment procedures and the treatment outcomes of stressed patients in the hospital from the perspective of the hospital doctors. Physicians from all disciplines who had completed the course "Psychosomatic Basic Care" as part of their specialist training documented selected treatment cases. 2,028 documented treatment cases of 367 physicians were evaluated. Anxiety, depression and family problems were the most common causes of psychosocial stress. In over 40 % of the cases no information was found on the medical history. Diagnostic and therapeutic conversations took place with almost half the patients (45%). From the vantage point of the physicians patients receiving diagnostic and therapeutic conversations achieved significantly more positive scores with respect to outcome variables than patients without these measures. Collegial counseling was desired for more than half of the patients and took place mainly among the ward team. There were few significant differences in the views of surgical and nonsurgical physicians. Psychosomatic basic care in general hospitals is possible, albeit with some limitations. Patients undergoing psychosocial interventions have better treatment outcomes. Therefore, extending training to 80 hours for all medical disciplines seems reasonable.

Current standards in the diagnostics and therapy of hair diseases – hair consultation

Hair and scalp diseases present an extensive diagnostic and therapeutic task. Treating them is often a challenge for the physician in daily practice. Unclear diagnoses, chronic conditions with long-lasting therapies and the uncertainty of the patient may often lead to unsatisfying situations for both the patient as well as the doctor. The complaints can be divided into (1) hair loss, (2) increased hair growth and (3) abnormal hair quality. A structured history and the objectification of the clinical findings with the help of standardized diagnostic methods and score systems or classifications enable a diagnosis in most patients already at the first visit. Moreover, such structured processes strengthen the treatment satisfaction and compliance of both the patient and the therapist. In the meantime, diagnostic measures and clinical practice guidelines are available for the most common hair disorders. Expertise in basic psychosomatic care and an empathetic approach to the fears and concerns as well as practical advice for the daily contact with hair disorders should be integrated as separate elements in the management of hair diseases; in most cases they are gratefully welcomed by the patients. The aim of this article is to provide the physician with a guideline for the structured management of a hair patient. An overview of recent new developments and the currently available clinical practice guidelines for diagnosis and therapy of hair disorders is presented.

Psychosomatic Aspects of Endometriosis

From a patient's perspective and experience endometriosis is characterized by six major challenges and stressors: 1) often the diagnosis is delayed; 2) the cause of the disease is unknown; 3) it is a chronic recurrent disease; 4) it affects young women; 5) it is accompanied by chronic pain and dyspareunia; 6) it may lead to infertility. These features create psychological needs for patients which should be responded to by an integrated basic psychosomatic care. This includes respect and empathy, patient centered communication, adequate response to negative emotions, establishment of a helpful and lasting therapeutic relationship, psychoeducation, empowerment and shared decision making. Apart from this basic psychosomatic care which can be provided by each treating physician or nurse, some conditions need more specialized psychosomatic care in the context of a multidisciplinary team: Chronic pain services, Infertility treatment teams, Sexual counselling and therapy and treatment of psychiatric comorbities or sequelae of the disease like depression, anxiety disorder etc. Psychosomatic care should thus be integrated into the biomedical diagnosis and therapy of endometriosis.

Ärztliche Psychotherapie in der Haus- und Facharztpraxis: Eine empirische Untersuchung in Südbaden

The present study investigates the kind and frequency of medical psychotherapy carried out in GPs' offices in South Baden, Germany. Established GPs and other primary-care physicians from South Baden (n = 64) who had successfully completed additional training in psychotherapy were queried about their current psychotherapeutical services using a questionnaire. The data were evaluated by applying descriptive and correlative statistical procedures. The response rate was 93.8 % (n = 60). Standard psychotherapy short-term psychotherapies with up to 25 hours and long-term psychotherapies with up to 50 hours) had been supplied, with an average of 8.3 patients per doctor and quarter. Services rendered outside standard psychotherapy regimen including the approved services for basic psychosomatic care, especially short-term psychotherapeutic interventions of up to ten sessions, were performed with an average of 108.9 patients per doctor. As predictors for the performance of these services we found (1) patients with a high educational level (p = 0.002), (2) the cooperation with other psychosocial professional groups (p = 0.008), and (3) the participation in quality-assurance measurements (p = 0.009). Physicians with additional training in psychotherapy offered a great amount of psychotherapeutical services not covered by the the standard psychotherapy guidelines of the national health services. These offers, borne primarily by idealism, should be acknowledged by new reward models in the future.

