Child and adolescent Liaison-Consultation Psychiatry and Psychosomatic Medicine in a Clinical-Teaching Hospital. / Psiquiatría de Enlace y Medicina Psicosomática Infanto Juvenil en un Hospital Clínico-Docente.

Psychosomatic medicine explores the psychological, behavioral, and social elements that influence people's health and quality of life. This discipline develops skills and knowledge used in the evalua tion and management of psychosocial elements interfering in the process of illness and healing. The Child and Adolescent Consultation-Liaison Psychiatry (CACLP) is a discipline that has been empi rically installed in order to favor adherence to treatments and recovery of children and teenagers du ring the process of illness. There is a need for developing this discipline in Chile, but so far there are limited national and international records and literature dedicated to it. The objective of this article is to update the concepts of structure and describe how a CACLP unit in a high complexity teaching hospital works in general, discussing the clinical challenges involved in these issues.

Health Issues Among Healthcare Workers During COVID-19 Pandemic: a Psychosomatic Approach.

Healthcare workers as the front-liner to fight COVID-19 pandemic, need reassurance of their safety. The stress and the demands from the healthcare system can affect their health as well as the morality. Hence, psychosomatic approach should be used to keep their condition in good shape. The combination between biological, psychological, and social approaches may affect their vulnerability from SARS-CoV-2 infection. The biological aspect includes personal protective equipment, nutrition, and resting/sleeping time. The psychological distress is shown to affect the immune system; and mental relaxation and management of work shift may reduce the distress. There should be an effort from the stakeholders to keep the morality of the healthcare workers. The social aspect such as providing place to live, having supportive family members, and avoiding stigmatization also improve their psychological health. In conclusion, psychosomatic approach is important to keep the healthcare workers healthy.

[Internal medicine between soma and psyche : Functional bodily complaints and depressive disorders in outpatient care]. / Innere Medizin zwischen Soma und Psyche : Funktionelle Körperbeschwerden und depressive Störungen in der ambulanten Versorgung.

Somatoform disorders are encountered in primary medical care with above-average frequency but are too rarely named as such in the differential diagnostics. The prevalence is approximately 30 % with a predominance of female patients. This patient group puts the physician-patient relationship to the acid test from the very beginning due to the fixation on organ-related symptoms, the expectations of repeated instrumental diagnostics and the special way of acting. The consequences are frequent changes of physicians, chronification and disappointment on both sides; however, a workable physician-patient relationship can be developed through an empathic but critically distanced fundamental attitude of the general internist based on a biopsychosocial illness concept. In the further course corrections in the understanding and expression of the illness on the part of the patient can be achieved with a pacing and leading strategy and with psychoeducative measures. The primary psychologization of functional complaints will not satisfy the affected person but outpatient psychotherapy should be initiated only after the patient has been well-prepared. Measures with medications mostly remain unspecific and serve only for relief of symptoms. For comorbidities with anxiety and/or depressive disorders the use of selective serotonin reuptake inhibitors should be considered.

Emotion, Social Relationships, and Physical Health: Concepts, Methods, and Evidence for an Integrative Perspective.

Emotional characteristics and processes are robust predictors of the development and course of major medical illnesses and premature mortality, as are a variety of indicators of the presence and quality of personal relationships. Despite clear evidence of close interconnection between these two domains of risk and protection, affective characteristics and relationships have largely been studied separately as influences on health. After a recent conference on integrative perspectives on emotions, relationships and health co-sponsored by the American Psychosomatic Society and the Society for Affective Science, the present review builds on prior calls for integration, related theory, and current research to outline what is known about the interconnection of these domains as it specifically relates to their overlapping influences on health. Areas of interest include the following: their interconnected roles over the course of development, which may inform current efforts to understand the influence of early life events on adult health; the parallel positive and negative factors in both domains that could have distinct influences on health; the role of emotion regulation in relationship contexts; and measurement, design, and analysis approaches to capture the dyadic and dynamic aspects of these interconnected influences on health. We conclude with a discussion of an emerging research agenda that includes the following: common biological foundations of affective and relationship processes, the cultural embeddedness of affective and relationship processes, the potential contribution of affective-relational processes to health disparities, and implications for intervention research.

