Review: Comparison of Psychosomatic Outpatient Clinic with Community and Inpatient Liaison Services

The paper reviewed here is ‘Toward Defining the Scope of Psychosomatic Medicine Practice: Psychosomatic Medicine in an Outpatient, Tertiary-Care Practice Setting’ by Rundell and colleagues and freely available here. This is an article on a Mayo Clinic study in which a comparison was made between consecutive patients seen by Liaison services on the inpatient unit, consecutive patients seen in a psychosomatic medicine clinic and consecutive patients seen in a community outpatient clinic. As the services were being characterised, I classed this as an exploratory analysis. For categorical data and depending on cell sizes, the authors used Fisher’s exact test or the Chi Squared test and for continuous data they used the t-test.

The data are clearly displayed. Several tables efficiently display odds ratios with p-values of the comparisons between the three settings. What I found particularly interesting were the differences in the diagnoses between the three settings. Alcohol and drug dependence as well as delirium were significantly more likely (with meaningful differences in referral rates) in the inpatient Liaison setting than in the psychosomatic clinic setting. From the data the primary anxiety disorders and depressive disorders were significantly more likely in the psychosomatic setting than in the inpatient setting. Depressive disorders were more likely in the psychosomatic outpatient setting than in the community outpatient clinic setting. Interestingly the patients in the Liaison inpatient and psychsomatic outpatient settings were significantly older than in the community outpatient settings (the means differed by 11 years). Those seen in the Liaison inpatient were more likely to be separated than in the other two settings.

In terms of treatments psychotherapy referral rates increased in the following order:-

Inpatient Liaison < Psychosomatic Outpatient < Community Outpatient

Antidepressant prescriptions were more likely in the psychosomatic outpatient setting than in the liaison inpatient setting which might be accounted for by the differences in primary anxiety and depressive disorders in those settings. The reverse held for antipsychotic prescriptions.

In the discussion, the authors discuss their findings. They suggest that the psychosomatic outpatient clinic as a useful training setting, supporting this with data from the Academy of Psychosomatic Medicine. I thought the methodology and results section were clearly presented and the discussion focused on practical implications of these findings. I found the differences between psychotherapy referrals in the different settings as well as the prevalence of anxiety and depressive disorders across the settings particularly interesting.

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