Primary psychosomatic care has the task of promoting the understanding of psychosomatics and ensuring adequate care for patients in this field. It has the claim to belong to the medical primary care and complements here the mostly organ- or function-oriented conventional medicine. Above all, the psychosocial background of the disease can be better understood by the physician and the patient can be treated holistically. The aim is to improve the early detection and treatment of mental illnesses when they occur as a concomitant disease of somatic complaints. Since 2003, basic psychosomatic care has been part of the medical specialties of general medicine, internal medicine, gynecology, and obstetrics as continuing education.
Indications (areas of application)
- The primary care of patients in the context of the treatment of somatic complaints.
- the treatment of patients with:
- Anxiety disorders
- Cephalgia (headache)
- Depression
- Insomnia (sleep disorders)
- Panic attacks
- Back pain
- Pain syndromes
Furthermore, primary psychosomatic care offers help with:
- Uncovering and mediating physical/mental connections in numerous disease processes.
- Uncovering and processing conflicts
- Grief work
- Development of strategies for coping with the disease
- Partner counseling
- Diagnosis and therapy for sexual dysfunction
Primary psychosomatic care represents an important advancement in the emphasis on both the psychological causes of illness and the doctor-patient relationship. Thus, not merely the physical suffering of the patient is treated, but also the mind and personality are taken into account.
The procedure
In terms of basic psychosomatic care, the physician is to be enabled to include the patient’s physical and emotional state and his or her relationships with self and others (including the physician) in his or her diagnosis. Essentially, primary care consists of three basic elements:
- Basic diagnostics – recognition of psychological influences and disorders or the psychosocial component of the disease process.
- Basic therapy – basal psychosomatic treatment in a trusting doctor-patient relationship.
- Cooperation – with the psychosocial care system for any necessary psychotherapeutic treatment.
In the context of primary psychosomatic care, common mental disorders are identified and followed up in basic diagnostics, this includes the following disease groups:
- Mental illness – e.g. anxiety disorders or depression.
- Functional disorders – e.g. somatoform disorders, here there are symptoms or physical complaints without, which is an organic finding.
- Psychosomatic diseases – physical diseases whose pathogenesis (disease development) is to be associated with psychosocial factors, e.g. Bulimia nervosa (binge eating addiction).
- Somatopsychic disorders – psychological problems arising from the disease management of severe suffering (eg, cancer).
Basic therapy is based primarily on the integration of psychological and somatic aspects through verbal intervention: with the help of a systematic conversation, the connections of the disease process are recorded and analyzed. This takes place exclusively in individual conversation with the patient. The second main component of basic psychosomatic care is exercise and suggestive techniques. Autogenic training and relaxation therapy according to Jacobson (progressive muscle relaxation) are used both in individual treatment and in the form of group therapy. Furthermore, medical hypnosis (synonym: hypnotherapy) is one of the possibilities of basic therapy. In order to meet these requirements, the treating physician must have a sound knowledge of the biopsychosocial theory of disease and include this knowledge in a meaningful way when taking the patient’s medical history. The doctor-patient relationship also plays an important role: through self-reflection, the doctor must recognize the problems that arise from dealing with the patient and further develop his therapeutic skills.
