[Office-based psychosomatic medicine with a focus on acute care]. / Das Praxismodell der Psychosomatischen Medizin und Psychotherapie mit Akut- beziehungsweise Versorgungsschwerpunkt neben der Richtlinienpsychotherapie.

Objectives: In Germany, the office-based psychosomatic medicine with focus on acute care offers psychosomatic treatment besides primary care by general practitioners and regular psychotherapy. The aim of this study is to determine specific characteristics of these innovative office-based practices. Methods: In a qualitative cross-sectional study, twelve board-certified specialists in psychosomatic medicine, practicing office-based psychosomatic medicine were surveyed by means of semi-structured telephone-interviews. After transcription and coding in MAXQDA 2020, a content analysis was conducted. Results: The innovative practice model was characterized by high numbers of initial contacts in walk-in or pre-planned consultation hours. Besides regular psychotherapy long-term and low-threshold treatment was offered. Physician assistants organised the workflow and administrative tasks. For settlement the EBM-number psychosomatic interview or short-term treatment was used. Focusses were set on somatopsychic and socio-medical treatment and consultant support. Psychotherapy often was realised in form of group sessions by integrating behavioural and psychodynamic psychotherapy. Discussion: The innovative psychosomatic practice model with focus on acute care shows an independent profile. A treatment based on medical understanding of complex somatic disease processes can be provided to somatopsychic patients. Future studies should compare this practice model to psychosomatic practices receiving a treatment by guideline psychotherapy. Conclusions: In Germany, the practices of psychosomatic medicine with a focus on acute care closes an increasing gap in psychosomatic care and augments treatment possibilities, especially for elderly and multimorbid patients.

Younger and older chronic somatoform pain patients in psycho-diagnostics, physician-patient relationship and treatment outcome.

INTRODUCTION: Patients with chronic pain are found with highly variable clinical presentation and differing physical complaints. They are seen as a heterogenic group. Based on clinical observations, elderly patients seem to differ from younger patients with chronic pain. We examined whether there were systematic differences between young and old pain patients. METHODS: As part of a routine evaluation of university hospital care, a newly developed psychosomatic treatment model for chronic somatoform pain disorders was examined. The basis for treatment efficacy was a target-oriented, specific somatic and psychological intervention that included a stable physician-patient relationship. Particular attention was paid to differences in treatment outcome with regard to changes in both physical and psychopathological symptom levels. We hypothesised that younger pain patients had higher psychological burden and benefitted more from our treatment than older pain patients. RESULTS: Overall, 179 inpatients (57.5% women) with chronic pain were examined (age between 16 and 79 years). The group as a whole yielded high scores on the somatisation dimension (SCL-90) and showed a considerable amount of psychopathological symptoms, such as depressive mood and anxiety (HADS) and a great emotional instability (FPI-R). Age differences were only found with regards to patients' degree of aggression (SCl-90): younger patients showed higher aggressive tendencies than older ones (p< 0.05). The treatment offered helped patients in both age groups especially with regard to reduction of depressive mood (HADS, p< 0.01) and anxiety levels (HADS, p< 0.01). Regression analysis showed different age groups and gender as significant predictors of anxiety reduction under therapy (R2=.108; model: p< 0.01). DISCUSSION AND CONCLUSION: Results show that younger chronic pain patients suffer more from a considerable amount of psychological distress than older ones, but our treatment approach was equally effective in both groups. However, age and gender differences, as well as the patient's baseline level of anxiety influenced the outcome. These factors need to be studied in future research.

[Integrative therapy of a patient with complex psychosomatic complaints]. / Integrative Therapie einer Patientin mit komplexenpsychosomatischen Beschwerden.

We present the case of a 76-year-old female patient with complex psychosomatic complaints. The patient suffered from depression, panic attacks, chronic pain and dyspepsia with nausea and loss of appetite. In addition to the conventional psychosomatic care, the patient received individual homeopathic treatment for her dyspepsia, resulting in complete remission. The therapeutic value of homeopathy in the present case is discussed in the context of recent findings from placebo research.