The fate of integrated treatment: whatever happened to the biopsychosocial psychiatrist?
OBJECTIVE
The authors suggest that pharmacotherapy and psychotherapy, the major treatment modalities in psychiatry, have become fragmented from one another, creating an artificial separation of the psychosocial and biological domains in psychiatry.


METHODS
After a brief discussion of the economic factors influencing this trend, the authors provide a selective overview of recent research. In the absence of systematic empirical data regarding which patients and which conditions might benefit from integrated treatment by one psychiatrist, the authors propose specific clinical situations that call for such integration and also discuss concerns about cost-effectiveness.


RESULTS
Recent research suggests that combining psychotherapy and pharmacotherapy may have advantages over either treatment alone in certain clinical situations involving specific disorders. While few of the studies on combined treatment have tested whether a one-person or two-person model of treatment provision is more effective, there are a number of advantages to the one-person treatment model in which a psychiatrist conducts the psychotherapy and prescribes medication for the same patient.


CONCLUSIONS
The authors suggest that further research is needed to clarify the optimal situations for the one-person model of integrated treatment and also propose systematic teaching of integrated treatment in all residency training programs.
Gabbard
G O
GO
Department of Psychiatry, Baylor College of Medicine, Houston, TX 77030, USA. ggabbard@bcm.tmc.edu
Kay
J
J
D001689:Biological Psychiatry / Q000639:trends*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D003158:Community Psychiatry / Q000639:trends*; D005544:Forecasting; D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010819:Physician's Role; D011613:Psychotherapy / Q000639:trends*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D016896:Treatment Outcome
D011619:Psychotropic Drugs