Psychosomatic in Psychiatry_UNTAD 2012.ppt

8/9/2019 Psychosomatic in Psychiatry_UNTAD 2012.ppt

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Psychosomatic in

PsychiatryRonny Tri Wirasto


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Psychosomatic Medicinetoday:

aspects of aetiological models• Disposition % Trigger - &aintenance• Developmental, i"e" early relationship

e periences in'uence attachment patternsand stress resilience !epigenetics$

• (ymptoms as conse)uence ofdevelopmental de*cit and of functional/

intentional adaptation• +nterpersonal conte t highly relevant for

symptom manifestation and maintenance


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research methods.linical research (creening and diagnostic studies of psychosomaticdisorders !psychooncology, di iness etc"$ R.Ts of disorder-oriented short term psychotherapies !somatoform, eating disorder, depression in .0D,PT(D, body therapy etc$

1uideline development, health care research, )ualityof life research

2europhysiological studies

2euroimaging 2europhysiological studies !0R3 etc"$ O ytocin

4pidemiological studies !in co-operation$


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strategic preferences• .ommon ground/ synthesis of theadvantages of psychogenetic andintegrative tradition for own pro*le inresearch and clinic, e"g" 2on-reductionist e planatory models +nteractional, relational perspective!participant observer$

Organismic rather than dualisticunderstanding of human illness in general andtypical 5psychosomatic6 problems in particular (cienti*c foundation of coherent concepts


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levels of explanation inpsychological medicine

• 7endler 7( in 7endler 7(, Parnas 8 !4ds$9 Philosophical +ssues in Psychiatry !:;;


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Multilevel explanatorymodels

4 planatory models are often implicit in day to day research 0owever, modern versions of the 5neuron doctrine6 have massively gained acceptance !1old and (tol=ar #ehav#rain (c >???$ eliminativist rather than reductionist

The 5bio-psycho-social model6 is no real model !4ngel 1 " (cience >?@@A >?B9>:?->CB$ eclectic 53anilla model6 !1haemi 2 #8 Psychiatry :;;?$

7arl 8apers strict dichotomy of e plaining andunderstanding is

also not very helpful !Euchs T in 7endell 7, Parnas 8, l"c"$ 4 planatory aims are mostly not well di erentiated

in psychological medicine mechanisms9 constitutive e planations aetiology % prognosis9 e planation of transitions


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PM vs. CLP: whatPM vs. CLP: whatrelationship?relationship?

• 5Disciplines such as !F$ consultation-liaisonconsultation-liaisonpsychiatrypsychiatry !F$ stemmed from the psychosomatic*eld !F$" Their psychosomatic linGages are crucialfor their balanced developments6 HEava I (onino, :;;;J

•

5+f general hospital psychiatry was the soilsoil in whichthe roots of . P were planted, than P& was thefertili erfertili er that nourished its growth6 H ipsitt, :;;>J

• 5P& refers to a variety of concepts, from holistichealth care to biopsychosocial research toconsultation-liaison worG" CLP is a very speci!cCLP is a very speci!cclinical endeavorclinical endeavor that has its roots in 10P,psychobiology and P&6 HRamchadani I Wise, :;;KJ

• 5F. P, a clinical derivativea clinical derivative of P&F6 HWise, :;;;J


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PMPM vs.vs. CLP CLP

ClinicalClinicalactivitiesactivities

• The “psychosomatist”as clinician doesn’t exist

•

Addresses all patients, not justpsychosomatic ones• Psychosomatic-related problems areonly a small proportion of everydayC P clinical activities

EducationEducationandand

trainingtraining

• !nder- and post-"raduate• #octor-patientrelationship $%alint&

• 'ore in contact (ith everyday clinicalproblems and (ith collea"ues of othermedical specialties $day-to-day and on-the-field diffusion of the bio-psycho-social approach&•

iaison meetin"s

ResearchResearchactivitiesactivities

• )tron" interdisciplinarytradition• %iolo"ical correlates ofthe psycho-somatic

interface

• *pidemiolo"y of the med-psycomorbidity• +uality mana"ement, "uidelines, *%'