Between the Error Bars: How Modern Theory, Design, and Methodology Enrich the Personality-Health Tradition.

The study of relationships between personality traits and health has a long history in psychosomatic research. However, personality science has evolved from an understanding of personality as fixed traits to one that acknowledges that personality is dynamic. Dynamic approaches to conceptualizing and measuring personality and individual differences can enrich personality-health research. In this Presidential Address (American Psychosomatic Society, 2018), I consider how different formulations of personality-stable traits, stable signals in a noisy or variable measure, within-person changes, and intraindividual variability-can be implemented to better understand how personality is related to health and particularly to immune function. These approaches recognize and, in some cases, capitalize on the fact that personality factors can display variability as well as stability over time. They also require repeated measurement and therefore greater methodological sophistication that considers reliability and generalizability, Simpson's paradox, and the difference between variability and flexibility. Dynamic qualities of personality and individual differences potentially influence health, and designs and methodology that incorporate them can illuminate the important processes that occur inside the error bars.

A short intervention targeting psychosomatic care in older adults with complex health care needs-results of a randomized controlled trial.

OBJECTIVE: The aim of this randomized controlled trial (RCT) was to assess the efficacy of a short intervention targeting psychosomatic care in older adults with complex health care needs. METHODS: Participants were recruited in the frame of the 11-year follow-up of a large population-based study by means of the INTERMED interview. The INTERMED interview is an integrative assessment method to identify bio-psycho-social health care needs. Persons with high health care needs (interview score ≥ 17) were invited to take part. Participants were randomized with a 1:1 ratio to a control and an intervention group. The intervention group received a home visit conducted by a doctor trained in psychosomatic medicine. The primary hypothesis stated that the intervention group would have a better outcome with respect to health related quality of life (HRQOL) measured by the 12-item short-form health survey (mental component score, MCS) 6 months after randomization (T1). Secondary outcomes were physical HRQOL, health care needs, depression, anxiety, and somatic symptom severity. RESULTS: In total, 175 participants were included. At the three-year follow-up (T2), 97 participants (55.4%) were included. At T1, we did not find a difference regarding MCS between the intervention and control groups. At T2, the intervention group showed significantly lower health care needs compared with the control group. Regarding HRQOL, depression, and somatic symptom severity the two groups did not differ at T2. CONCLUSIONS: The primary hypothesis was not confirmed. However, results indicate that a short intervention with complex patients could lead to reduced bio-psycho-social health care needs.

Implementation of an electronic routine outcome monitoring at an inpatient unit for psychosomatic medicine.

BACKGROUND: Patient-reported outcomes (PROs) can be part of an electronic routine outcome monitoring (eROM). eROM can improve patient involvement, treatment outcomes and simplify scientific data assessment. Available studies on eROM focus on its evaluation only and lack a detailed description of the prior implementation procedure. OBJECTIVE: The aim was to implement an eROM assessment at a division of Psychosomatic Medicine and provide a detailed description of the implementation procedure. METHODS: According to the Replicating Effective Program concept the project consisted of 4 phases: pre-condition (1), pre-implementation (2), implementation (3) and maintenance and evolution (4) mainly focusing the description of the implementation procedure and a short evaluation. RESULTS: We describe the actions taken during the implementation procedure and steps which were taken to overcome identified barriers. All decisions were carried out based on the Participatory Action Research process. A core set consisting of sociodemographic and clinical data and a comprehensive questionnaire battery covering symptoms, functioning parameters and psychological constructs was implemented. In total 164 patients, took part in the eROM assessment from June 2015 to December 2016. The evaluation showed that eROM was appreciated by health-care professionals (85.2%) and patients (70.2%) alike. The majority of patients (89.4%) and health-care professionals (85.7%) experienced no delays in daily clinical routine due to eROM. CONCLUSION: The detailed description of the implementation process can guide institutions planning to implement eROM into their daily clinical routine. Focusing scientific efforts on the implementation process is essential since this influences all further steps such as evaluation and acceptance.