Differentiation Is Useful

Jacobi et al in their article on child abuse and neglect rightly mention Munchhausen syndrome by proxy (MSBP). However, in the article, symptoms of children with a factitious disorder are confused with symptoms of by proxy (3), and Munchhausen syndrome by proxy (MSBP) is an important subcategory among the factitious disorders (2). The differentiation makes for an important difference from the perspective of pediatricians and within the context of basic psychosomatic services and the work of Balint groups: In Munchhausen syndrome by proxy (1), the psychological or real parent (for example, the mother) presents the child under the pretext of manufactured symptoms of disease (Pseudologia phantastica); for example, a 2 year old child is reported to have had “seizures” at night. In factitious disorders by proxy, by contrast, manipulative measures are taken that are directly harmful for the child (for example, administration of medical drugs). It also makes sense to differentiate between the two syndromes from a clinical perspective because it is often possible to address the dynamic in Munchhausen syndrome at the level of psychosomatic basic care as the mother’s own suffering (for example, excessive fears related to her body, which are projected on to the child). By contrast, in the factitious disorders, the disruption to the relationship between child and psychological parent is usually much more severe and unraveling the entire dynamic is a protracted process—and, additionally, the child is at immediate risk.

Chronischer Beckenschmerz der Frau aus gynäkologischer Sicht

Chronic pelvic pain in women is a difficult subject that challenges the gynecologist in practice. Possible gynecological causes are endometriosis, adhesions/PID, pelvic varicosis and ovarian retention syndrome/ovarian remnant syndrome. Other somatic causes are irritable bowel syndrome, bladder pain syndrome and fibromyalgia.Confirmed psychosocial factors contributing to chronic pelvic pain are comorbidity with anxiety disorders, substance abuse or depression, but the influence of social factors is less certain. The connection to physical and sexual abuse also remains unclear. Important diagnostic steps are studying the patient's history, a gynecological examination and laparoscopy. Multidisciplinary therapeutic approaches are helpful. Basic psychosomatic care and psychotherapy should be integrated into the therapeutic concept at an early stage of the disease.

Allgemeine Behandlungsgrundsätze, Versorgungskoordination und Patientenschulung beim Fibromyalgiesyndrom und chronischen Schmerzen in mehreren Körperregionen

A guideline for the treatment and diagnostic procedures for fibromyalgia syndrome (FMS) was developed in cooperation with 10 German medical and psychological associations and 2 patient self-help groups. A systematic literature search including all controlled studies evaluating physiotherapy, exercise and strength training as well as physical therapies was performed in the Cochrane Collaboration Reviews (1993-12/2006), Medline (1980-12/2006), PsychInfo (1966-12/2006) and Scopus (1980-12/2006). Levels of evidence were assigned according to the classification system of the Oxford Centre for Evidence-Based Medicine. Grading of the strengths of recommendations was done according to the German program for disease management guidelines. Standardized procedures to reach a consensus on recommendations were used. Patient's information at first diagnosis of FMS is strongly recommended (grade A). Patient-centered communication is recommended (grade B). A stepwise treatment approach depending on the adapatation to restrictions in daily life and response to treatment options can be considered (grade C). The long-term treatment should be based on principles of basic psychosomatic care and shared decision making on treatment options.

Konsiliar-Liaisondienst und Ambulanz einer Psychosomatischen Universitätsklinik: Patientenzuweisung, Anlass der Vorstellung, Empfehlungen

While psychosomatic clinics in German hospitals in general provide consultation-liaison and outpatient services, up to now no direct comparisons of the two systems of care have been made. Based on a comparison of 750 CL patients and 617 outpatients from a university hospital during the course of one year, differences between the two patient populations were recorded for referral, reasons for presentation, and psychotherapeutic recommendations. Compared to outpatients (43 years), the average age of CL-patients was higher (50 years); the proportion of men was higher, and level of education was lower. Adjustment disorders and psychological factors in somatic disorders were more frequently diagnosed (versus more somatoform, affective and anxiety disorders in outpatients). CL patients had fewer experiences with psychotherapy and were overall less distressed than outpatients. More frequently they were recommended basic psychosomatic care or psychiatric outpatient treatment and less outpatient psychotherapy. Implications for concepts of care are discussed. A uniform basic documentation for the two fields of care seem to make sense.

