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Internistische Psychosomatik

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Zusammenfassung

Die psychische Komorbidität internistischer Patienten im Sinne einer ICD-Diagnose des Kapitels F beträgt mehr als 35%: Neurotische, besonders somatoforme, Schmerz-, affektive Störungen und Suchterkrankungen sind häufig. Die Liegedauer ist bei psychischer Komorbidität deutlich erhöht. Es benötigen 5% der internistischen Patienten ein psychosomatisches Konsil. Neue, komplexe Behandlungsstrategien, wie Transplantationen, Kardioverter-Defibrillatoren, Medikamentenpumpen, erfordern häufig spezifische psychosoziale Interventionen. Ältere Patienten haben Erkrankungen, die zunehmend chronifizieren und komplexer werden. Damit werden Lebensqualität und psychische Komorbidität zu zentralen Outcomevariablen der Volkskrankheiten. Das zweite große Aufgabenfeld internistischer Psychosomatik ist die Untersuchung und die Behandlung psychosomatischer Patienten im engeren Sinne (Essstörungen, Schmerz- und somatoforme Störungen), weil internistische Diagnostik und Therapie erforderlich oder die Motivation der Patienten primär somatisch ist. Organisationsmodelle reichen von Konsil-/Liaisondiensten bis zu integrierten psychosomatischen Abteilungen oder Fachabteilungen an Allgemeinkrankenhäusern. Aussichtsreiche Forschungsstrategien werden neben der Erforschung psychosomatischer Mechanismen in der Entwicklung pragmatischer Behandlungsprogramme, ihrer Überprüfung in klinischen Studien und der Versorgungsforschung gesehen. Darüber hinaus sollte eine Intensivierung nationaler und internationaler Forschungsnetze erfolgen, wenn immer möglich unter Beteiligung anderer Disziplinen, um auch im Bereich der Forschung konkurrenzfähig zu bleiben.

Abstract

Psychiatric comorbidity among internal medicine patients, based on an ICD-10 chapter F diagnosis, is over 35%. Neurotic, especially somatoform disorder, pain disorder, affective disorder, and addictions are common. Length of stay is markedly higher for patients with psychosomatic comorbidities. Five percent of internal medicine patients require a psychosomatic consultation. New, complex treatment strategies, such as transplants, internal defibrillators, and medication pumps, often call for specific psychosocial interventions. Illnesses among older patients are becoming more chronic and complex. As a consequence, quality of life and psychic comorbidity are becoming central outcome variables for common diseases. Also important within the field of internal psychosomatic medicine is the diagnosis and treatment of psychosomatic patients with more narrowly defined disorders (eating disorders, somatoform disorders, pain disorders). Particularly for these groups, psychosomatic diagnostics and treatment is essential, while patient motivation is primarily somatic. Organisational models range from consultation/liaison services to integrated psychosomatic departments or specialist departments in general hospitals. In addition to basic research on psychosomatic mechanisms, research strategies should include the development of pragmatic treatment programs and their evaluation in clinical studies and health care research. Finally, national and international multidisciplinary research networks should be intensified, in order to remain competitive.

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Correspondence to Wolfgang Herzog.

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Herrn Prof. Dr. Ernst Richard Petzold zum 65. Geburtstag gewidmet.

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Herzog, W., Nikendei, C., Friederich, HC. et al. Internistische Psychosomatik. Psychotherapeut 48, 348–356 (2003). https://doi.org/10.1007/s00278-003-0327-0

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