[DGPPN compass of participation for vocational integration of persons with mental illnesses]. / DGPPN-Teilhabekompass zu beruflichen Integrationsmaßnahmen für Menschen mit psychischen Erkrankungen.

Working and living for persons with mental illnesses are a major concern of rehabilitative psychiatry. In Germany the definition of rehabilitation for persons with mental illnesses is closely linked to different sectors of social welfare and to the strongly organized supply chain of prevention, acute treatment, rehabilitation and care. In successfully supporting people with mental health problems in terms of vocational integration, professionals face various obstacles. Besides finding the correct content, structural and organizational difficulties can also arise. The welfare system with its specific institutions and settings is complicated which often leads to delays in the onset of rehabilitation. Some essential reasons are insufficient knowledge about established options of rehabilitative treatment and about responsibilities related to participation in specialized training and further education for professional caregivers. Also information and (positive) experiences from pilot projects working in an inclusive, cross-sectional way and across different settings are practically unavailable in Germany. The presented compass of participation from the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) for vocational integration of persons with mental illnesses starts at this point: it provides guidelines for psychiatric and psychotherapeutic practitioners, general practitioners as well as for physicians working in residential or day care institutions with a psychiatric and psychotherapeutic background. Both the paper and planned online versions should help professionals to help people, particularly those with severe mental illnesses to navigate the system of services for vocational integration in Germany.

Practice Patterns Revisited in Pediatric Psychosomatic Medicine.

BACKGROUND: Given the heightened focus on the implementation of integrated care and population health management strategies, there is a critical need for an analysis of pediatric psychosomatic medicine (PPM) programs. OBJECTIVE: The goal was to survey current practice patterns in academic PPM programs in North America regarding their service composition, clinical consultation services, changes in service demand, funding, and major challenges so as to inform and support advocacy efforts on behalf of children in their need for responsive and effective PPM services. RESULTS: With a 52.5% survey response rate from 122 child and adolescent psychiatry programs in North America, the demand for PPM services was reported to have significantly increased over the past decade as seen in the described expansion in clinical consultation services and the reported higher patient acuity, as well as new responsibilities in the care of youth with psychiatric illnesses who require boarding on medical inpatient services. Although an increased willingness by hospital administrators to fund PPM services was apparent, adequate funding remained a core issue. Although the value of research is well recognized, few programs are engaged in systematic PPM investigation. CONCLUSION: This survey provides evidence that the current field of PPM appears to be in an increasingly stronger position within academic medical centers. It is just as apparent today, as it has been in the past, that there is a need to communicate at local, regional, and national levels that PPM is an essential behavioral health service.

Psychosomatic consultation in the workplace: opportunities and limitations of the services offered--results of a qualitative study.

PURPOSE: In Germany, innovative concepts of anchoring psychotherapeutic consultations within an occupational setting emerge in models like the "psychosomatic consultation in the workplace" (PCIW). Characteristic quality is the close cooperation between company-based occupational health physicians (OPs) and external psychotherapeutic consultants. Little is currently known about the attitudes of OPs and other stakeholders in companies in terms of possible contributions of these offers to their tasks within the field of mental health and work. METHODS: Data were collected via individual interviews with different stakeholders (n = 8) and two OP focus groups (each n = 5) with and without experience with PCIW. Data were analysed with content analysis. RESULTS: Common mental disorders (CMD) were perceived as occurring increasingly but still being stigmatized. PCIW allows employees quick access to a neutral psychotherapist and thus might help to avoid chronification of CMD. For companies, this may mean that longer periods of absenteeism (and presenteeism) can be avoided. The interviewees also feel that the ongoing collaboration with a psychotherapeutic specialist may sensitize OPs to recognize mental disorders earlier and provide basic treatment. PCIW was stated as an early, easy and fast first access to psychotherapy. The effort of PCIW is limited if structural changes in the workplace are necessary to reduce mental stressors. Also, if financed by the company, PCIW should have clear time limits and cannot aim to replace health insurance benefits. CONCLUSIONS: Taking above-mentioned limitations into account, PCIW appears to be a promising tool to bridge the gap between OP-conducted company-based health promotion and early secondary care.

