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  • Print publication year: 2011
  • Online publication date: August 2011

9 - Training

Summary

This chapter discusses the terminology, stressing the difficulties of the words and concept of medically unexplained symptoms (MUS), and discussing the pros and cons of alternative terms. A fundamental problem with the concept underlying medically unexplained symptoms is the dualism it fosters. The chapter provides the empirical foundation of positive psychobehavioural descriptors, and refers to their suitability as diagnostic criteria in more detail. It has been shown that patients with chronic unexplained symptoms report a negative self-concept of being weak, not tolerating stress and not tolerating any physical challenges. Avoidance of physical activities was the most powerful discriminator between patients with somatic complaints needing medical help and feeling disabled, and those with somatic complaints but without healthcare needs or disability. An important conceptual issue concerns the influence on classification of the psychophysiological models for the experience of disabling bodily symptoms.

References

1. FinkP, RosendalM, ToftT. Assessment and treatment of functional disorders in general practice: The extended reattribution and management model – an advanced educational program for nonpsychiatric doctors. Psychosomatics 2002; 43: 93–131.
2. RollnickS, MasonP, ButlerC. Health Behavior Change a Guide for Practitioners, 1st edn. Edinburgh: Churchill Livingstone, 1999.
3. CatalanJ, GathDH, AnastasiadesP, BondSA, DayA, HallL. Evaluation of a brief psychological treatment for emotional disorders in primary care. Psychological Medicine 1991; 21: 1013–18.
4. RosendalM, BroF, SokolowskiI, FinkP, ToftT, OlesenF. A randomised controlled trial of brief training in assessment and treatment of somatisation: effects on GPs’ attitudes. Journal of Family Practice 2005; 22: 419–27.
5. ToftT.Managing Patients with Functional Somatic Symptoms in General Practice. Denmark: Faculty of Health Sciences, University of Aarhus; 2005.
6. FrostholmL. Illness Perceptions in Primary Care Patients. Denmark: Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital and Faculty of Health Sciences, University of Aarhus; 2005.
7. FrostholmL, FinkP, ØrnbølE, ChristensenKS, ToftT, OlesenFet al. The uncertain consultation and patient satisfaction: the impact of patients’ illness perceptions and a randomized controlled trial on the training of physicians’ communication skills. Psychosomatic Medicine 2005; 67: 897–905.
8. ToftT, RosendalM, OrnbolE, OlesenF, FrostholmL, FinkP. Training general practitioners in the treatment of functional somatic symptoms: effects on patient health in a cluster-randomised controlled trial (The Functional Illness in Primary Care Study). Psychotherapy and Psychosomatics 2010; 79: 227–37.
9. RosendalM, OlesenF, FinkP, ToftT, SokolowskiI, BroF. A randomized controlled trial of brief training in the assessment and treatment of somatization in primary care: effects on patient outcome. General Hospital Psychiatry 2007; 29: 364–73.
10. CreedF. Should general psychiatry ignore somatization and hypochondriasis?World Psychiatry 2006; 5: 146–50.
11. BassC, PevelerR, HouseA. Somatoform disorders: severe psychiatric illnesses neglected by psychiatrists. British Journal of Psychiatry 2001; 179: 11–14.
12. World Health Organization. Schedules for Clinical Assessment Neuropsychiatry. Geneva: World Health Organization, Division of Mental Health; 1991.
13. CreedF, GuthrieE. Techniques for interviewing the somatising patient. British Journal of Psychiatry 1993; 162: 467–71.
14. de JongeP, HuyseFJ, HerzogT, MaltU, OpmeerBC, KuiperBet al. Referral pattern of neurological patients to psychiatric consultation-liaison services in 33 European hospitals. General Hospital Psychiatry 2001; 23(3): 152–7.
15. NeisesM, DietzS. Psychosomatische Grundversorgung in der Frauenheilkunde. [Psychosocial primary case in gynaecology.] Stuttgart: Schattauer; 1999.
16. BalintM.The Doctor, His Patients and the Illness. London: Pitman Medical Publishing; 1964.
