Psychosomatic disorders (clinical picture, epidemiology, therapy, models of medical care)

53,6% of the patients of general hospital suffer from psychosomatic disorde rs (PSD). Two-dimensional (psychologic/clinical) model of psychosomatic int errelations is presented which proposes the estimation of the influence of both somatic and psychological factors within PSD pathogenesis. The clinica l classification of PSD includes 4 types: somatization (somatoform disorder s) - organ neuroses - 27%; psychogenic (nosogenic) reactions - 57%; stress- related exacerbation of the medical illness (symptomatic lability) - 14%; e xogenous (somatogenic) reactions - 1%. Except psychotherapy, PSD treatment demands pharmacological intervention (including tranquilizers, antidepressa nts, cerebroprotectors and neuroleptics), Pharmacotherapy should be proceed ed with the account of both its possible somatic effects and its interactio n with conventional medical agents. The results of the follow-up study prov e superiority of psychopharmacotherapy over psychotherapy in terms of long- term efficacy. The most effective model of the organization of psychiatric care in PSD clinic is liason psychiatry (psychiatrist consults and general practitioner treats). inpatient treatment of non-psychotic PSD patients req uires an organization of specialized units within a general hospital.