[Basic psychosomatic care in ophthalmology. Relevance, training and case examples]. / Psychosomatische Grundversorgung in der Augenheilkunde. Relevanz, Ausbildung, Fallbeispiele.

BACKGROUND: The incidence of psychosomatic disorders and their impact on society are increasing. Many patients suffer from psychosomatic symptoms. Medical studies and most notably medical training for ophthalmologists do not sufficiently cover these topics and do not adequately prepare doctors for dealing with patients suffering from psychosomatic disorders. OBJECTIVE: Training in basic psychosomatic care can be absolved by all physicians irrespective of specialization. The structure, benefits and importance of this professional training are explained. MATERIAL AND METHODS: The curriculum of the German Medical Association forms the basis of training in basic psychosomatic care. The personal experiences of the authors after completing the training as well as case studies are presented. RESULTS AND CONCLUSION: Training in basic psychosomatic care conveys practical skills for dealing with patients with psychosomatic symptoms, which are often not acquired during medical training for ophthalmologists, where technical procedures predominate. Thus the professional ability is broadened with an immediate positive effect not only on the physician-patient relationship but also on the professional and private environment. Training in basic psychosomatic care should be obligatory in the specialist training of ophthalmologists.

Clinical Characteristics and Referral Patterns of Outpatients Visiting a Japanese Psychosomatic Medicine Clinic.

BACKGROUND: The definition of psychosomatic medicine is not consistent across countries. PURPOSE: The study purpose was to clarify the applicability of the definition of psychosomatic illness issued by the Japanese Society of Psychosomatic Medicine to different types of referral in a university hospital. METHODS: The sample consisted of 1067 outpatients visiting a psychosomatic clinic. Participants completed questionnaires to assess degrees of somatization, depression, anxiety, and psychosocial stress after completing clinical interviews based on the Diagnostic and Statistical Manual, Fourth Edition, Text Revision. All subjects were classified into psychosomatic and non-psychosomatic groups, and the non-psychosomatic group was further divided into three additional groups: depression, anxiety, and other. RESULTS: In total, 398 (37 %) of the subjects were placed in the psychosomatic group. The percentage of the psychosomatic group was 46 % in those referred within the hospital, 37 % in those referred outside the hospital, and 28 % in those without referral from physicians. Concerning the non-psychosomatic group, 269 (25 %) were placed in the depression group, 229 (22 %) in the anxiety group, and 171 (16 %) in the other group. Membership in the psychosomatic group was positively associated with age and the severity of somatosensory amplification (both p < 0.05), but negatively associated with the severity of depression and anxiety as well as the classification of non-referral (all p < 0.05). CONCLUSIONS: Although patients with psychiatric disorders, including depressive and anxiety disorders, are frequently seen in the Japanese psychosomatic clinic, patients who are diagnosed with psychosomatic illnesses tend to have been referred by physicians within the hospital. The concept of psychosomatic medicine needs to be further developed to assist both clinical practitioners and patients.

Emergent treatments based on the pathophysiology of bipolar disorder: A selective review.

Bipolar disorder is a chronic psychiatric disorder that is a cause of significant symptomatology even in the setting of optimal treatment. Most current treatments are developed from serendipity, and not based on known pathophysiology. In this review we examine a number of somatic and pharmacologic therapies that are poised to become part of the armamentarium of interventions to treat bipolar illness. As a group, these interventions are derived from a growing understanding of the biological underpinnings of bipolar disorders. We will look at emergent treatments based on our understanding of the molecular biology, neuroanatomy, and the genetics of bipolar disorder.

