[Effects of psychotherapeutic interventions on length of stay in cardiology inpatients]

[Outcome of simultaneous psychosomatic/internal-medicine inpatient care--a naturalistic follow-up study]

OBJECTIVES

The effectiveness of simultaneous psychosomatic and internal-medicine inpatient care has not yet been satisfyingly investigated. What outcome is found in patients treated in a psychosomatic/internal medicine setting? Can we predict a reduction in depression and symptom severity?

METHODS

The study design is prospective and naturalistic. Patients from a psychosomatic/internal-medicine setting and a solely internal-medicine ward filled in self-report questionnaires on the day of admission, five days thereafter, and three months after discharge.

RESULTS

A total of 221 patients from a psychosomatic/internal-medicine setting and 418 patients from a solely internal-medicine ward were included. Patient characteristics differed significantly between the two wards. Treatment was associated with a reduction of depression and somatic symptom severity over time. Depression severity improved more in the psychosomatic/internal-medicine setting than in the internal-medicine ward (ES = 0.37 vs. ES = 0.65). The strongest predictor of improvement of depression and somatic symptom severity was the patients' belief that their physical well-being was influenced by psychological factors (B = 1.44 and 1 = 0.65).

CONCLUSIONS

The results document a differential approach to admission in an integrated psychosomatic/internal medicine setting and underline the favourable course for psychological and somatic symptoms.

[Consultation-liaison and outpatient services of a psychosomatic university hospital: patient referral, reasons for presentation, recommendations]

OBJECTIVES

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

Implications for concepts of care are discussed. A uniform basic documentation for the two fields of care seem to make sense.