What is Psychosomatic Medicine?

Psychosomatic medicine (PM) is a newly licensed subspecialty in the field of psychiatry; it is also known as consultation-liaison (C-L) psychiatry. C-L psychiatry provides knowledge, practice, and instruction in the relation between mental and physical illness. This field is associated with services like diagnosis, therapeutics and research of illnesses in this area. Hence it connects psychiatry and other medical specialties, so that physicians and psychiatrists can discuss how to best manage patients with psychosomatic illness.

Image Credit: BlurryMe / Shutterstock

History of Psychosomatic Medicine

The ancient Greeks and the French were well aware of psychosomatic disorders. Hippocrates was the first physician to affirm that mental factors have an impact on health and disease. The French philosopher Rene Descartes refreshed the psychological ethics of Hippocrates through his “body-mind dualism” theory, which promoted many scientific studies in relation to the body and mind.

Initially, physicians of C-L psychiatry were not aware of the psychosomatic features of medically ill patients. In the USA, C-L psychiatry started to evolve and underwent a series of developmental changes in the 20th century. In 2003, C-L psychiatry was given the comprehensive name psychosomatic medicine.

Objectives of Psychosomatic Medicine

The psychosomatic medicine service (PMS) provides a complete approach to the emotional, cognitive, and behavioral needs of a patient through its dual function—as a consultant and as a part of a primary care crew. Both the functions of C-L psychiatry pursue the following objectives:

• Medical intelligence: C-L psychiatrists need to possess extensive knowledge about physical, social, and neurological disorders and their relation to abnormal illness. They should be capable of implementing this intelligence in patient care. Practitioners in this field should also be aware of the therapies used for psychosomatic patients.
• Patient care: Specialists in this field improve the quality of psychiatric care for both in- and outpatients. A warm atmosphere, appropriate consultations, and evidence-based patient care promotes the physical and mental health of the patient.
• Evaluation of mental factors: This enables complete assessment of the psychological and social factors responsible for an individual’s mental illness through observation under psychiatric consultants. The symptoms of mental disorders are diagnosed and effectively treated by psychiatric therapies.
• Individual therapy plans: In addition to being a skilled diagnostician, the C-L psychiatrist is required to develop effective treatment plans for individual patients, which are effective in the prevention, treatment, and recovery of physical disease.
• Collaborative care: The consultant promotes education on mental health and psychosocial skills for patients, their families, and medical physicians, which results in effective exchange of information. This cooperative care enables them to take care of the root cause of the patient’s disease.
• Training: Specialists provide training to junior consultants and to the nonpsychiatric healthcare provider to help them identify aberrant reactions in patients caused by treatment, plus the psychological care required in such reactions.

Functions of Psychosomatic medicine

1. Clinical function:

In relation to the clinical function of psychosomatic medicine, there are two categories of psychiatrists:

• Consultation psychiatrists: They are usually seen in outpatient departments and in chronic care facilities where they can impart advice to requesting physicians involved in treatment of patients.
• Referral psychiatrist: They assist the medical physician by providing comprehensive psychiatric care to patients who are hospitalized.

2. Educational function:

Specialists in psychosomatic medicine provide education to nonpsychiatric physicians, medical students, and nursing staff about

• the psychological needs of patients based on their behavior
• immediate management of psychiatric conditions
• use of psychotropic drugs and recognizing drug reactions in patients

3. Research function:

The field of psychosomatic medicine offers opportunity for research in the interface between medicine and psychiatry. Most research studies in this field over the last century has been conducted by consulting liaison psychiatrists, who are responsible for the rise of subspecialties like psycho-oncology, psycho-immunology, and psycho-obstetrics.

4. Administrative function:

This function is generally authorized either by the government or the respective institution. It usually involves an assessment of the violent actions of patients while they are under forcible restraint, and nonvoluntary treatment. For example, the psychiatrist in this department will assess the patient’s tendency to refuse medical procedures.

Other Services of Psychosomatic Medicine

Other ways in which PM contributes to medical care include:

• The specialist in psychosomatic medicine delivers emergency services to attempted suicide patients and help with managing their serious behavioral disturbances.
• PM specialists participate in consultation services for patients with psychosomatic illness who undergo surgery.
• The consultant will provide optimal care for patients with complicated medical illnesses such as AIDS, cancer, or patients being advised for transplants. This service of C-L psychiatry calls for close connection with primary physicians.
• Some psychiatrists collaborate with the specialized care team for early detection and prevention of symptoms in patients.

The above practices of psychosomatic medicine are limited in the field of teaching and in specialty hospitals because of the shortage of PM psychiatrists. In order to overcome this shortfall, the American psychiatric association, the University of Michigan, and other psychiatric academies have enhanced authorized fellowship programs.

References

• http://medicine.yale.edu/psychiatry/psychosomatic/training/fellowship/
• https://www.psychiatry.org/psychiatrists/practice/professional-
• http://www.maprc.org.au/consultation-liaison-psychiatry
• https://metrosouth.health.qld.gov.au/consultation-liaison-psychiatry
• http://www.scielo.br/scielo.php?pid=S0101-81082005000100009&script=sci_arttext&tlng=en
• http://hospitals.jefferson.edu/departments-and-services/consultation-liaison-psychiatry.html
• https://www.healthcareers.nhs.uk/explore-roles/psychiatry/liaison-psychiatry
• http://www.uwmedicine.org/education/documents/gme/Supervision-Policies/Psychosomatic-Medicine-Supervision-Policy.pdf
• http://oxfordmedicine.com/oso/search:downloadsearchresultaspdf;jsessionid=6732CB3D759CD453A923D9F05D21522E?isQuickSearch=true&page=2&pageSize=10&q=manag*+pain&sort=relevance&t1=OXMEDO_SERIES%3Apittsburgh_pocket_psychiatry_series