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# matter of terminology?# matter of terminology?$ %$ %

• (urvey by Thompson H>??CJ 9 P& was not even amongthe L options of name considered

• The term MPsychosomatic 9 – 5denotes an ill-de!ned areaill-de!ned area of interest with poorly de*ned

boundaries !F$ implies causationcausation !F$ does not convey therange of activities and the current nature of clinical worG6H&c+ntyre, :;;:J

– often has 5 negative associationsnegative associations 6, and the e clusion of theword Mpsychiatry is not accepta"le to psychiatristsnot accepta"le to psychiatrists HThompson, >??CJ

– 5may !F$ threatenthreaten the consultation psychiatrist, who is

constantly trying to demonstrate the validity of psychiatrywithin medical settings6 HWise, :;;;J – often has a negative connotation among the generalnegative connotation among the general

pu"licpu"lic !describes an illness that is imaginary, not important,or even malingered$ H(tone et al, :;;KJ


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# matter of terminology?# matter of terminology?$ &$ &

• The term M.onsultation – &erely refers to an actionaction – 5is e clusionary and fundamentally an insultinsult to our

psychiatric colleagues6 H#ronheim, >??:J• The name debate is 5 a displacementa displacement from

concerns about the current economics and otherstresses of psychiatric practice6 HThompson, >??CJ

• 'o term'o term in the end seemed to be entirelyentirely

satisfyingsatisfying and physicians will in any casecontinue to call for a 5psych consult6 HThompson, >??CJ


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(he su"specialty in PM(he su"specialty in PM)*+, $ %)*+, $ %

• P& is the thth su"specialtysu"specialty in Psychiatry to beapproved9 P& and . P seem to have become two astwo asoneone 9

– 5P&, alsoalso Gnown as . P6 H evin, :;;CJ – 5P&, sometimessometimes Gnown as . P6 H0ausman, :;;:J – 5. P or, as suggestedas suggested , P&6 H7ornfeld, :;;:J

which + '/( (0*1+ '/( (0*1 N• Psychosomatic M1D C '1M1D C '1 is a subspecialty of

Psychiatry, or of +nternal &edicine, or it is not a sub-specialty of anything, because all medicine should beP& !ie bio-psycho-social$, and it is rather a supra-supra-specialtyspecialty H&c7egney et al, >??>J

• The approving process9 a >L-year 5 long-foughtlong-fought"attle"attle 6 H evin, :;;CJ , accounting for the establishedposition that CL psychiatristsCL psychiatrists reached through years


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(he su"specialty in PM(he su"specialty in PM)*+, $ &)*+, $ &

• CLPCLP has now to 2change its dress32change its dress3 !or rather todisguise itself $, ie change titles of te tbooGs and oftraining courses !see what happened at 0arvardF$

• The !unacceptable$ alternativealternative is a plethora ofplethora ofdi4erent and competing +ervicesdi4erent and competing +ervices with less andless de*ned competences !P&, . P, behavioralmedicine, health psychology, clinical psychologyF$

• 4 pected an increase in the num"er of CLincrease in the num"er of CL

fellowship programsfellowship programs and positions H(aravay, :;;CJ ,e panded =ob marGet and new career opportunities!F$, signi*cant increase in interestincrease in interest in .fellowships H(teinberg, :;;CJ

Maybe new chances! but also…


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(he su"specialty in PM(he su"specialty in PM)*+, $ 5)*+, $ 5

FThe subspecialty in P& may be considered asa cultural defeat for Psychiatrycultural defeat for Psychiatry , after thelong way that tooG start from asylums and,within the net of community psychiatry(ervices, landed to deal with the boundariesof psychiatry !liaison with P., 10, other(ervicesF$F +t is instead, we thinG, a victoryvictory

for those who didn6t love psychiatryfor those who didn6t love psychiatry , thepsychiatric patient and psychiatrists, who willbe accepted only at the condition of changingtheir nature and name


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(ummary• .ore of psychosomatic is psychiatry• Psychosomatic medicine is in . P

area study, research and care

Psychosomatic in Psychiatry_UNTAD 2012.ppt

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