Psychosomatische Versorgungspraxis und Kooperationsbedarf aus Sicht niedergelassener Ärzte und Psychologen

Cooperation in psychosocial care is gaining increasing importance due to newly established psychosomatic departments in the acute care setting and to structural changes following the Health Care Modernization Act. The presented study aims at describing the psychosomatic treatment and cooperation practice in the ambulatory sector and the cooperation possibilities with the inpatient psychosomatic care sector. Registered doctors in all specialties along with psychotherapists working in private practice in the southwestern region of the Association of Panel Doctors (Nordbaden) were surveyed about this in a written questionnaire in 2003. Respondents totaled 497 (33 %). General practitioners (GPs) and somatic specialists first estimated the psychosocial treatment necessities based on patients in their own practice. Half reported cooperation with a psychosomatic colleague, 10 % took part in a Balint-style group. GPs and somatic specialists unlicensed in psychosomatic basic care reported significantly lower numbers on the existing psychosocial care practice compared to those with the respective license. GPs and somatic specialists regard diagnostic procedures as central for improving their daily psychosomatic/psychosocial care. More than 50 % would request a brief diagnostic screening instrument. Psychiatrists and psychotherapists prefer the option of case conferences. The reported cooperation preferences of a psychosomatic department follow established setting structures with little mention of cooperation options falling outside established sectors. GPs and psychiatrists/psychotherapists share the same priority in designating a contact person in the department for crisis intervention. This expresses their feelings for greater need in direct and acute cooperation features. Somatic specialists prefer to request a second opinion from the department. The predominant diagnoses to admit patients for both psychiatrists and psychotherapists are eating disorders, pain syndromes, and personality disorders.

Psychophysiology of visceral pain syndromes

Psychosomatics of visceral pain syndromes. From a psychosomatic point of view visceral pain syndromes can be classified into nociceptive (somatic and visceral) pain syndromes without and with maladaptive pain coping resp.psychic comorbidity, functional pain syndromes (typical symptom clusters without biochemical or structural abnormalities in clinical routine diagnostics) and psychic disorders with pain as main symptom. With regard to the etiology and the course of chronic inflammatory bowel diseases (IBD) as representatives of somatic pain syndromes and of irritable bowel syndrome/chronic pelvic pain as representatives of functional pain syndromes empirically validated psychosocial aspects are summarized: Personality traits, illness behavior, daily hassles, life events and psychic comorbidity and effects of psychotherapy. Psychosocial factors are decisive in the etiology and the course of functional pain syndromes as determinants of their severity (psychosomatic disease in a narrow sense). Psychosocial factors are not decisive for the etiology, but for the course of IBD (psychosomatic disease in a broader sense). Within general pain therapy of visceral pain syndromes a biopsychosocial approach should be applied right from the beginning (psychosomatic basic care). Within special pain therapy of visceral pain syndromes a qualified psychiatric - psychotherapeutic diagnostics and co-therapy should be mandatory.

Psychosocial competence of general practitioners in managing psychiatric patients: initial results of a questionnaire study

Given the frequency of patients with psychosocial problems and mental disorders in primary care our study focuses on the relationship between the psychosocial qualifications of general practitioners and their management of these patients. A questionnaire was sent to all general practitioners in Hessen asking for sociodemographic and profession-related data as well as their psychosocial competence and their procedure during a regular day in practice. Based on 396 questionnaires we compared five groups of general practitioners with different psychosocial qualifications, proportionate incidence of diagnoses, medical procedures and referrals to specialists and hospitals. The average age of the participants of our study is 45 years, they have been working for 14 years. 163 general practitioners without and 59 with a special interest in psychosocial qualification and 174 psychosocially qualified physicians participated in the study. Of a total of 65 patients seen during the reference day 18 were diagnosed as suffering from mental disorders. Their number increased with greater psychosocial competence of the physicians. Psychosomatic and reactive disorders are the most frequent mental disorders to be seen in primary care with nearly 60%. Verbal therapy is often applied, procedures of the so-called psychosomatic basic care and prescription of psychotropic drugs play only a minor role. Nearly every fourth patient is referred to other specialists, referrals for inpatient treatment occur with 1.3% only. Because of the low response rate our study is not representative. Nevertheless the results permit some conclusions concerning the relationship between psychosocial qualification of general practitioners and their management of patients with mental disorders.