Anxiety, depression and hostility, in varying proportions, are at the root of most psychosomatic disorders. Psychosomatic medicine is principally concerned with those illnesses that present primarily somatic manifestations. The presenting complain is usually physical as you know very well; patients rarely complain of their anxiety or depression or tension, but, rather, of their vomiting or diarrhea or anorexia or premature ejaculation to their respective consultants.

Types of Patients
A special evaluation of the psychological and somatic factors of three major groups of medical patients is generally observed.

Psychosomatic Illness Group
Patients in this group suffer from such disorders as peptic ulcers, asthma, ulcerative colitis, irritable bowel syndrome etc. or children suffering from learning disability or nocturnal enuresis.  In these disease processes one cannot foist a strictly psychogenic explanation, since the particular set of emotional factors found, for example, in the typical ulcer case may also appear in patient with no history of ulcer.

Reactive Group
Patients in this group do have actual organic disorders, but they also suffer from an associated psychological disturbance. For example, a patient with a heart disease or renal disease or with menopausal symptoms may have a reactive anxiety or depression regarding their condition. The anxiety, in turn, may produce physical manifestations that complicate the somatic situation.

Psychiatric Group
Patients in this group suffer from physical disturbances caused by psychological illness, rather than physical illness. Their somatic disabilities may be real (objective) or unreal. When real, the disability involves the voluntary nervous system and is termed a conversion disorder, previously called a conversion hysteria. Among the unreal disabilities are hypochondriasis and delusional preoccupation with physical functioning, which is often seen in schizophrenic patients.   

Combined  Pschomedical Treatment  Approach
The combined Psychomedical Treatment Approach, in which the Medical Consultant treats the somatic aspects and the team of Psychiatrist and Psychologists handles the psychological aspect of the disease. This Psychomedical Treatment Approach requires the closest collaboration between the team of physicians. The purpose of the medical therapy by the physician concerned is to build up the patient’s physical state and the function of the team of psychiatrist and psychologist is to take care of the psychological aspect of the patient. Basically a holistic approach to cure the patient.

Disorders such as bronchial asthma, nocturnal enuresis, peptic ulcers, erectile dysfunction in which psychosocial processes play a distinct role in the development and the course, may respond well to the combined Psychomedical Treatment Approach.

In the acute phase of somatic symptoms, such as an acute attack of ulcerative colitis or peptic ulcer or severe headache during pre –menstrual tension medical therapy is the primary form of treatment. Psychotherapy and counseling, with its long-range goals, consists at that stage of reassurance and support. As the pendulum of disease activity shifts and the illness progresses to a chronic state, medical therapy along with psychotherapy becomes primary. Some worker suggests that after a thorough psychometric examination, and assessing the anxiety component of the individual an anxiolytic and/or antidepressant is beneficial to the patients.

The team of psychiatrist and psychologists’function in this Psychomedical Treatment Approach to make the patient participate in the process of improving their life situations.

The symptoms themselves must be treated by the Consultant, but the Psychiatrist can help patients focus on their feelings about the symptoms and gain understanding of the unconscious processes involved.

It has been well documented that if the patients are handled sensitively by the combined Psychomedical Treatment Approach the result can be fantastic.

Indications
Any acute or chronic Psychosomatic Disorder should receive psychosomatic evaluation by the Psychiatrist and specific medication by the Consultants i.e. A combined Psychomedical Treatment Approach should be the choice.           

Reasons for Consultation
Psychological presentation of any organic disease
Psychological complication of any organic disease
Psychological reaction to any organic disease
Psychological results of stress and strain
Somatic presentation of psychiatric disorder
Psychosomatic disorder

Goal
It has been seen that it is very useful to set up a tentative, elastic spectrum of therapeutic goals in the treatment of psychosomatic disorders. The end desire is cure, which means resolution of structural impairment and reorganization of the personality, so that needs and tensions no longer produce pathophysiological results.

Psychomedical Treatment aims
a more mature general life adjustment
increased capacity for physical and occupational activity
amelioration of the progression of the disease
reversal of pathology
avoidance of complications of the basic disease process
decreased use of secondary gains associated with the illness
increased capacity to adjust to the presence of the disease

The  Approach
Treatment of psychosomatic disorders from the psychiatric viewpoint is a very difficult task. The purpose of therapy is to understand the motivations and mechanism of disturbed function and to help the patients understand the nature of their illness and the implications of their costly adaptive patterns. This insight should result in changed and healthier patterns of behavior.

The  PSYCHOLOGICAL PROFILE will include

The Patient referred to the Censer for Psychological Profile will be sent back to the referring Consultants after completion of the Test and a copy of the report will be sent directly to the referring Consultant.

Other facilities include  (Optional)

Limitation
In the Western Countries, as we all know that psychiatric’s consultation is not a taboo as it is in the developing countries. It is mainly due to the lack of awareness among the people about mental health.

When psychosomatic patients first become ill, they are usually convinced that the illness is purely organic in origin. They might reject psychological help for their sickness, and in

fact, the very idea of emotional illness may be repugnant because of personal prejudices concerning psychiatry.

In these kind of cases the patient should be made clear about the advantages of the collaborative approach that the patient receives the benefit of the efforts of specialists trained in various medical disciplines, each working in the area in which he or she is best equipped to function.

However, some Physician/Surgeon Consultant do resist the Psychiatric approach because of unfamiliarity with the specialized language in psychiatry, and a general prejudice on the high cost of psychotherapy.

In case of any query or questions please contact :

NATIONAL INSTITUTE OF BEHAVIOURAL SCIENCES (NIBS)
7 & 8 C.I.T. ROAD, OVER SENCO MEGA SHOP, KOLKATA - 700 014
(OVER SENCO MEGA SHOP)
NEAR MOULALI  JUNCTION
PHONE NO. 2246 9662 / 2286 5203
E-mail : nibsindia@vsnl.com