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The University Clinical Hospital was a pioneer in 1977, inaugurating the first modern units in our country
This discipline considers that any patient must be treated for their bodily ailments, but also for their psychological aspect, mood, feelings and cognitive state. Almost all of the hospitals in the National Health System carry out activities related to psychosomatic medicine.
Researchers from the University of Zaragoza and the Aragón Health Research Institute lead the work published in the journal Journal of Psychosomatic Research
Researchers from the University of Zaragoza and the Aragón Health Research Institute, Antonio Lobo, Ricardo Campos, Tirso Ventura and Carlos Marco, lead the work published by the Journal of Psychosomatic Research, one of the most influential international journals related to psychosomatic medicine, documenting the results of the national survey that accredits the important development of the Psychosomatic and Liaison Psychiatry Units (UPPE) in Spain, and places this country as one of the European countries with the most advanced discipline. The survey has been carried out by the Workgroup from the Spanish Society of Psychiatry (SEP)
With some relevant background, the Zaragoza University Clinical Hospital, together with the Ramón y Cajal University Hospital in Madrid, were the pioneers who in 1977 inaugurated the first modern UPPE in our country, inspired by the American model, and the main Aragonese hospitals have very active UPPE. The survey now published indicates that practically all of the 112 hospitals of the National Health System (SNS) surveyed carry out clinical activities that correspond to the discipline and 66 of them (58.9%) already have a specific Unit that meets the inclusion criteria. The survey has been carried out with an original methodology, after nominating “responsible persons” in each of the Autonomous Communities (CA) of the country, who at the same time have appointed those responsible in each of the hospitals in their AC.
What are Psychosomatic and Liaison Psychiatry Units? The UPPE diagnose and treat mental health problems in patients hospitalized in medical-surgical wards of general hospitals; In addition, 74% of the hospitals participating in the survey serve outpatients and there are important connections with Primary Care. The discipline is inspired, on the one hand, by the philosophy of the traditional psychosomatic movement, which considers that any patient, as a person, must be treated for their bodily ailments, but also for their psychological side, their state of mind, their feelings. or your cognitive state.
And it is based, on the other hand, on the following solid “empirical” data (“evidence”), although not yet well known: one third of medical surgical or Primary Care patients have clinically significant psychological problems; and these psychological problems, with different degrees of intensity, complicate the course of the bodily illness, worsen the prognosis and, therefore, need to be diagnosed and treated, which also has a positive impact, at least in the medium and long term, on costs. of the treatment.
The national survey has also documented that 83.3% of hospitals with UPPE maintain active “liaison” programs with medical-surgical services. These modern programs mean the inclusion of mental health professionals in medical-surgical teams, in such a way that the coordination and focus of a “comprehensive” medicine and the training of all professionals in psychological and psychiatric aspects in their patients. The study also documents that the “liaison” programs in our country cover a very wide spectrum of medical-surgical specialties, and the most common are located in the Oncology Services; Bariatric Surgery Units (morbid obesity); and Neurology Services.
Other data of interest point to the very important clinical activity carried out by the UPPE: 26% of the Spanish hospitals studied annually treat more than 1.000 new medical-surgical patients in whom their caregivers have detected psychiatric problems in addition to their physical illness; and, in hospitals with more than 1.000 beds, 29% care for more than 1.500 of these patients. Previous studies by the SEP Working Group have shown that among the psychiatric problems most frequently treated in medical-surgical settings are complications of brain or systemic diseases, with basically delirium, dementia or “organic” depression; patients in whom a serious physical problem coexists with the abuse of alcohol or other substances and drugs; the Depression; and anxiety. The problems in which the UPPE are consulted are often serious, and include cases with a high risk of suicide in the medical ward or serious psychomotor agitations that are difficult to control.
Finally, the survey documents the fundamental teaching and research activity in these Units. The current official MIR Psychiatry Program in our country already requires a rotation in these Units, and the survey indicates that 90,9% of those that participated in the survey have an accredited rotation program. Furthermore, in support of their teaching potential, PIR residents often rotate clinical psychologists at UPPE; and 61% of them welcome the rotation of doctors from other specialties, particularly Family and Community Medicine, Geriatrics, Neurology and Internal Medicine. The research role in these Units is accredited by systematic publications in “impact” journals; participation in European Union programs; the previous Spanish Research Network in Liaison Psychiatry and Psychosomatics accredited by the FIS and the Carlos III National Research Institute (ISCIII); and, currently, for its participation in the CIBERSAM Network (ISCIII).
Despite the important progress of the discipline in our country, the national survey also documents pending needs to improve the function of these Units. The SEP Working Group seeks to ensure that all Spanish SNS hospitals have an accredited Unit; and that the discipline be considered a sub-specialty of Psychiatry, as it already is in the US and in some European countries.
The full article can be freely downloaded until September 20, 2019