17.Uexküll Th v, Wesiack W. Integierte Medizin als Gesamtkonzept der Heilkunde: ein bio-psycho-soziales Modell. In: Adler RH, Herzog W, Joraschky P, Köhle K, Langewitz W, Söllner W, Wesiack W (eds). Psychosomatische Medizin, 7th Edition. München: Urban & Fischer (Elsevier); 2011: 3-40.
18. AntonovskiA. The salutogenic model as a theory to guide health promotion. Health Promotion International 1996; 2: 11–18.
19. FritzscheK, SandholzerH, BrucksU, HärterM, HögerC, WirschingM. Psychotherapeutische und psychosoziale Behandlungsmaß nahmen in der Hausarztpraxis [Psychotherapeutic and psychosocial treatment measures in the family practice.]Psychotherapie Psychosomatik Medizinische Psychologie 1999; 44: 214–19.
20. FritzscheK, SandholzerH, BrucksU, CierpkaM, DeterHC, HärterMet al. Psychosocial care by general practitioners – where are the problems? Results of a demonstration project on quality management in psychosocial primary care. International Journal of Psychiatry in Medicine 1999; 29: 395–409.
21. FritzscheK, LarischA. Treating patients with functional somatic symptoms. A treatment guide for use in general practice. Scandinavian Journal of Primary Health Care 2003; 21: 132–5.
22. GoldbergD, GaskL, O’DowdT. The treatment of somatization: teaching techniques of reattribution. Journal of Psychosomatic Research 1989; 33: 689–95.
23. RudolfG, HenningsenP. Somatoforme Störungen: Theoretisches Verständnis und therapeutische Praxis [Somatoform disorders: Theoretical understanding and therapentic practice]. Stuttgart;Schattauer; 1998.
24. DickinsonWP, DickinsonLM, deGruyFV, MainDS, CandibLM, RostK. A randomized clinical trial of a care recommendation letter intervention for somatization in primary care. Annals of Family Medicine 2003; 1: 228–35.
25. SmithGR Jr, RostK, KashnerTM. A trial of the effect of a standardized psychiatric consultation on health outcomes and costs in somatizing patients. Archives of General Psychiatry 1995; 52: 238–43.
26. CierpkaM, ReichG, KraulA. Psychosomatic illness in the family. In: L’AbateL, ed. Family Psychopathology: The Relation Roots of Dysfunctional Behavior. New York: Guildford Press; 1999.
27. FritzscheK, CampagnoloI. Die kooperation zwischen Hausaerzten und Psychotherapeuten. Ein Beispiel für Psychosomatische Vernetzung [Collaboration between general practitioner and psychotherapist. An example of psychosomatic networking]. Zeitschrift für Allgemeinmedizin 1998; 4: 318–20.
28. LarischA, SchweickhardtA, WirschingM, FritzscheK. Psychosocial interventions for somatizing patients by the general practitioner: a randomized controlled trial. Journal of Psychosomatic Research 2004; 57: 507–14.
29. RiefW, MartinA, RauhE, ZechT, BenderA. Evaluation of general practitioners’ training: how to manage patients with unexplained physical symptoms. Psychosomatics 2006; 47(4): 304–11.
30. SöllnerW. Personal communication 2010.
31. FritzscheK, SteinB, LarischA, WeidnerK, DiefenbacherA, BurianRet al. First curriculum for care of patients with mental and psychosomatic disorders in the context of a consultation-liaison service. Psychotherapie Psychosomatik Medizinische Psychologie 2009; 59: 246–7.
32. FritzscheK, SchmittMF, NüblingM, WirschingM. Arztliche Psychotherapie in der Haus- und Facharztpraxis: Eine empirische Untersuchung in Sudbaden [Medical psychotherapy in the house and speciality care practice: an empirical investigation in South Baden]. Zeitschrift für Psychosomatische Medizin 56: 348–55.(in press).
33. SöllnerW, CreedF. H and EACLPP Workgroup on Training. European guidelines for training in consultation-liaison psychiatry and psychosomatics: Report of the EACLPP Workgroup on training in consultation-liaison psychiatry and psychosomatics. Journal of Psychosomatic Research 2007; 62(4): 501–9.
34. AngelinoA, LyketsosCG. Training in psychosomatic medicine: A psychiatric subspecialty recognized in the United States by the American Board of Medical Specialties. Journal of Psychosomatic Research (in press).
35. LeentjensAFG, RundellJR, WollcotDL, GuthrieE, KatholR, DiefenbacherA. Psychosomatic medicine and consultation-liaison psychiatry: scope of practice, processes, and competencies for psychiatrists or psychosomatic medecine specialists. A consensus statement of the European Association of Consultation-Liaison Psychiatry (EACLPP) and the Academy of Psychosomatic Medicine (APM). Psychosomatics 2011; 52(1): 19–25.