Consultation-liaison psychiatrists' management of somatoform disorders

The authors studied interventions recommended by consultation-liaison (C-L) psychiatrists when they diagnosed somatoform disorder prospectively in a c ohort of 4,401 consecutive inpatients referred to the C-L psychiatry servic e of a general( teaching hospital, using standardized MICROCARES methodolog y. A DSM-III-R somatoform disorder was diagnosed in 2.9%, somatoform pain d isorder in 1.4%, conversion disorder in 0.7%, hypochondriasis or somatizati on disorder undifferentiated/not otherwise specified in 0.6%, and somatizat ion disorder in 0.2%. In 3.4%, somatoform disorder was considered a differe ntial diagnosis. Psychiatric comorbidity included mood disorder (39%), pers onality disorder (37%), and psychoactive substance rise disorder (19%). Rec ommendations were made about antidepressants in 40% of the patients, anxiol ytics in 18%, scdatives in 18%, and antipsychotics in 10%. Psychiatrists re commended the following: more laboratory tests for 14%; additional medical/ surgical consultations for 11%; an increase in the vigor of medical treatme nt for 13%; and psychological treatment for 76%; also they stressed mt earl ier discharge of 16%. Psychiatrists were more likely to request a prolongat ion of inpatient stay for patients with comorbid somatoform mood, anxiety a nd personality, disorder: Differences in characteristics and treatment of t he subgroups tended to be consistent with their constructs and comorbid psy chiatric diagnoses.