[PSYCHOSOMATIC RELATIONSHIPS DURING GASTROINTESTINAL DISEASE ON THE MODEL OF IRRITABLE BOWEL SYNDROME].

On the model of irritable bowel syndrome basic concept of psychosomatic relationships in diseases of the gastrointestinal tract and main methods of treatment tailored to their specific effects on the gastrointestinal tract are analyzed.

Somatic symptoms and psychological concerns in a general adolescent population: Exploring the relevance of DSM-5 somatic symptom disorder.

OBJECTIVE: DSM-5 somatic symptom disorder (SSD) constitutes a major change for psychosomatic medicine and psychiatry, as well as for epidemiological research in these fields. This study investigates somatic symptoms and psychological concerns among adolescents in order to systematically explore the relevance of SSD for general adolescent populations. METHODS: A cross-sectional population-based design, with a symptoms-based strategy and a symptom-and-psychological-concern-based strategy, was used to estimate the prevalence of somatic symptoms and psychological concerns in a general adolescent population (n=2476, mean age=16years, 49% boys, 51% girls). Somatic symptoms and psychological concerns in relation to gender, and self-reported medical and psychiatric conditions were investigated. The association between somatic symptoms, psychological concerns, and functional impairment in school-, family-, peer- and physical activities was studied. RESULTS: Reporting 3+ persistent distressing somatic symptoms was significantly more common than reporting one or more persistent distressing somatic symptom(s) combined with serious psychological concern. The prevalence of such complaints was significantly higher in girls. The proportion of medical and psychiatric conditions was highest in the group reporting 3+ persistent distressing somatic symptoms combined with serious psychological concern. Belonging to this group most significantly increased odds ratios for functional impairment. CONCLUSION: For large-scale studies on SSD, results suggest the use of measures based on multiple somatic items in combination with psychological concerns, and a methodologically sound standardized measure of functional impairment. To further enhance clinical decision-making, the relation of symptoms to functional impairment, and the substantial overlap of SSD with medical and psychiatric conditions during adolescence should be addressed.

[Review Model for the Assessment of Psychometric Instruments--Recommendations of the German College of Psychosomatic Medicine (DKPM)]. / Kriterienkatalog zur Beurteilung psychodiagnostischer Selbstbeurteilungsinstrumente--Empfehlung des Deutschen Kollegiums für Psychosomatische Medizin (DKPM).

OBJECTIVES: Psychometric instruments are commonly applied in psychotherapeutic research and care for the baseline assessment of symptoms, the planning of therapeutic interventions, the assessment of the longitudinal course of symptoms and outcomes of therapeutic interventions as well as quality management of care. Psychometric properties as well as economic aspects should be considered in the selection of specific instruments. It is assumed that users of psychometric instruments face a great variety of instruments and related information. For that reason, it seems challenging to absorb the current knowledge and to integrate it into clinical practice and research. Thus, it is likely that well-known, established and easily accessible instruments are commonly used, while new developed instruments might not be disseminated in research and healthcare. METHODS: Based on available international review models, the working group "Psychometrics and Psychodiagnostics" of the German College of Psychosomatic Medicine (DKPM) has developed and tested a review model specifically tailored for psychotherapeutic research and care. RESULTS: The different steps of development, as well as the final review model based on the consensus of the working group are presented. The review model contains 6 generic terms (reliability, validity, objectivity, reference groups and aspects of application) with 21 different criteria to be assessed with 0-3 asterisks (*). The criteria are clearly operationalized and the practical use of the review model is explained and discussed. CONCLUSIONS: With the review model for the assessment of psychometric instruments a well-defined evaluation system is made available for research and clinical practice which has been developed by an expert group. The review model facilitates systematic, transparent and comparative evaluation of psychometric instruments along clearly defined criteria. It also supports the selection of psychometric instruments in research and care. Next, the working group aims at disseminating and implementing the review model as well as the application and publication of reviews for different psychometric instruments based on the review model.